J.Jpn. Surg. Soc.. 79(8): 751-756, 1978

---

Report on the annual meeting

INDICATION OF THE MODIFIED RADICAL MASTECTOMY

As regards with seven years survival rate and recurrent rate, there were no significant difference between the two mastectomies, (modified radical mastectomy and radical mastectomy) 82%: 78% in the stage I, and 69%: 75% in the stage II, as well as in the T1nla and T2nlb. We found metastases in the Rotter's interpectoral lymph node (2.8%), in the lymph node above the axillary vein (1%) which we do not usually dissect in the modified radical mastectomy. We also found eight cases (7%) with parasternal metastases in 115 patients without axillary metastasis by microscopic examination and 18 patients (3.2%) with invasion to the pectoral muscles, which were classified into four types, 1) direct invasion type, 2) infiltrating type in the septa of the pectoral muscle, 3) invasion into the lymphatics in the pectoral muscle, 4) invasion into the lymphatics in the sheath of the nerve. These findings were observed even in the cases of the stage II, or pathologically axillary aegative patients.
Accordingly, we must choose strictly indication of the modified radical mastectomy as follows.
1) Circumscribed type of the cancer which is measuring less than 2cm in diameter,
2) Delimited cancer sized less than 1 cm which is locating in the inner half sector of the breast.
We exclude a tumor situated in the inframammary fold, because such tumor easily infiltrates into the fatty tissue surrounding breast tissue, and we find high frequency of the parasternal metastases in spite of the small tumor.
We recommend a new reconstractive surgery after radical mastectomy for patients with breast cancer in the stage II, with anasomosis of the vessels in the free groin flap to the thoracoacromial vessels using microsurgical technique.
A merit of this technique is in feasibility of the complete axillary dissection under a wide view and prevent from the tight feeling and restriction of the movement of the arm due to an adhesion of the skin to the chest wall directly.
Further, we could plasysty breast, if young patient want it.
In conclusion, we consider it is reasonable to do modified radical mastectomy for patient in the stage I, and radical mastectomy with reconstructive surgery for patient in the stage II, in view of the seven years survival rate, local recurrence of the breast cancer, invasion to the pectoral muscle and parasternal metastasis.

---

---

To read the PDF file you will need Adobe Reader installed on your computer.