Simple Mastectomy
This process is repeated for the lower flap, proceeding from the medial end to the lateral end. Toward the lateral end of the dissection, a Littlewoods forceps is placed on the superior flap and another on the inferior flap, close to the lateral angle of the incision. The dissection is deepened until the anterior border of the latissimus dorsi (the lateral limit of the dissection) is identified. With the skin envelope raised completely, the next step is to lift the breast off the pectoralis major. Langenbeck retractors may be used to retract the flaps, starting at the medial angle. A perforating branch of the internal mammary artery is commonly encountered here; it should be coagulated with the diathermy device before it retracts. The breast is then lifted off the muscle, with care taken to ensure that all the perforators along the way are coagulated (see the image below).
