Under general anaesthesia, an elliptical incision is made over the breast. Skin flaps are raised and all breast tissue — including the nipple-areola complex — is removed from the chest wall. The pectoralis major and minor muscles are preserved. Axillary lymph node dissection (levels I, II, and III as needed) is performed through the same incision or a separate axillary incision. The specimen is sent for histopathological assessment. One or two drains are placed before wound closure. Surgery takes 2–4 hours.