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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this is done from withoutinward in a direction directly opposite to that carried out in the Halsted operation, so that the entiremass is removed toward the median line. Beginning with the humeral insertion of the pectoralis major muscle, the forefinger of the left hand ofthe operator is slipped under the edge of the muscle from above downward and the muscle is divided ashort distance from its insertion. The proximal end of the muscle is seized by hooks and pulled in thedirection of its origin while its fibers are separated from those in immediate contact with the clavicle. Anassistant, while holding the hooks, quickly draws the breast with the other hand in the direction of theepigastrium. The finger is now hooked under the insertion of the pectoralis minor and the muscledivided. The axillary region is freely exposed and the thin fascia overlying the vessels being divided, thelarger vessels are readily identified. In this way the dissection of the axilla can be carried out with great
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Fig. 258.—Illustrating Warrens operation for mammary carcinoma. Closure of the wound completed. precision, and the origin of all the large branches can be secured with the ligature. A few sweeps of theknife separate the mass from the latissimus dorsi muscle. The breast is now seized by the operator andrapidly dissected off the thoracic wall from without inward. The origin of the pectoralis minor is firstdivided, and the final act of the operation consists in severing the origin of the pectoralis major while thebreast and attached tissues are firmly held away from the sternal margin. Closure of the wound isbegun on its outskirts at four different points, viz., at each end and on each side. A few stitches shouldbe taken at the axillary and at the sternal ends of the wound first. The flap is then turned in and held inplace by a temporary stitch. While it is gradually pushed up into place from below by sutures, firmlygirding together the edges of the skin to which the flap was originall

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