[Verified Answer]: Case Study 8A PREOPERATIVE DIAGNOSIS:…

Case Study 8A PREOPERATIVE DIAGNOSIS: Carcinoma of the right breast, status post neoadjuvant chemotherapy POSTOPERATIVE DIAGNOSIS: Carcinoma of the right breast, status post neoadjuvant chemotherapy PROCEDURE PERFORMED: Right modified radical mastectomy, left prophylactic mastectomy PREOPERATIVE HISTORY: The patient is an unfortunate 37-year-old woman who had a pregnancy associated breast cancer of the right breast with extensive involvement of the breast, clinically a stage III breast cancer. She underwent neoadjuvant chemotherapy with a complete clinical response to therapy with no residual palpable tumor in the breast and no palpable adenopathy. She has elected to undergo a bilateral mastectomy. She will have reconstructive surgery at a later time. OPERATIVE NOTE: The patient was taken to the operating room. General anesthesia was induced. A Foley catheter was inserted. Her arms were placed on pads. Her legs were placed on pads. Bear hugger was applied and her entire upper torso was sterilely prepped and draped in usual fashion. Symmetric skin sparing mastectomies were planned incorporating the nipple-areolar complex on both sides. We began on the left side. An elliptical incision was made incorporating the nipple-areolar complex, carried down through the skin into the subcutaneous tissue. Flaps were raised circumferentially from the superior aspect to the clavicle, medially to the midline, inferiorly to the inframammary, fold and laterally out to the latissimus dorsi. The breast was then removed from the pectoralis major muscle incorporating the fascia, reflected laterally and truncated. It was marked for orientation, weighed, and sent to pathology. Hemostasis was achieved where necessary using electrocautery. There was no evidence of bleeding at the end of the case. Moist laps were placed under the flaps and we moved to the right breast. Again, an elliptical incision was created incorporating the nipple-areolar complex and a little more skin laterally in that breast because the breast was a larger breast on that side. Flaps again were raised from superior infraclavicular and a portion of the breast circumferentially to the midline and subsequently to the inframammary fold and subsequently out to the latissimus dorsi muscle. The breast was removed from the pectoralis major muscle incorporating the fascia, reflected laterally. The clavipectoral fascia was opened and a sampling of level I and level II axillary lymph nodes were dissected on both sides, sparing the long thoracic and the thoracodorsal neurovascular bundle, as well as at least 1 intercostal brachial cutaneous nerves. The axillary lymph nodes will be examined for metastasis. There was no palpable adenopathy in level III. The breast and axilla were marked for orientation, weighed, and sent to pathology. Irrigation was performed. Hemostasis was achieved where necessary using some Surgiclips and electrocautery. There was no evidence of bleeding at the end of the case.