THE INTRODUCTION of new technical concepts in the surgical therapy of cancer of the breast has raised two significant questions, both relevant to the extent of the operation. First, do the sometimes less than radical surgical procedures for breast cancer conducted in a small general hospital give five-year survival rates comparable to those obtained in large medical centers? And second, is there clinical evidence indicating that the scope of the operation should be enlarged for medially situated lesions?
The studies of Handley and Thackray1 have indicated that the internal mammary chain of lymph nodes is involved in a high percentage of malignant growths of the breast. Their studies, as well as those of Urban2 have produced evidence that lesions in the medial aspect of the breast are more likely to metastasize to the mediastinal nodes than are laterally located lesions which show some preference for spreading to the