RT Book, Section
A1 Hunt, Kelly K.
A1 Kronowitz, Steven J.
A2 Morita, Shane Y.
A2 Balch, Charles M.
A2 Klimberg, V. Suzanne
A2 Pawlik, Timothy M.
A2 Posner, Mitchell C.
A2 Tanabe, Kenneth K.
SR Print(0)
ID 1145760490
T1 Mastectomy and Breast Reconstruction
T2 Textbook of Complex General Surgical Oncology
YR 2018
FD 2018
PB McGraw-Hill Education
PP New York, NY
SN 9780071793315
LK accesssurgery.mhmedical.com/content.aspx?aid=1145760490
RD 2024/04/19
AB Mastectomy  has  been  utilized  in  the  surgical  management  of  patients  with  breast  cancer  for  centuries.  It  was  William  Stewart  Halsted  who  popularized  the  technique  of  radical  mastectomy  after  his  initial  publication  in  the  mid-1890s.1  Halsted  believed  that  breast  cancer  spread  from  the  primary  tumor  in  the  breast  parenchyma  to  the  regional  lymph  node  basins  and  then  to  distant  sites.  He  felt  that  this  sequential  progression  of  spread  could  be  halted  if  all  of  the  breast  tissue,  skin,  chest  wall  musculature,  and  regional  lymphatics  were  resected.  In  addition  to  the  extensive  chest  wall  resection,  the  Halsted  radical  mastectomy  included  removal  of  the  level  I,  II,  and  III  axillary  lymph  nodes.  Halsted’s  initial  publication  reported  a  5-year  survival  rate  of  40%  and  a  local-regional  control  rate  of  73%.  The  extended  radical  mastectomy  was  introduced  to  include  internal  mammary  nodal  dissection  based  on  retrospective  comparisons  showing  improved  survival  with  the  more  extensive  procedure.  A  multinational  randomized  trial  was  initiated  in  the  1960s  to  compare  survival  rates  with  the  Halsted  radical  mastectomy  versus  the  extended  radical  mastectomy.2  The  trial  did  not  show  any  difference  in  survival  outcomes  between  the  two  surgical  procedures,  however  it  was  underpowered  and  patients  were  not  staged  and  selected  for  participation  based  on  imaging  studies.  Subsequent  studies  failed  to  confirm  any  survival  advantage  with  the  extended  radical  mastectomy  and  this  procedure  was  largely  abandoned  in  favor  of  radiation  to  the  regional  nodes.