General Surgery · Breast

Mastectomy (Simple)

DATE AND TIME: [Date and time]
URGENCY: Elective / Non-elective
SURGEON: [Name]
ASSISTANT: [Name / None]
ANAESTHETIST: [Name]

OPERATION: Simple (Total) Mastectomy ± Sentinel Lymph Node Biopsy
ANAESTHETIC: General anaesthesia
ANTIBIOTICS: [Drug and dose / Not indicated]
VTE PROPHYLAXIS: TED stockings, intermittent pneumatic compression.
POSITION: Supine, arm on operative side extended on arm board at 90°. Arm wrapped separately to allow axillary access.

INDICATION:
[Multifocal carcinoma / extensive DCIS >4 cm / patient choice / recurrence post-breast conservation / risk-reducing mastectomy in BRCA mutation carrier / male breast cancer]. Histological confirmation obtained pre-operatively. Axillary staging planned: [SLNB / ALND]. Reconstruction discussed — [offered / declined / immediate / delayed]. Side and site confirmed and marked by surgeon pre-operatively.

INCISION: [Describe incision]

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