other with the surgeon facing the posterior

chest wall and the assistant facing the breast

and anterior chest wall.

STEP 2: PARTIAL MASTECTOMY

Infiltration

Infiltrate the subcutaneous tissues overlying

the operative field with 1 : 200000 solution of
adrenaline : normal saline.
• Anteriorly: infiltrate the subcutaneous
tissues overlying the tumour-bearing
quadrant as far as the subareolar region.
This accentuates the subcutaneous layer and
Dissection and partial mastectomy
facilitates subsequent dissection of the
breast disc.
• Posteriorly: continue the infiltration over When performing the resection, great care
the superficial surface of the L D as far should be tal<en to avoid 'button-holing' the
posteriorly as the lumbosacral fascia and skin at the edges of the dissection pocket.
inferiorly to the level of the costal margin. Special care should be taken in the region of
the nipple and the areolus.
Incision
• Make the S-shaped incision and deepen it • Now separate the anterior surface of the
into subcutaneous fat. breast disc from the envelope of skin and
• Dissect medially until the lateral border of subcutaneous fat which overlie the tumour-
the pectoralis major (PM) is identified in bearing quadrant. This subcutaneous space
the upper half of the wound. can be easily developed using a broad-

• Develop a space between the pectoralis bladed scalpel, which is introduced at the

fascia superficially and the PM deeply. I n medial edge of the S-shaped incision and

this way, a retromammary space is swept over the anterior surface of the breast

developed as far medially as the lateral disc in the subcutaneous plane with the flat

border of the sternum. This mobilises the surface of the blade parallel to the skin.

posterior surface of the breast disc, Dissection can be carried medially as far as

including the tumour-bearing quadrant. the medial border of the breast, and
centrally to include the subareolar region
and major ducts draining the quadrant
concerned.