D Mastectomy
Total mastectomy (simple or complete mastectomy) removes only the breast; no axillary node dissection is involved. It is used for the treatment of ductal carcinoma in situ. Radical mastectomy involves removal of the breast, underlying pectoral muscles, and axillary lymph nodes. There are two major alternatives to radical mastectomy: modified radical mastectomy and wide local excision of the tumor (partial mastectomy or lumpectomy) with axillary dissection. This treatment is followed by postoperative radiation therapy to the remaining breast.
2. Preoperative assessment
Patients often have no other underlying medical problems. The anesthetic implications of metastatic spread to bone, brain, liver, lung, and other areas should be considered. Preoperative assessment should be routine, with special consideration to the following:
a) Cardiac: Cardiomyopathies may result from chemotherapeutic agents such as doxorubicin (>550 mg/m2). Patients exposed to this type of drug may experience cardiac dysfunction, and a cardiac consultation may be needed to determine ventricular function.
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