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tion attached, is passed to the surgeon. The surgeon uses the electrosurgical pencil to dissect the breast tissue away from the overlying skin extending from the areola down to the fascia of the pectoralis minor muscle. As the dissection is carried deeper into the patient, the surgical technologist anticipates the need of X-ray-detectable sponges, clamps, retractors and pick-ups. Once the pectoralis muscle is reached, the dissection is then carried laterally to dissect out the sentinel node of the lymphatic system. All breast tissue, with the sentinel lobe attached, is separated from the skin, lymphatic system and underlying musculature. After the complete dissection is complete, the electrosurgical pencil is handed safely back to the surgical technologist, who cleans the tip and places it back into the holster to prevent burns to the patient. 3 Breast cancer is the most common cancer that affects Ameri- can women today. Additionally, it is the leading cause of death in women ages 40–44 years of age, and is the secondmost common killer of all ages after lung cancer. saline implant is removed by the surgeon and handed to the surgical technologist. The surgical technologist hands the specimen off of the field to the circulator, who places it in a bucket and correctly identifies and labels it. The sur- geon then uses the electrosurgical pencil to further open the capsule that has been created by the saline implant. Addi- tional remaining breast tissue is removed and hemostasis is achieved. At the completion of the mastectomy, the wound is irrigated with sterile water to prevent cancer seeding. All instruments from this point on are considered con- taminated as a result of the cancer. A clean set-up is already prepared prior to this portion of the procedure and is uti- lized for the remaining portions of the procedure on the right, once-cancerous breast. AlloDerm®, a collagen matrix that preserves all the elements necessary for revascular- ization and cellular repopulation, is placed into the pocket created by the implant/dissection, located within the muscle layers. The material is first soaked in sterile saline for five min- utes before it is transferred to another kidney basin full of saline for another five minutes prior to passing to the plastic surgeon. It is then cut to size Once the breast tissue has been dissected, the tissue is removed through the areolar area and handed to the surgical technologist. The surgical technologist labels the specimen on a piece of sterile towel and hands it off to the circulating nurse. The nurse then labels the specimen and immediately takes it to pathology. As the surgery continues, the pathology department personnel examine the sentinel node under the microscope to see if the cancer has metas- tasized to the lateral margins of the breast. Once the speci- men has been carefully examined under the microscope, the pathology department calls the operating room to let the surgeon know if the lateral margins of the breast, as well as the lymphatic system, are indeed clear of the aggressive breast cancer. In this particular case, the lateral margins of the breast and the lymphatic system showed no signs of the aggres- sive cancer. Once the breast specimen is removed, a new #15 blade, loaded onto a #3 knife handle, is handed to the surgeon, who uses it to make a three-inch incision into the fascia between the pectoralis minor and the pectoralis major muscles. Once the incision is made, the patient’s original and placed into the pocket . Non- absorbable sutures are used to keep the graft in place. Following the insertion of the AlloDerm® into the pock- et to create a posterior border to the breast pocket, a sterile tissue expander is passed to the plastic surgeon and placed into the newly-created pocket. A butterfly needle is passed to the surgeon and attached to a sterile, infusible IV tube, attached to a pressurized IV infuser filled with warm saline. The surgeon inserts the butterfly needle into the port on the tissue expander, inflating the tissue expander with 540 cc of warm, sterile saline. For closure, two Jackson-Pratt drains are placed from the muscle pocket to the outside of the body. A 3-0 silk suture is utilized to keep the drains secured in place to the skin. Additionally, absorbable 3-0 polyglactin sutures are passed to the surgeon on a Mayo-Hegar needle holder along with toothed forceps. The sutures are used to close the muscle pocket. Finally, a skin stapler and two Adson, toothed forceps are used to close the areolar incision in a longitudinal fashion. Following the closure of the right breast, a different, clean set-up is used to carry out the same procedure on the left breast. The sentinel lobe is not removed from the left 454 | The Surgical Technologist | OCTOBER 2009