## Surgical Management of Breast Cancer — Correct Statements ### Statement Analysis **Key Point:** Modified radical mastectomy (MRM) removes the breast tissue and axillary lymph nodes (Levels I–III), but PRESERVES both pectoralis major and minor muscles. The pectoralis major is only removed in a radical (Halsted) mastectomy, which is now rarely performed. ### Correct Statements (Options 0, 1, 2) | Statement | Accuracy | Rationale | |-----------|----------|----------| | SLNB is standard for cN0 disease | ✓ Correct | Sentinel lymph node biopsy is the gold standard for staging clinically node-negative breast cancer [cite:NCCN Breast Cancer Guidelines] | | ALND indicated for positive SN | ✓ Correct | Positive sentinel nodes mandate axillary lymph node dissection (ALND) for accurate staging, though de-escalation may be considered in select early-stage cases | | BCT requires adjuvant RT | ✓ Correct | Radiotherapy after BCT reduces locoregional recurrence from ~20% to ~5% and is standard of care [cite:EBCTCG meta-analysis] | ### Incorrect Statement (Option 3) **Warning:** The statement claims MRM removes pectoralis major muscle — this is FALSE. MRM preserves both pectoral muscles. **High-Yield:** - **Modified Radical Mastectomy (MRM):** Removes breast + axillary nodes (Levels I–III) + preserves pectoralis major and minor - **Radical (Halsted) Mastectomy:** Removes breast + axillary nodes + pectoralis major + pectoralis minor (now obsolete) - **Skin-sparing / Nipple-sparing mastectomy:** Oncologically equivalent to MRM when appropriate patient selection; improves cosmesis **Mnemonic: "MRM = Muscle Retained"** — The modified procedure retains the pectoral muscles, unlike the old radical approach. ### Clinical Pearl The shift from radical to modified radical mastectomy in the 1970s–1980s was a major advance, as removing pectoralis major provides no survival benefit and significantly impairs shoulder function and cosmesis.
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