👉Nerve damage during a modified radical mastectomy includes transection of sensory nerves to the breast and breast skin and possible transection of motor nerves to the pectoralis major muscle (medial pectoral neurovascular bundle), serratus anterior muscle (long thoracic nerve), and latissimus dorsi muscle (thoracodorsal nerve).
👉Transection of sensory nerves to the breast skin is unavoidable as most of these sensory nerves traverse the breast.
👉The most common complaint after a mastectomy is numbness of the mastectomy skin flaps as well as of the nipple/areolar complex if preserved.
👉Only 10% to 15% of patients report preserved sensation in the nipple areolar complex after nipple-sparing mastectomy.
👉Phantom breast pain is a possible outcome after mastectomy and occurs in 14% to 17% of patients at one-year after surgery.
👉Damage to motor nerves is associated with axillary dissection rather than mastectomy.
👉The medial pectoral neurovascular bundle pierces the pectoralis minor muscle then wraps around the lateral border of the pectoralis major muscle.
👉Transection of this nerve can result in atrophy of the lateral portion of the muscle.
👉Functional deficit associated with this injury is typically minor.
👉Transection of the long thoracic nerve during an axillary dissection will result in a winged scapula.
👉The winged scapula is most visible when a patient is standing straight and pushing against a wall with both arms.
👉The affected scapula will visibly protrude while the normally innervated scapula will remain flush with the back.
👉Injury to the thoracodorsal nerve can impact several activities such as rock climbing, rowing, and standing from a seated position.
👉This latter function is especially significant as an individual ages because the upper body is relied on more often for strength compared with the legs.
👉Injury to the thoracodorsal nerve may also have implications if other components of the thoracodorsal neurovascular bundle are damaged as this may limit use of the latissimus dorsi flap for subsequent breast reconstruction.
👉The relative likelihood of these injuries is low.
👉Injury to the long thoracic nerve is most commonly reported.
👉Damage to the brachial plexus would be very unlikely during a modified radical mastectomy, however, brachial plexopathies can occur as a result of postmastectomy radiation.
👉REFERENCES
- Ahmed A, Bhatnagar S, Rana SP, et al. Prevalence of phantom breast pain and sensation among postmastectomy patients suffering from breast cancer: a prospective study. Pain Pract. 2014;14:E17-28.
- Porzionato A, Macchi V, Stecco C et al. Surgical anatomy of the pectoral nerves and the pectoral musculature. Clin Anat. 2012; 25(5):559-575.
- Freeman SR, Washington SJ, Pritchard T et al. Long term results of a randomized prospective study of preservation of the intercostobrachial nerve. Eur J Surg Oncol. 2003;29(3):213-215.
👉Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y cirujano de mamá de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:
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Es experto en el manejo del cáncer de mama.
👉Es miembro de la American Society of Breast Surgeons:
Training:
• General surgery:
• Michigan State University:
• 2004 al 2010
• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:
• Fox Chase Cancer Center (Filadelfia):
• 2010 al 2012
• Masters in Science (Clinical research for health professionals):
• Drexel University (Filadelfia):
• 2010 al 2012
• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:
• IFHNOS / Memorial Sloan Kettering Cancer Center:
• 2014 al 2016
Rodrigo Arrangoiz MS, MD, FACS, FSSO 