Successful treatment of stages IIIa and IIIb carcinoma of the breast by mastectomy in the elderly high risk patient using local anesthesia.

Modified radical mastectomy has served as the standard surgical treatment for patients with operable carcinoma of the breast. Recent data suggest that lumpectomy combined with radiation therapy is adequate treatment for smaller carcinomas of the breast. However, large carcinomas of the breast may still require a modified radical mastectomy for adequate local treatment or until lesser procedures are proved sufficient. This study was done to describe the use of local anesthesia and modified radical mastectomy (with sparing of the pectoralis minor muscle) in 17 patients who were considered a poor risk for general anesthesia and had Stages IIIa and IIIb carcinomas of the breast. Patient acceptance was excellent in 14, moderate in two and poor in one patient. Blood loss never exceeded 75 milliliters and a mean of 120 milligrams of Xylocaine (lidocaine) was used. No apparent central nervous system toxicity was observed. Mean time on the surgical service was 2.7 days. Modified radical mastectomy can be successfully accomplished in patients considered a "poor risk" for general anesthesia and with locally advanced carcinoma of the breast using local anesthesia with minimal blood loss and excellent patient acceptance.