Clinical Significance of Scanlon's Procedure in a Modified Radical Mastectomy for Patients with Infiltrating Breast Cancer

PURPOSE: Modified radical mastectomy is the most commonly performed operative treatment because of extensive microcalcifications, multicentric tumors, early pregnancy, and patient preference, despite of the eligibility of many women for breast-conserving surgery. Various modifications of this operation have been described, including preservation of the pectoralis minor, resection of the pectoralis minor, and division of the origin of the pectoralis minor. The purpose of this study was to identify the indications of Scanlon's technique by evaluating the benefit of complete axillary dissection and the cosmetic results of chest walls in patients who had undergone a modified radical mastectomy (MRM) for breast cancer. METHODS: In fifty nine patients who had undergone MRM for infiltrating breast cancer from January 1992 to December 1997 and performed follow-up study of CT of chest walls, we examined operative techniques, dissected & involved axillary lymph nodes (ALNs) retrospectively and atrophy of pectoralis muscles by clinical examination and CT findings of chest walls. RESULTS: We analyzed all the results of aforementioned study, based on various operative techniques. The largest groups were Auchincloss of 63.6% in stage IIA, Scanlon of 50% in stage IIB and Patey of 28.6% in stage IIIA. The mean numbers of harvested ALNs were 20.4 in Scanlon, 20 in Patey and 15 in Auchincloss. The largest groups were Auchincloss of 77.3% in the harvested ALNs of 10-19, Scanlon of 40% in the harvested ALNs of 20-29 and Patey of 14.3% in the harvested ALNs of 30-39. The mean numbers of involved ALNs were 4.4 in Patey, 2.6 in Scanlon and 0.9 in Auchincloss. The largest groups were Auchincloss of 63.6% in the non-involved ALNs, Auchincloss of 31.8% in the involved ALNs of 1-3, Scanlon of 20% in the involved ALNs of 4-9 and Patey of 28.6% in the involved ALNs of 10 or more. Through the clinical examinations and CT studies of chest wall, such changes of chest walls were found, as suggestive of injury of medial pectoral nerve of 2 cases (9.1%) and of lateral pectoral nerve of 1 case (4.5%) inAuchincloss, of injury of medial pectoral nerve of 1 case (3.3%) in Scanlon and of injuries of medial pectoral nerve of 3 cases (42.9%) and of lateral pectoral nerve of 1 case (14.3%) in Patey. Postoperative complications were arm lymphedema of 1 case in each technique and anemia of 4 cases (13.3%) in Scanlon. CONCLUSION: We conclude that in the MRM for patients with resectable breast cancer, Scanlon's technique is superior to Auchincloss or Patey in preventing axillary recurrence and atrophies of pectoralis muscles by successful complete axillary dissection with preservation of medial and lateral pectoral nerve in cases of more advanced stage over stage IIB with involved ALNs of one to nine. However Patey's technique seems to be necessary in cases of metastasis of the interpectoral node or the subclavicular node regardless of poor results of cosmesis.

Chest Wall Muscle Changes after a Mastectomy: Findings of Chest CT

BACKGROUND: Chest CT after a mastectomy in breast cancer patients is usually performed to detect recurrence or metastasis. It is essential for surgeons and radiologists to know the appearance of the chest wall in a postmastectomy state. Especially, muscle atrophies of the chest wall, such as that of the pectoralis major muscle, indicate whether modified radical mastectomy (MRM) was properly performed or not. METHODS: We performed a retrospective analysis of chest wall changes in mastectomy patients with follow-up chest CT findings to evaluate the results of MRMs. The medical records and CT findings of chest wall atrophy for a total 38 patients who were treated at Kangnam St. Mary's Hospital, the Catholic University of Korea, were reviewed. The mean age was 58.3 yeras, and the interval between operation and follow-up CT was 6.6 years. The operations performed were a radical mastectomy (RM) in 3 patients and a MRM in 35 patients: Patey in 28 patients, Auchincloss in 6 patients, and Scanlon in 1 patient. RESULTS: In the RM, muslce atrophies were noted at the m. subscapularis in 3 patients (100 %), the m. serratus anterior in 2 patients (66.7%) and the m. lattisimus dorsi in 1 patient (33.3%). In MRM, the Patey and Auchincloss operations showed m. pectoralis major atrophies in 22 patients (78.8%) and 5 patients (83.3%) respectively. Additionally m. pectoralis minor atrophy was noted in all 6 patients (100%) who underwent the Auchincloss operation. However, there was no muscle atrophy in patients who received scanlon operation. CONCLUSIONS: These results suggests that lateral pectoral nerve injury is the main cause of m. pectoralis major atrophy in MRM. The scanlon operation which preserves the nerve by dividing of pectoralis minor m. at its origin is a suitable operation for chest-wall muscle preservation. We hope that by the future study, we can confirm the best way of preventing chest-wall muscle atrophy in MRMs.

Chest Well Muscle Changes after A Mestectomy Findings of Chest CT / 한국유방암학회지

BACKGROUND: Chest CT after a mastectomy in breast cancer patients is usually performed to detect recurrence or metastasis. It is essential for surgeons an radiologists to know the appearance of the chest wall in a postmastectomy state. Especially, muscle atrophies of the chest wall, such as that of the pectoralis major muscle, indicate whether the modified radical mastectomy (MRM) was properly performed or not. MATERIALS AND METHODS: We performed a retrospective analysis of chest wall changes in mastectomy patients with follow-up chest CT finding to evaluate the results of MRMs. The medical records and CT findings of chest wall atrophy for a total of 38 patients who were treated at Kangnam St. Mary's Hospital, the Catholic University of Korea, were reviewed. The mean age was 58.3 years, and the interval between operation and follow-up CT was 6.6 years. The operations performed were a radical mastectomy (RM) in 3 patients and a MRM in 35 patients: Petey in 28 patients, Auchincloss in 6 patients, and Scanlon in 1 patient. RESULTS: In the RM, muscle atrophies were noted at the m, subscapularis in 3 patients (100%), the m. serratus anterior in 2 patients (66.7%), and the m. lattisimus dorsi in 1 patient (33.3%). In MRM, the Patey and Auchincloss operations showed m. pectoralis major atrophies in 22 patients (78.8%) and 5 patients (83.3%) respectively. Additionally m. pectoralis minor atrophy was noted in all 6 patients (100%) who underwent the Auchincloss operation. However. there was no muscle atrophy in patients who received Scanlon operation. CONCLUSIONS: These results suggest that lateral pectoral nerve injury is the main cause of m. pectoralis major atrophy in a MRM. The Scanlon operation which preserves the serve by dividing the pectoralis minor m. at its origin is a suitable operation for chest-wall muscle preservation. We hope that by the future study, we can confirm the best way of preventing chest-wall muscle atrophy in MRMs.