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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d, can be fully exposed by removing thesternal portion of the pectoralis major muscle and the costo-coracoid membrane. Theexposure of this space in the operation for mammary carcinoma is of paramount im-portance because it lodges the subclavian lymph nodes, which are especially liable toescape removal owing to their sheltered position, which communicate with all of the SURGICAL ANATOMY OF THE BREAST 33 other axillary sub-groups of lymph nodes and which may, as Stiles has shown, becomeinvolved in the cancerous process without involvement of the lower groups. In themajority of cases the lymphatic nodes of the subclavian group are situated behind, aswell as above and below the pectoralis minor muscle, so that one cannot be sure of thecomplete removal of these isolated structures if the muscle be left in situ. The deep infra-clavicular triangle contains the third portion of the axillary vein, the sheath of which, r/jf/c/e. Costo-cnrBcnid memPectoral 15 msjar 5///7er/iad/ /d/erafdeep fisae
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Biaqram showing line nf section. Fig. i6.—Diagram of the pectoral fascia and^the axillary fascia. a process of the pre-vertebral layer of the deep cervical fascia, is, as stated above, attachedto the costo-coracoid membrane. Both structures may be inseparably attached to theadjacent lymph nodes when the latter show advanced cancerous involvement. Inthe latter event edema of the arm may result from pressure upon the axillary vein. Anattachment of the lymph nodes to the wall of the vein necessitates excision of the in-volved segment. This space contains in addition the first portion of the axillary artery, 34 THE BREAST the acromo-thoracic artery and vein, and the cords of the brachial plexus. Successfulsurgical treatment of mammary cancer can only be hoped for through effacement of theinfra-clavicular triangles, removal of the anterior wall of the axillary space, consisting ofthe clavicular and sternal portions of the pectoralis major, the pectoralis minor muscleand the clavi-pectora

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