Total mastectomy with special reference to surgical technique, extent of axillary dissection and complications

Total mastectomy and partial axillary dissection as advised in the DBCG (Danish Breast Cancer Cooperative Group) protocols was performed in 104 consecutive females with operable primary invasive breast cancer, aged 34-82 years, median 47 years. The glandular removal was complete as assessed by microscopic examination of side resection planes and deep fascia of the surgical specimen. The number of removed axillary lymph nodes ranged from 1 to 28, median 8. The mortality was zero. There were no general complications. Wound complications comprised seroma (47.1%), flap margin necrosis (5.8%) and infection (1.9%). The pitfalls in securing total mastectomy are discussed as is the extent of axillary dissection for staging purposes. Furthermore, the problem of axillary dissection and axillary irradiation in node positive patients is considered.