Breast

Mastectomy (Simple)

OPERATION: Simple (Total) Mastectomy ± Sentinel Lymph Node Biopsy
ANAESTHETIC: General anaesthesia
VTE PROPHYLAXIS: TED stockings, intermittent pneumatic compression.
POSITION: Supine, arm on operative side extended on arm board at 90°. Arm wrapped separately to allow axillary access.

INDICATION:
[Multifocal carcinoma / extensive DCIS >4 cm / patient choice / recurrence post-breast conservation / risk-reducing mastectomy in BRCA mutation carrier / male breast cancer]. Histological confirmation obtained pre-operatively. Axillary staging planned: [SLNB / ALND]. Reconstruction discussed — [offered / declined / immediate / delayed]. Side and site confirmed and marked by surgeon pre-operatively.

PROCEDURE:
WHO Checklist performed. Correct side confirmed. Breast and axilla prepared and draped.

[SENTINEL LYMPH NODE BIOPSY (if planned — performed before mastectomy):
Blue dye injected periareolarly before scrubbing. Short incision made over site of maximum radioactivity detected by gamma probe. Axilla opened — blue lymphatic channels identified and followed to sentinel node. Gamma probe used to confirm. Sentinel node(s) excised atraumatically. [Further hot/blue nodes retrieved.] Haemostasis confirmed. Wound held open for axillary content reassessment after intra-operative testing result. [Intra-operative OSNA / touch imprint / frozen section result: negative / positive — proceed to ALND.] Axillary wound closed with subcuticular suture.]

Mastectomy:
Transverse elliptical incision drawn encompassing the nipple and approximately 5 cm of skin around the marked tumour site, placed as low as possible near the inframammary fold. Incision confirmed closeable before proceeding. [Adrenaline solution infiltrated subcutaneously to aid haemostasis.]

SKIN FLAP ELEVATION: