Modified Radical Mastectomy Incision
For modified radical mastectomy, the axillary dissection should be performed through the mastectomy ellipse using a transverse elliptical incision that encompasses the nipple-areolar complex and extends to allow adequate access to the axilla. 1
Standard Incision Approach
The traditional approach for modified radical mastectomy utilizes a transverse elliptical incision that:
- Encompasses the nipple-areolar complex centrally 1
- Extends laterally toward the axilla to allow complete axillary dissection through the same incision 1
- Provides adequate exposure for Level I and II axillary node dissection while maintaining oncologic completeness 1
The key principle is that axillary dissection in mastectomy patients must be performed through the mastectomy ellipse itself, not through a separate incision. 1 This differs fundamentally from breast conservation surgery, where separate incisions are required to avoid unnecessary deformity.
Technical Considerations
Incision Design
- The ellipse should be oriented transversely across the breast mound 1
- Adequate size is critical to allow complete breast tissue removal and axillary access in one piece 1
- The incision must extend sufficiently lateral to reach from just posterior to the pectoralis major border to nearly the anterior border of the latissimus dorsi for proper axillary exposure 1
Axillary Access Through the Mastectomy Incision
The mastectomy ellipse provides exposure for:
- Complete Level I and II axillary dissection 1
- Preservation of the long thoracic nerve, thoracodorsal nerve, and medial pectoral nerve 1
- Optional preservation of the intercostal brachial cutaneous nerve when oncologically safe 1
Critical Pitfall to Avoid
Never create a continuous incision from the breast to the axilla in a linear fashion, as this results in unnecessary deformity. 1 The elliptical design that encompasses both areas in a single well-planned incision provides superior cosmetic outcomes while maintaining complete oncologic resection.
The transverse orientation and elliptical shape allow the surgeon to remove all breast tissue, the nipple-areolar complex, and perform complete axillary dissection through one incision with optimal exposure and acceptable cosmetic results. 1