The inevitable handling of soft tissues during mastectomy for mammary carcinoma increases the danger that tumor cells may be carried to nearby lymph nodes. Metastases laterally toward the axillary lymph nodes are visible and accessible and have received much attention. Metastases medially toward the supraclavicular and internal mammary nodes have not received sufficient attention, although they constitute the greater danger. The danger can be reduced by the type of operation here described. In it, the first incision is planned to block lymphatic and venous draining in the medial direction before beginning the extensive manipulations involved in mobilizing the primary breast tumor and dissecting the axillary structures.
Berens JJ. REAPPRAISAL OF SURGICAL TREATMENT OF MAMMARY CARCINOMA. JAMA. 1959;170(12):1365–1369. doi:10.1001/jama.1959.03010120001001
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