Limits of the dissection for mastectomy

(Inset) Limits of the modified radical mastectomy are delineated laterally by the anterior margin of the latissimus dorsi muscle, medially by the sternal border, superiorly by the subclavius muscle, and inferiorly by the caudal extension of the breast approximately 3 to 4 cm inferior to the inframammary fold. Skin flaps for the modified radical technique are planned with relation to the quadrant in which the primary neoplasm is located. Adequate margins are ensured by developing skin edges 3 to 5 cm from the tumor margin. Skin incisions are made perpendicular to the subcutaneous plane. Flap thickness should vary with patient body habitus but ideally should be 7 to 8 mm thick. Flap tension should be perpendicular to the chest wall with flap elevation deep to the cutaneous vasculature, which is accentuated by flap retraction.