Successful Madden’s Mastectomy for Left Breast Carcinoma in a 68 Y.O. Female

PACE Hospitals’ expert Oncology team successfully performed a Madden's mastectomy on a 68-year-old female patient who presented with a lump in the upper outer quadrant of the left breast. The aim of the procedure was to achieve complete surgical removal of the tumor, prevent local progression of the disease, and minimize the risk of recurrence or distant spread as part of a curative treatment approach.

Chief complaints

A 68-year-old female patient with a body mass index (BMI) of 22 presented to the Oncology Department at PACE Hospitals, Hitech City, Hyderabad, with a complaint of a lump in the upper outer quadrant of the left breast, measuring approximately 3×2 cm, noticed for the past 20 days. The lump was mobile beneath the skin. There was no associated history of pain, nipple discharge, or axillary lymph node swelling. The patient denied any history of trauma to the breast, skin changes over the breast, unexplained weight loss, or loss of appetite.

Past Medical History

The patient had a history of hypertension and was receiving ongoing medical treatment to manage blood pressure effectively.

On Examination

On examination, the patient was conscious and oriented with stable vital signs. Local examination of the left breast revealed a palpable lump in the upper outer quadrant, which was mobile, non-tender, and without any overlying skin changes. No nipple discharge was observed. Axillary lymph nodes were not palpable. There were no signs of inflammation, skin dimpling, or ulceration. Systemic examination, including cardiovascular, respiratory, and abdominal systems, was unremarkable with no abnormalities detected.

Diagnosis

Upon admission to PACE Hospitals, the patient underwent a comprehensive evaluation, including a detailed review of her medical history and physical examination by the Oncology team. Given her presentation with a palpable lump in the upper outer quadrant of the left breast, with no associated lymph node involvement or distant metastasis, there was a high clinical suspicion of localized breast carcinoma (Breast cancer).

The patient underwent a thorough diagnostic workup including imaging and biopsy, which confirmed a diagnosis of carcinoma of the left breast staged as T2N0M0, indicating a tumor size between 2 to 5 cm without regional lymph node involvement or distant spread or metastasis.

Based on the confirmed findings, the patient was advised to undergo Breast Cancer Treatment in Hyderabad, India, under the expert care of the Oncology Department.

Medical Decision-Making

After consultation with Dr. Ramesh Parimi, a surgical oncologist, a comprehensive evaluation was conducted to determine the most appropriate diagnostic and therapeutic approach for the patient diagnosed with carcinoma of the left breast staged as T2N0M0. Clinical examination, imaging studies, and biopsy confirmed the presence of a malignant tumor in the upper outer quadrant of the left breast without regional lymph node involvement or distant metastasis.

It was determined that the patient had a localized breast carcinoma with a moderate-sized tumor, and surgical management in the form of Madden’s Mastectomy was identified as the most appropriate intervention to achieve complete tumor removal and minimize the risk of recurrence.

The patient and her family were thoroughly counselled about the diagnosis, treatment options, and the potential risks and benefits of surgery. They were informed of the importance of timely surgical intervention to improve prognosis and overall outcomes.

Surgical Procedure

Following the decision, the patient was scheduled for Madden’s Mastectomy Surgery in Hyderabad at PACE Hospitals, under the expert supervision of the Oncology Department.

The following steps were carried out during the procedure:

• Anesthesia and Patient Positioning: The patient was placed under general anesthesia and positioned supine with the left arm abducted to expose the left breast and axilla adequately.

• Incision and Skin Flap Creation: An elliptical incision was made around the breast tissue, including the overlying skin, to allow for adequate exposure. Skin flaps were carefully raised to preserve healthy tissue.

• Removal of Breast Tissue and Axillary Lymph Node Dissection: The breast glandular tissue was completely removed along with level I and II axillary lymph nodes, while preserving the pectoralis major muscle.

• Hemostasis and Drain Placement: Meticulous hemostasis was achieved. Surgical drains were placed in the axillary region to prevent postoperative fluid accumulation.

• Closure and Dressing: The surgical wound was closed in layers using absorbable sutures for the deep tissue and non-absorbable sutures or staples for the skin. A sterile dressing was applied.
  

Postoperative Care

After surgery, the patient’s postoperative recovery was uneventful. She was monitored in the Surgical Intensive Care Unit (SICU) and received intravenous broad-spectrum and aminoglycoside antibiotics for infection prevention, along with proton pump inhibitors to protect the gastric mucosa. Pain was managed with oral analgesics, and her antihypertensive medication was continued to maintain stable blood pressure. Additionally, an intravenous antifibrinolytic agent was administered to reduce bleeding risk. 

The surgical site and drains were regularly assessed, and the patient remained stable without complications. She was later shifted to the general ward, where wound healing progressed well, and gradual mobilisation was initiated. After a stable recovery, the patient was discharged in stable condition with detailed instructions.

Discharge Medications

At the time of discharge, the patient was prescribed an oral broad-spectrum antibiotic to prevent postoperative infections and support wound healing. A proton pump inhibitor was included to reduce gastric acid secretion and protect the gastric mucosa during the recovery phase. Additionally, an oral analgesic with antipyretic properties was advised to manage postoperative pain and control any fever that might arise. The patient was also advised to continue her previously prescribed antihypertensive medication for ongoing blood pressure management.

Advice on Discharge

The patient was advised to continue with the surgical drain in situ and to monitor the drain output regularly. Proper drain care instructions were provided, and the patient was instructed to report any signs of infection, excessive drainage, or blockage.

Emergency Care

The patient was informed to contact the emergency ward at PACE Hospitals in case of any concerning symptoms, including fever, increased redness, swelling, pain, or abnormal discharge from the surgical site.

Review and Follow-Up

The patient was advised to schedule a follow-up appointment with the Oncologist in Hyderabad at PACE Hospitals, 3 days after discharge.

Conclusion

This case highlights the importance of early evaluation and timely surgical intervention in managing localized breast carcinoma. The patient underwent a successful Madden’s mastectomy with an uneventful postoperative recovery. Ongoing follow-up and supportive care were advised to ensure optimal long-term outcomes.