[A choice of reconstructive plastic surgery with endoprosthesis of the breast after radical mastectomy]. / Vybor rekonstruktivno-plasticheskoi operatsii s éndoprotezirovaniem molochnoi zhelezy posle radikalnoi mastéktomii.

The creation of silicone endoprosthesis led to new approaches in solving the problems of plastic replacement of the breast after radical mastectomy. Two variants of reconstructive plastic operations with endoprosthetics of the breast were employed: group one--the formation of the seat of the endoprosthesis using a transposed musculocutaneous flap from the latissimus dorsi muscle; group two--the formation of the seat of the endoprosthesis by stretching the skin with a specially designed stretcher-expander and subsequent implantation of the endoprosthesis. The first method is rather injurious, sometimes cannot be performed because of anatomical contraindications, and is fraught with the development of necroses in the transposed tissues. Among 34 patients operated on by the first method two had marginal necrosis of the skin above the endoprosthesis. No complications were recorded among the 46 patients who underwent operation by the second method. The condition of the endoprosthesis and the tissues surrounding it was appraised in the immediate and late periods by radiological and ultrasonic examination. The variants of endoprosthetics of the breast which we applied may be employed with competence in clinical practice, but a reconstructive-plastic operation with the use of a skin expander is preferable.

[Radical mastectomy technics]. / Tekhnika radikal'noi mastéktomii.

The authors elaborated a new approach to radical mastectomy which, combined with nonoperative measures makes it possible to prevent the development of postmastectomy-induced edema by means of a lympho-venous anastomosis (LVA). The choice of the level of LVA formation and their number is substantiated. With due regard for the conditions named, the cubital fossa and the lower third of the upper arm on the anterointernal surface is the most rational zone. To accelerate lymph drainage through the collaterals and reduce lymph loss, goal-oriented ligation of the lymph vessels which are divided during mastectomy is additionally carried out; this is successfully done when they have been stained. As a result, wound lymphorrhea ceases practically at days 4 to 5.

[Lymphovenous anastomoses in the prevention of post-mastectomy edema of the arm]. / Limfovenoznye anastomozy dlia profilaktiki postmastéktomi- cheskogo oteka verkhnei konechnosti.

Analysis of the clinical and experimental data has prompted the authors to try surgical correction of an impaired lymph drainage in the arm after radical mastectomy by effecting lymphovenous anastomoses. These anastomoses are intended to eliminate lymphostasis, the principal reason of a postmastectomy edema, by draining the lymph, outflowing from the arm, to the vein. The optimal sites for the formation of a lymphovenous anastomosis have been found the cubital fossa and the anterointernal surface of the lower third of the shoulder. The formation of such an anastomosis simultaneously with radical mastectomy eliminates operation lymphorrhea of the wound already by days 4-5 postoperation, this facilitating the wound healing. Such an approach to radical mastectomy technique may completely prevent the development and progress of a postmastectomy edema of the arm.