After preparing the surgical field, the surgeon marks two horizontal semi-oval lines bordering the mammary gland.

After the marking, it cuts them with a scalpel to the deep layers of the dermis and cuts the surgical coagulant to the subcutaneous fat while coagulating the small bleeding vessels.

Mobilization of skin flaps. To do this, the assistant takes the edges of the flaps on the sharp one-tooth hooks of the Chassignac (can be taken on the holders) and rearranges them as the flaps are mobilized, the operator in the meantime mobilizes the skin with the adjacent fiber with a surgical coagulant right down to the large pectoral muscle forming the upper and lower flaps.

The mammary gland remains fixed to the large pectoral muscle in the fatty capsule.

With the help of a surgical coagulator, the mammary gland is separated from the large thoracic, jagged muscle from the medial edge of the breast and laterally up to the axillary region.

When working in the axillary region, light is created for a better view, the power of the coagulator is reduced for more delicate work with the tissues. Mobilizing the axillary tissue near the axillary - subclavian vein should not use a coagulator in order not to damage large vessels, the most convenient in this case surgical scissors for Cooper with curved ends. The assistant in the meantime lifts the edge of the large pectoral muscle with a four-tooth blunt hook or a hook of Farabef. The surgeon has scissors parallel to the main vessels (axillary artery and vein) and in small steps the axillary fiber is separated from the axillary and subclavian veins reaching the inner edge of the small pectoral muscle. Large vessels that depart directly from the main ones are sent to the removed cellulose and the mammary gland are taken to the Moscow clamp, intersect and are bandaged with capron. In the deeper layers of the axillary tissue, a thoraco-dorsal vascular-neural bundle is distinguished along the anterior surface of the latissimus muscle of the back, a long thoracic nerve is also inside it, which serves as the medial border of lymphodissection. Having selected the basic anatomical structures of the axillary region, the axillary tissue is separated from the anterior surface of the latissimus muscle of the back. Thus, the mammary gland is removed in a single block with axillary tissue of I-II levels simultaneously with the implementation of hemostasis.

The audit of the operating field, control hemostasis is performed.

Installation of drains - one in the armpit, the other under the flaps.