Operative surgery, for students and practitioners . s of the clavicle down intothe upper border of the elliptical incision. The corners of the skin-flapswhich are thus marked out are seized with the fingers and, includingbut little of the fat layer, are dissected away from the breast (tumor)and from the underlying surface of the muscles, etc., upward, towardthe clavicle; inward, toward the sternum, and outward, toward theaxilla. In this way we expose the sternal and clavicular portions and OPERATIONS UPON THE BREAST. 503 the tendon of the pectoralis major muscle. In the space between theupper
Operative surgery, for students and practitioners . s of the clavicle down intothe upper border of the elliptical incision. The corners of the skin-flapswhich are thus marked out are seized with the fingers and, includingbut little of the fat layer, are dissected away from the breast (tumor)and from the underlying surface of the muscles, etc., upward, towardthe clavicle; inward, toward the sternum, and outward, toward theaxilla. In this way we expose the sternal and clavicular portions and OPERATIONS UPON THE BREAST. 503 the tendon of the pectoralis major muscle. In the space between theupper border of the pectoralis major and tlie deltoid the cephalic veinand the descending branch of the acromio-thoracic artery are corresponding to the line of reflection of the external flapthe edge of the latissimus dorsi is exposed. The tendon of the pectoralis major is hooked up upon the fingerand divided close to its attachment to the humerus, and then, followingalong the upper border of this muscle, between it and the edge of the. Pig. 150.—Amputation of the Breast. Halsted-Meyer incision for amputationof the breast and to clean out the axiUa. deltoid as far as the clavicle, this muscle (pectoralis major) is cut awayfrom its attachment to the clavicle and reflected downward, thusexposing the next underlying layer, or etage, which consists ofthe pectoralis minor muscle covered by its fascia and some loose con-nective tissue and the costo-coracoid membrane. Frequently that portion of the pectoralis major which arises fromthe clavicle can be saved. This will add much to the usefulness of thearm after the operation. A distinct groove is seen between that por-tion of the pectoralis major which arises from the clavicle and thatwhich arises from the chest-wall. If it is desifed to save the clavicu-lar portion of the muscle the finger is introduced into the groove be-tween these two portions and that part of the tendon which corresponds 304 THORAX. to the pectoral o
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