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side because there is no evidence of cancer present. Only one drain is placed on the left side, which is considered “clean,” due to the fact that it is cancer free. Once the left breast incision is closed with staples, 3-0 undyed polygle- caprone 25 suture is passed on a Crile-Wood needle holder to close the skin. The staples are removed as individual mattress sutures are placed, and then a continuous running suture is placed to close the skin incisions on both sides. Straight Mayo scissors are used to cut the suture edges. After complete closure on both sides, one-inch wound- closure strips are applied over the incisional area. A wet towel is used to clean the breast and abdominal areas, fol- lowed by a dry towel to dry the breast and abdominal area. Two sterile, abdominal pads are placed over the skin inci- sion site, the drapes are removed and the ABD pads are secured with a bandeau-style wrap. Finally, the patient is taken off of anesthesia and extubated. Following extubation, the patient is transported to the post-anesthesia care unit. Complications of the total bilateral modified radical mastectomy include bleeding, infection, reactions to anes- thesia, adhesion formations, thrombi or emboli formation, cancer metastasis, psychological disfigurement problems and death. Additionally, the patient undergoing a radical mastectomy may additionally suffer from phantom breast pain, swelling of the breast area and the possibility of seroma formation. Complications to the tissue expanders include, but are not limited to, infection, bleeding, rupture of implants, dimpling of the skin as well as visualization impedance during follow-up return mammograms. The advantage to immediate breast reconstruction, as this particular patient opted for, include not waking up to the trauma of losing the anatomical look of the breasts and eliminating the need for additional reconstructive surgery. A B O U T T H E A U T H O R Brittany Stapp-Caudell is working as a surgical technologist at Com- munity Regional Medical Center in Fresno, California. She graduated from the surgical technology pro- gram at San Joaquin Valley College in Fresno, in September 2009, and is currently awaiting the results of her certifica- tion examination. References 1. Drake. Gray’s Anatomy for Students . Elsevier Churchill Livingstone. Spain. 2005. 2. Cohen B. Memmler’s The Human Body in Health and Disease . Lippincott Williams &Wilkins. USA. 2005. 3. Huether, McCance. Understanding Pathophysiology . Mosby. St Louis. 2008. 4. American Cancer Society. 2009. Accessed: April 25, 2009. Available at: http://www.cancer.org/docroot/home/index.asp 5. Frazier. D. (2008). ‘Breast cancer’ breastcancer.org. Retrieved April 24, 2009, from breastcancer.org 6. Medline Plus. Mastectomy . 2009. Accessed: April 25, 2009. Available at: http://www.nlm.nih.gov/medlineplus/mastectomy.html 7. eMedicineHealth. Mastectomy . 2009. Accessed: April 27, 2009. Available at: http://www.emedicinehealth.com/mastectomy/article_em.htm 8. Mastectomy. 2007. Accessed Apri l 24, 2009. Avai lable at: http:// en.wikipedia.org/wiki/Mastectomy Additional Resources eMedicineHealth.com. Mastectomy. 2009. Available at: http://www.emedicine health.com/mastectomy/article_em.htm Imaginis.com. Mastectomy. 2009. Available at: http://www.imaginis.com/breast health/mastectomy.asp Breastcancer.org. Stages of Breast Cancer. 2009. Available at: http://www.breast cancer.org/symptoms/diagnosis/staging.jsp AlloDerm is a trademark of LifeCell Corp. Bair Hugger is a trademark of Arizant Inc. DuraPrep is a trademark of 3M. OCTOBER 2009 | The Surgical Technologist | 455