Mastectomy

Question 1

What is removed during a modified radical

mastectomy?

Answer 1

The breast and axillary lymph nodes.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 664.

Question 2

What is removed during a modified radical

mastectomy?

Answer 2

The breast and axillary lymph nodes
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 664

Question 3

1. What is removed during a simple mastectomy? 2.

Why is this procedure typically performed?

Answer 3

1. Only the breast tissue is removed during a simple
   mastectomy. 2. Simple mastectomies typically are used in highrisk
   patients for prophylaxis and for patients with ductal
   carcinoma in situ.
   Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
   Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
   Wolters Kluwer Health, 2014: 665

Question 4

What structures are preserved during an axillary

lymph node dissection?

Answer 4

The long thoracic nerve, the thoracodorsal nerve, and the nerve
and blood supply to the pectoral muscles. Surgeons also
attempt to preserve the intercostobrachial nerves.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 665.

Question 5

A patient who has undergone an axillary lymph node
dissection complains of numbness in the upper arm.
What nerves have been damaged?

Answer 5

The intercostobrachial nerves.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 665.

Question 6

Is muscle relaxation advised in patients undergoing

axillary dissection?

Answer 6

No. Muscle relaxation should be avoided so that surgical
identification of nerves can be achieved.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 667.

Question 7

List possible complications following a modified

radical mastectomy.

Answer 7

Seroma, lymphedema, infection, pneumothorax, flap necrosis,
damage to neurovascular structures in the axilla, hematoma.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 666.

Question 8

1. What type of regional anesthetic can provide
   adequate anesthesia for a lumpectomy with axillary
   node dissection or a modified radical mastectomy?
2. What dermatomes must be blocked?

Answer 8

A unilateral, multiple-level, paravertebral block. T1-T6
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 667.

Question 9

A patient undergoes a paravertebral block for pain
control associated with a mastectomy. List
contraindications to a paravertebral block.

Answer 9

Local anesthetic allergy, patient refusal, infection at the injection
sites, anatomic distortion of paravertebral space
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 667.

Question 10

A patient presenting for mastectomy has been
undergoing chemotherapy with the
chemotherapeutic agent doxorubicin. What organ
can be affected by this drug?

Answer 10

The heart. Patients receiving doxorubicin can have severe
cardiac dysfunction.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 666.