MYOPLASTY OF PECTORALIS MINOR AS A METHOD OF PREVENTION OF PERSISTING LYMPHORRHEA DURING THE RADICAL MASTECTOMY AND RADICAL RESECTION

Introduction. The main method of treatment of patients with breast cancer (BC) is surgical. In the course of surgery, a large number of lymphatic vessels are crossed, which inevitably leads to a violation of the lymph flow. The paper discusses the possible correction of this negative phenomenon. This paper describes the problem of lymphorrhea in breast cancer patients after the radical mastectomy and radical resection. Breast cancer is the most widespread type of tumors in the female population. Surgical treatment for BC patients involves the radical or partial resection of the breast (with or without oncoplastic technique application) with the tumor along with axillary, subscapular, and subclavicular lymphadenectomy accompanied with the dissection of a number of lymphatic collectors from the upper limb and lymphorrhea. Objective. The efficiency of the pectoralis minor myoplasty in the axillary area of the dead-space for the prevention of lymphorrhea after the radical mastectomy and radical resection is evaluated. Material and Methods. The main group included 30 patients who underwent 30 surgeries with myoplasty of pectoralis minor (Madden’s radical mastectomy or radial resection) in the Tver Oncological Center at the Department of Breast Pathology from 2016 to 2017. The control group included 30 patients who underwent Madden’s mastectomy or radical resection without myoplasty (conventional option). Results. In the main group, during the mastectomy, the patients with lymphorrhea had the drainage removed at the (5.3 ± 1.2)-th day. The total amount of the drainage was around (235.4 ± 3.6) ml. The average daily volume of the drained liquid was (47.1 ± 2.7) ml. In the control group, during the radical mastectomy without myoplasty, the drainage was removed on the (12.7±1.4)-th day. The average total amount of the drained liquid was (1691.6 ± 32.5) ml. The average daily drained volume was (130.3 ± 2.5) ml. The patients from the main group, who underwent the radical resection, had the drainage removed on the (5.2 ± 1.2)-th day. The total amount of the drained liquid in patients with lymphorrhea was 25 ml/day. The summed amount of the drained liquid was (223.7 ± 11.3) ml. The average daily drained volume was (44.6 ± 2.3) ml. The patients of the control group, who underwent radical resection, had the drainage removed on the (11.2 ± 2.0)-th day. The average total volume of the drained liquid was (835.5 ± 26.4) ml. The average daily drained volume was (69.9 ± 2.2) ml. Conclusion. The Ismagilov intra-operational method for the closure of the dead space with further pectoralis minor myoplasty (Patent RF No. 2385673, issued on 10.04.2010) combined with post-operational compression wear indication is a simple and efficient method for prevention of post-operational lymphorrhea. Myoplasty showed to be efficient in the reduction of lymphorrhea regardless of the volume of the surgical intervention (radical mastectomy or radical resection).

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