AMPUTATION OP THE BREAST 
BY MEANS OF THE ANTERIOR AXILLARY INCISION. 
Associate in Surgery, Rush Medical College, in affiliation with the Uni- 
versity of Chicago; Assistant-Surgeon St. Joseph’s Hospital; 
Assistant-Surgeon Presbyterian Hospital. 
CHICAGO. 
EMANUEL J. SENN, M.D. 
REPRINTED FROM 
THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 
MA Y 27, 1899. 
CHICAGO 
American Medical Association Press 
1899 AMPUTATION OP THE BREAST. 
BY MEANS OE THE ANTERIOR AXILLARY INCISION. 
EMANUEL J. SENN, M.D. 
Amputation of the breast in malignant disease is 
no longer regarded as a palliative operation in pro- 
longing life; but should have for its purpose a per- 
manent result, as verified by recent statistics. The 
operative technic of Halsted, which is simply a prac- 
tical application of the profound anatomic research 
of Haidenhain in this region is certainly to be recom- 
mended. Of late, I have removed the breast, together 
with the axillary contents, without making an incis- 
ion in the axilla. 
The object of this short article is not to describe 
the radical operation for removal of the breast, which 
is only too well treated in all works on operative sur- 
gery, but to dwell on the value of the anterior axillary 
incision as a preliminary. The accompanying illus- 
trations are more explicit than a detailed description 
of the operation. The breast is circumscribed by two 
curvilinear incisions which meet above at the border 
of the pectoralis major muscle. The incision is then 
continued slightly internal to the outer border of this 
muscle, in an upward direction, to a point about one 
inch above the apex of the axilla, where it takes an 
outward course in the deltoid region, forming a grad- 
ual curve, which terminates at the level of the apex 
of the axilla, (Fig. 1.) 
Figure 2 shows the breast removed from the tho- 
racic wall, but suspended by the axillary glands and 
adipose tissue, which are about to be enucleated en 
masse by blunt dissection. Figure 3 represents the 
operation completed. 
I wish to lay stress on the following advantages of 
the anterior axillary incision; 
1. It exposes to the operator a larger field for rad- 
ical work than the ordinary.axillary incision. 2 
2. By making traction on the axillary flap, it is 
easily freed from the subcutaneous tissues with a few 
strokes of the knife, exposing at once the position of 
the axillary vein. 
3. Injury to the vein is greatly diminished, because 
the incision bares all the surrounding muscular land- 3 
marks to this important structure. Moreover, dissec- 
tion is done away from the vein instead of toward 
the vein, as must be done through an incision in*the 
axilla. 
4. The axillary space is unfavorable to primary 
wound healing, being often the seat of a fistula long 
after the rest of the wound has healed intact. It is a 
region difficult to render aseptic; hence the advant- 
age of access to this region from without. 4 
5. The incision is so situated that it does not im- 
pede free motion of the arm, the patient being able 
to extend the arm to the head at the first dressing. 
There is no subsequent cicatricial contraction, as in 
an axillary soar, to interfere with the physiologic func- 
tion of the arm. 
6. The cicatrix is not dragged upon by motion of 
the arm, consequently scar tissue is little exposed to 
trauma through mechanic stretching; hence the di- 
minished liability of recurrence of the disease.