The Small Incision And Intradermal Suture For Modified Radical Mastectomy (The Report Of 33 Cases)

Object:To evaluate the short-term results of the small incision and intradermal suture for modified radical mastectomy (S-MRM) compared with modified radical mastectomy (MRM).Methods:33 patients were treated by S-MRM ( group A ). Stage 0 were 4 cases, stageⅠwere 11 cases, stageⅡa were 13 cases, stageⅡb were 5 cases according to American Joint Committee on Cancer pathological staging. Thirty-seven cases of same stage breast cancer treated with traditional modified radical mastectomy (MRM) (group B) in last year by retrospectively reviewed. All available data including operation time, blood loss in operation, number of the tested lymph nodes, total postoperative lymph flow and duration of drainage, the complications and the incision length of chest-wall were analyzed. All data was analyzed byχ2 test.Results:In our study , 3 patients were treaded by S-MRM ( group A ). The mean diameter of the tumor is 2.33cm .The American Joint Committee on Cancer pathological staging after operation was TisN0M04 cases,T1N0M011 cases,T2N0M09 cases,T1N1M04 cases,T2N1M05 cases. In our study nipple-areolar complex (NAC) was removed in all 33 cases. The incision length of chest wall were 12.55±1.64cm (range, 10.0~15.0cm) in group A, 21.91±2.11cm in group B. The operation time were 129.55±15.73min (range, 110-170min) in group A, 108.51±14.85min (range, 90-150min).Significant difference existed in incision length and operation time in operation between two groups. In group A, the total postoperative lymph flow was 241.82±61.50ml (range, 130~330ml), the duration of drainage was11.06±3.12d (range, 7~17d), the number of dissected lymph nodes were 13.46±2.87 (range, 9~17), The blood loss in operation were 148.18±30.49ml (range, 100~230ml) in group A, 147.16±28.17ml (range, 100~200ml) in group B. The cosmetic result in group A was much better than that in group B. Metastasis was detected in lymph nodes (pN1) of 9 cases, local subcutaneous hydrops 17 cases. Punctured by injectior and exserted the hydrops out, bind up with some pressure on the very place. The hydrops was sum up in the lymph flow.The skin of the flap was bruised 11 cases, and it was all sbsorbed by itself without treatment. Cuticular border necrosis of the incision (width 0.4-0.8cm) 5 cases . And was healed by eschar formation. Compared with traditional modified radical mastectomy incision length of chest wall of S-MRM is short. And with intradermal suture we can get a smaller scar and superior cosmetic results. The complications for istance blood loss, time of postoperative drainage have no difference between the two groups. Operative time of S-MRM is longer than MRM, but with more exercise and new skills .The time will be shorter. In all 33 cases .28 parents were satisfied and 5 patients were just agree with the appearance .It is just because of the bruised of the flap and the subcutaneous hydrops. As time past the appearance of chest of the patient turns more cosmetic the scar becomes less apparent. There were no local and distant recurrences after a median follow-up of 5.8 months.Conclusion:(1)S-MRM have no difference in effect of operation (blood loss,number of ALN) compared with traditional-MRM. Because of the small incision , the space of the operation is so small that make it take a lot long time . But with more exercise and new skills the time will be shorter.(2)The S-MRM and traditional-MRM have the same rate in complications(the duration of drainage,postoperative lymph flow,subcutaneous hydrops,cuticular border necrosis) after operation.(3)S-MRM is an effective surgery with superior cosmetic results for early stage breast cancer compared with traditional-MRM. Because it has shorter incision and with intradermal suture the scar of the operation is not as apperant as MRM.(4)S-MRM keep a larger square of shin flap compare with MRM. Provide a good condition for II stage breast reconstruction. (5)The cosmetic results of S-MRM release the emotional distress of the patients after operation.