August 1997


Arch Surg. 1997;132(8):933. doi:10.1001/archsurg.1997.01430320135027

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Of William Halsted's (1852-1922) many seminal contributions to clinical surgery, one of the most eponymically remembered is his radical mastectomy. It is commonly believed that Halsted first discussed this surgical technique in an article published in The Johns Hopkins Hospital Reports (1894-1895;4:297-350). At that time, he presented 50 cases and wrote that

the pectoralis major muscle, entire or all except its clavicular portion, should be excised in every case of cancer of the breast.... The suspected tissues should be removed in one piece (1) lest the wound become infected by the division of tissues invaded by the disease or of lymphatic vessels containing cancer cells and (2) because shreds or pieces of cancerous tissue might readily be overlooked in a piecemeal extirpation.

Halsted listed 15 steps involved in this technique, ranging from placement of the skin incision to the complete excision of axillary contents. Four years later, he presented an

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