Extended mastectomy for cancer of the breast

In one out of four cases of operable breast cancer internal mammary metastases are present. The internal mammary involvement of tumors of the outer quadrants is also considerable (18%), being especially frequent in cases with axillary metastases (41%). The 5‐ and 10‐year survival rates show that the prognosis of cases with involvement of both axillary and internal mammary nodes is very poor; whereas, cases with internal mammary metastases only have an unexpectedly good prognosis. The removal of the internal mammary chain is essential for better prognostic evaluation and also seems justified by the radicality additionally given to the Halstead operation. However, only the results of a coordinated clinical trial will give a reliable evaluation of the true value of the procedure. A new technique of super‐radical operation is described. The operation is safe, without considerable functional or cosmetic impairment. However, only long‐term results will allow evaluation of its effectiveness.