File:The breast- its anomalies, its diseases, and their treatment (1917) (14776950123).jpg

Identifier: breastitsanomali00deav (find matches)
Title: The breast: its anomalies, its diseases, and their treatment
Year: 1917 (1910s)
Authors: Deaver, John B. (John Blair), 1855-1931
Subjects: Breast Breast X-rays Breast Diseases Breast Neoplasms Radiotherapy
Publisher: Philadelphia, P. Blakiston's Son & Co
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons

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dbe carefully dissected from the several muscles, and to do this best, the fascia covering the muscles shouldbe sacrificed. In fact, so thorough should be the a.xillary dissection that nothing is left on its inneraspect save the posterior thoracic or nerve of Bell; on the posterior aspect, only the long subscapularnerve, and superiorly, possibly the superior thoracic artery, if it arises as an independent branch highup on the first portion of the axillary. In such circumstances it is impossible, in my judgment, to reachit with safety. It is so deeply placed that there is great danger of doing serious damage to the veinand artery, the former particularly, if an attempt is made to secure the vessel at the root. . . . A thorough dissection of the axilla can usually be finished in 20 minutes, and it is entirely accom-plished through the single straight incision. It should invariably be from above downward, withoutinward, and en masse. A piecemeal extirpation is not to be considered. . . .
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-Illustrating the Rodman operation for mammarj carcinoma,vessels divided at their origin. Axilla freely exposed and It is best to attack the axilla before removing the breast because (as taught by Gross) the axillamay be so extensively involved that a complete eradication of the growth is impracticable and furtheroperative steps injudicious. Although since the more thorough axillary operation has become a routineprocedure, many cases considered inoperable in Grosss time would not be so now. In working towardthe axilla the danger of expressing cancer cells into adjacent, even remote tissues is avoided. There-fore, the breast should not be handled, massaged or in any way disturbed until the axillary dissectionhas been finished and the completion of the operation is near at hand. In my opinion this is one. indeed,the best reason for not working from sternum to axilla, and for reversing the technic of Halsted andmany others. This procedure also lessens hemorrhage when the vessels are liga

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