Licence: Public Domain Mark
Credit: Amputation of the female breast / by W.W. Keen. Source: Wellcome Collection.
Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.
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![nil surface you find auy patches of gray translucent tissue, you have evidently left diseased tissue on the chest-wall. By the little nicks you can fit the breast into its original place, determine just where the diseased part has been left, and remove it.|| Having amputated the breast, what next? Open the axilla and clear it of everything except the vessels and nerves. I think I can say safely, that with probably one exception in ten, in arm- pits in which, in examining through the skin, I have found no- enlarged glands whatever (and this is especially true of fat women),. I have found at the operation that they were enlarged. Therefore,, my rule, where the disease is malignant, is now invariably to ojien. the armpit thus: Continue the incision out along the border of the great pectoral or the latissimus-dorsi. When the skin and fas- cia are cut through, I abandon the knife and use the forceps and Allis' blunt dissector to tear through the tissues. Your first land- mark will be the axillary vein, which you will easily recognize by its dark blue color. This guides you at once to the artery and the bundle of nerves. It is not a dangerous procedure if you will only be careful. The Allis blunt dissector, of course, will not cut any vessels, and so does not obscure the tissues by staining them with blood. The few vessels that are torn and bleed are seized at once by hseraostatic forceps. The only danger is that of tearing the- vein—a very serious accident, but one not liable to occur with rea- sonable care even when the glands are closely adherent to the walls- of the vein. The next structure to be avoided is the subscapular artery and vein running down the anterior border of the scapula, which you can always easily find. Along with them runs the second subscap- ular nerve, which we should always save unless it is involved in the diseased tissues. As it goes to the latissimus-dorsi and teres major, if you cut it it makes a serious inroad on the movements of the arm. Watch, therefore, for the artery and nerve. Having now cleaned out the armpit, separate the pectoral muscles, and every now and then you will catch some enlargedi ] If Halsted'R method is used it would not be needful to use this meant of determin- ing whether there Is any such deeper Infiltration elnce the pectoral muscle is removed with the breast](https://iiif.wellcomecollection.org/image/b22321779_0017.jp2/full/800%2C/0/default.jpg)
