Which nerve is at risk of injury during a radical mastectomy?

The long thoracic nerve is particularly at risk during a radical mastectomy because this surgical procedure involves the removal of breast tissue along with surrounding lymph nodes and potentially the associated muscles, including the serratus anterior. The long thoracic nerve, responsible for innervating the serratus anterior muscle, is situated near the lateral chest wall and can easily be damaged during the dissection process. Injury to this nerve can result in a condition known as "winged scapula," where the shoulder blade protrudes abnormally because the muscle that stabilizes it is weakened or paralyzed.

In contrast, the median, radial, and ulnar nerves are located in areas further away from the surgical field associated with a radical mastectomy and do not have a direct relationship with the structures being removed. The focus of the radical mastectomy is on the breast and axillary region, making protection of the long thoracic nerve particularly critical during this type of surgery. Understanding the anatomy and path of these nerves is essential for minimizing complications such as motor deficits after surgery.