. The breast: its anomalies, its diseases, and their treatment . gland freely exposed. As the breast falls notonly downward but outward, when the patient is in the upright position, this incision is concealed fromview. The dissection should be carried down to the outer edge of the pectoralis major muscle; when fibersof this muscle have been exposed the knife will have passed through the deep layer of the superficialpectoral fascia, a fascia which covers the posterior surface of the gland. This layer is separated from thedeep pectoral fascia covering the pectoralis major muscle by a loose layer
. The breast: its anomalies, its diseases, and their treatment . gland freely exposed. As the breast falls notonly downward but outward, when the patient is in the upright position, this incision is concealed fromview. The dissection should be carried down to the outer edge of the pectoralis major muscle; when fibersof this muscle have been exposed the knife will have passed through the deep layer of the superficialpectoral fascia, a fascia which covers the posterior surface of the gland. This layer is separated from thedeep pectoral fascia covering the pectoralis major muscle by a loose layer of connective tissue. The looseconnective tissue enables the dissection to be carried easily between the gland and the muscle, so thatthey are quickly separated from one another. The left hand of the operator can now manipulate thebreast so as to expose the entire posterior surface of the gland. The gland tissue is covered by the pos-terior layer of the pectoral fascia, but is readily recognized beneath it, as are also any cysts or tumorsthat may be Fig. 173.—Appearance of the breast at the conclusion of the operation. (Warren.) An incision radiating from the center to the periphery of the gland should be made through thefascia, to expose the subjacent growth. The segment of the gland containing the tumor should now beremoved by two radiating incisions which, meeting at the center of the gland, include a V-shaped portionof its tissue. The knife should make a clean cut through the gland tissue down to the loose adipose tissue whichligs in front of the gland. This adipose layer should not be removed, as its presence is important inpreventing a subsequent depression at this point. No attempt should be made to dissect out the tumor,whether it be solid or cystic. Solid tumors, such as the peri-ductal fibroma, or a cystadenoma, are sointimately associated with the gland tissue that they cannot be shelled out. The fibers of the capsuleseem to be continuous with those of t
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectbreast, bookyear1917
