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Simple Mastectomy mayo stand and back table surgery setup

Jerry Gann Avatar

setup author

Surgery setup images for Simple Mastectomy

Simple Mastectomy surgery instruments

Clamping & Occluding instruments

Hemostatic Clip Applier
Hemostatic Clip Applier
Penetrating Towel Clamp
Penetrating Towel Clamp
Curved Hemostat
Curved Hemostat
Right Angle Clamp
Right Angle Clamp
Kocher Forceps
Kocher Forceps
Tonsil Clamp
Tonsil Clamp
Allis Forceps
Allis Forceps

Cutting & Dissecting instruments

#3 Knife Handle
#3 Knife Handle
Metzenbaum Scissor
Metzenbaum Scissor
Curved Mayo Scissor
Curved Mayo Scissor
Straight Mayo Scissor
Straight Mayo Scissor

Grasping & Holding instruments

Toothed Forcep
Toothed Forcep
Smooth Adson
Smooth Adson
Adson Forceps
Adson Forceps
Russian Tissue Forceps
Russian Tissue Forceps
Ferris Smith Tissue Forceps
Ferris Smith Tissue Forceps
Non toothed Pickup
Non toothed Pickup
Debakey Forceps
Debakey Forceps

Retracting & Exposing instruments

Freer Skin Hook
Freer Skin Hook
Freeman Rake
Freeman Rake
Weitlaner Retractor
Weitlaner Retractor
Gelpi Retractor
Gelpi Retractor
Army-Navy Retractor
Army-Navy Retractor
Senn Retractor
Senn Retractor
Richardson Retractor
Richardson Retractor
Harrington Retractor
Harrington Retractor
Deaver Retractor
Deaver Retractor

Suctioning instruments

Yankauer Suction
Yankauer Suction

Suturing & Stapling instruments

Ryder Needle Holder
Ryder Needle Holder
Crile Wood Needle Holder
Crile Wood Needle Holder
Mayo-Hegar Needle Holder
Mayo-Hegar Needle Holder

What to expect during Simple Mastectomy

A Simple Mastectomy is a surgical procedure that involves the complete removal of the breast tissue, including the nipple and areola. This procedure is commonly used to treat breast cancer and is recommended for patients who have large tumors or tumors in multiple areas of the breast. The procedure is typically done under general anesthesia and requires a hospital stay of a few days. After the procedure, the patient may choose to have breast reconstruction surgery to restore the appearance of the breast.

Step 1: Incision and Dissection
The first step in a Simple Mastectomy is making an incision with either a 15 or 10 blade on a #3 knife handle. After the incision is made, the surgeon will begin dissection using adson pickups, metzenbaum scissors, and a bovie. Adson pickups are used to grasp tissue and hold it in place, while metzenbaum scissors are used to cut and dissect delicate tissue. The bovie is used to cauterize and control bleeding during the procedure.

Step 2: Retraction
As the dissection continues, the surgeon will need to retract the surrounding tissue to maintain visibility and access to the breast tissue. Retractors will gradually get bigger, starting with skin hooks or senns, and move up to richardsons or a harrington. Skin hooks or senns are used to lift the skin, while richardsons or a harrington are used to retract the deeper tissue layers.

Step 3: Ties and Clips
To control bleeding, ties should be loaded onto tonsils, and clips should be ready for use. Ties are used to ligate (tie off) blood vessels, while clips can be used to occlude (clamp shut) blood vessels or ducts.

Step 4: Longer Pickups
After a little bit of breast dissection, the surgeon will move onto longer pickups, usually debakeys. Debakeys are longer than adson pickups and have a wider jaw, making them better suited for handling and manipulating larger tissue structures.

Step 5: Smoke Plume Management
During the use of the bovie, smoke plume may be generated, which can be hazardous to the surgical team. The bovie smoke plume should be suctioned using the yankauer, a surgical suction instrument with a rigid, angled tip.

Step 6: Specimen Handling
Breast specimens should quickly be passed off of the surgical field and taken to pathology for examination.

Step 7: Closure
Closure will happen in layers, and the needle drivers used will depend on the suture needle size and how deep the surgeon is in the incision. Needle drivers are used to grasp and manipulate sutures during closure.

Step 8: Drain Placement
A drain may be placed at the end of the procedure to help remove excess fluid and blood from the surgical site. The type of drain used will depend on the surgeon’s preference and the specific needs of the patient.

The Surgery Sparknotes

  1. Make incision with 15/10 blade and #3 knife handle.
  2. Use adson pickups, metzenbaum scissors, and bovie for dissection.
  3. Use skin hooks/senns and richardsons/harringtons for retraction.
  4. Load ties onto tonsils and have clips ready for bleeding control.
  5. Switch to longer debakeys for larger tissue structures.
  6. Suction bovie smoke plume with yankauer.
  7. Quickly pass breast specimens off of the surgical field to pathology.
  8. Use appropriate needle drivers for sutures during closure.
  9. Consider placing a drain at the end of the procedure.

7 responses to “Simple Mastectomy”

  1. Tracy Avatar
    Tracy

    Five Stars! I’ll see you at work :)

  2. Alicia Ku Avatar
    Alicia Ku

    I have a question do this set up needs a separate table for closure?

    1. Diana Lei-aloha Avatar
      Diana Lei-aloha

      You should not need a separate table for closure in a simple mastectomy unless it’s the surgeon’s preference. There’s no “dirty” or contaminated portion that would warrant a separate table.

  3. Serena Munsinger Avatar
    Serena Munsinger

    Scrub tech student here! I have two questions…
    #1 Is it true that your type of irrigation should be sterile water instead of normal saline due to the saline spreading cancer? or is that dependent on the doctors preference? We’re taught this in my program but every time I’ve mentioned it others don’t seem to know if there is a difference.
    #2 what sutures are used for closing?

    1. Great questions!

      The first question is a tough one and one of those that is still under debate. Some surgeons may prefer to use sterile water for irrigation, while others may prefer to use normal saline. There is no evidence to suggest that one type of irrigation is superior to the other.

      The type of sutures used for closing a simple mastectomy will vary depending on the surgeon’s preference. From my experience, Vicryl is used for deep layers and monocryl is used for top layers.

  4. Mana Avatar
    Mana

    Do we need to table (Clean and dirty) for Mastectomy and breast reconstruction at the same time?

    1. The simple answer is to say a clean and dirty table is required for mastectomy and breast reconstruction at the same time. This is because the mastectomy part of the surgery is considered to be a clean procedure, while the breast reconstruction part is considered to be a dirty procedure. This is because the breast reconstruction part of the surgery involves placing implants or flaps into the body, which increases the risk of infection. By using a clean and dirty table, the surgeon can help to reduce the risk of infection.

      The clean table is used for all of the instruments and supplies that will be used in the mastectomy part of the surgery. The dirty table is used for all of the instruments and supplies that will be used in the breast reconstruction part of the surgery. The two tables are kept separate to help to prevent the spread of infection.

      However, some would argue that the infected cells are in the recipients body already and that the extra work isn’t necessary. I recommend following the CDC (in the US) or PHAC (in Canada), your hospitals, or the doctors guidelines for a case like this.

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