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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erile ether bottle and sterile gauze. Ample protection of the operativefield is afforded by sterile towels and sheets. With these preparations completed, the surgeon determines as nearly as possible, 566 THE BREAST by the position of the growth, the size and mobiUty of the breast and the mobilityof the surrounding skin, the greatest distance that the incision can be carried wide ofthe breast to insure subsequent closure of the wound. When the growth is large,involving practically the whole breast, and the surrounding skin is not freely movableowing to a scarcity of fat in the superficial fascia, diflGiculty is frequently encounteredin closing the wound. Much may be accomplished by extensive subcutaneous dissection both laterallyand medially. We believe that there is more danger in insufficient removal of the deepfascia in the average operable case, than of the skin likely to be involved. This methodis not applicable to all cases of cancer en cuirasse nor where extensive ulceration has
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Fig. 209.—Operation for carcinoma of the breast showing the method of protecting the field of opera-tion and the proper angle at which the arm should be held at the beginning of the operation. occurred, but with wide dissection of the skin, the iiaps being made extremely movable,the necessity for skin grafting rarely arises, and with few exceptions, necrosis of theflaps does not prolong convalescence. When it is evident that the described method will not suffice, it may be necessaryto resort either to some plastic means of wound closure, the success of which will dependupon the ingenuity of the operator, or to skin grafting. The incision is begun on the arm at a point opposite the insertion of the pectorahsmajor muscle at the level of the anterior edge of the deltoid muscle. It is carried upwardand inward well onto the shoulder to a point about two inches beyond the line of theanterior axillary margin, and then in a gradual curve, the concavity of which is out- CARCINOMA 589 ward, i

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