Abstract IT IS GENERALLY agreed that the operation of choice for carcinoma of the breast is radical mastectomy based on most of the concepts of Halsted and of Willy Meyer. No general agreement exists, however, on the amount of skin that should be removed in the performance of the operation. There are those who advocate removing a large amount of skin and covering the raw areas with skin grafts and those who allow enough skin to remain for a primary closure. The first group, or the "Halsted group," apparently believe that the cancer is spread by permeation and embolism into the lymphatic vessels to the skin. The second group subscribes to the conclusion of Handley,1 who believed that the spread of cancer was through the vertical lymphatic vessels. Both groups agree that embolism, permeation and, more rarely, vascular routes are available for dissemination of the carcinoma. Since the exact route References 1. Handley, W. S.: Cancer of the Breast and Its Treatment , ed. 2, New York, Paul B. Hoeber, 1922. 2. Oliver, D. R., and Sugarbaker, E. D.: The Significance of Skin Recurrences Following Radical Mastectomy , Surg., Gynec. & Obst. 85:360, 1947. 3. Brown, A.: Later Recurrences in the Skin Following Radical Amputation of the Breast for Carcinoma , Quart Bull. Northwestern Univ. M. School 20:18, 1946. 4. Lewis, D., and Reinhoff, W. F., Jr.: A Study of the Results of Operations for the Cure of Cancer of the Breast, Performed at Johns Hopkins Hospital from 1889 to 1931 , Ann. Surg. 95:336, 1932. 5. Conway, H., and Neumann, C. G.: Evaluation of Skin Grafting in the Technique of Radical Mastectomy in Relation to Local Recurrence of Carcinoma , Surg., Gynec. & Obst. 88:45, 1949. 6. White, W. C.: Skin Removal in Radical Mastectomy , Ann. Surg. 115:1182, 1942. 7. Harrington, S. W.: Results of Radical Mastectomy in 5026 Cases of Carcinoma of the Breast , Pennsylvania M. J. 43:413, 1940. 8. Rodman, J. S.: Skin Removal in Radical Breast Amputation , Ann. Surg. 118:694, 1943. 9. Haagensen, C. D., and Stout, A. P.: Carcinoma of the Breast , Ann. Surg. 116:801, 1942. 10. Rector, E. W.: The Relation of the Incidence of Local Skin Recurrence Following Radical Mastectomy to the Area of Skin Excised, to be published. 11. Finney, G. G.; Merkel, W. C., and Miller, D. B.: Carcinoma of the Breast , Ann. Surg. 125:673, 1947. 12. Marshall, S. F., and Hare, H. F.: Carcinoma of the Breast: Results of Combined Treatment with Surgery and Roentgen Rays , Ann. Surg. 125:688, 1947. 13. Eberbach, C. W.: Carcinoma of the Breast , Wisconsin M. J. 48:132, 1949. 14. Mathewson, C.: Personal communication to the author. 15. Gilchrest, R. K.: Personal communication to the author.
Archives of Surgery – American Medical Association
Published: Aug 1, 1950