CPT® Code 19306

1. Indications

The radical mastectomy procedure is indicated for the following conditions:

• Breast Cancer: This procedure is primarily performed for patients diagnosed with invasive breast cancer, particularly when the cancer is extensive and involves the breast tissue and surrounding structures.
• High Risk of Recurrence: Patients with a significant risk of cancer recurrence may require a radical mastectomy to ensure complete removal of malignant tissues.
• Locally Advanced Disease: In cases where the cancer has spread to nearby tissues or lymph nodes, a radical mastectomy may be necessary to achieve clear margins and remove affected lymphatic structures.

2. Procedure

The radical mastectomy procedure involves several critical steps to ensure the complete removal of the breast and associated tissues:

• Step 1: Incision An elliptical incision is made around the breast, extending into the axilla to include the tail of Spence. This incision allows access to the breast tissue and surrounding structures.
• Step 2: Removal of Breast Tissue The entire breast, including the skin, areola, and nipple, is excised en bloc. This means that the breast tissue is removed in one piece to minimize the risk of leaving behind any cancerous cells.
• Step 3: Excision of Pectoral Muscles The underlying pectoralis major and minor muscles are also removed as part of the procedure. This step is crucial for ensuring that all potentially affected tissues are excised.
• Step 4: Axillary Lymph Node Dissection Axillary lymph nodes are dissected from the underlying axillary vein, along with the neighboring nerves and muscles. This dissection is essential for assessing the spread of cancer and ensuring complete removal of affected lymphatic tissues.
• Step 5: Internal Mammary Lymph Node Removal (Urban-type) If an Urban-type radical mastectomy is performed, the internal mammary lymph nodes are dissected free from surrounding tissues and removed. This includes excising tissue connected to the sternum, portions of the rectus fascia, latissimus dorsi muscle, and clavicle.
• Step 6: Closure After the removal of all necessary tissues, the surgical site is closed. If there is insufficient skin for closure, a myocutaneous graft may be placed, or a breast reconstruction procedure may be performed prior to closure. Surgical wounds are typically closed around a suction catheter or drainage tube to manage post-operative fluid accumulation.

3. Post-Procedure

Post-procedure care following a radical mastectomy includes monitoring for complications such as infection, bleeding, and proper healing of the surgical site. Patients may require drainage tubes to manage fluid accumulation and will be advised on wound care. Pain management is also an essential aspect of post-operative care. Recovery time can vary, but patients are generally advised to avoid strenuous activities for several weeks. Follow-up appointments are crucial for assessing healing and discussing any further treatment options, such as chemotherapy or radiation therapy, depending on the pathology results and overall treatment plan.