Modern approaches to the prevention of secondary post-mastectomy edema in locally advanced breast cancer
The search for a solution to the problem of the development of postmastectomy edema is not carried out by trying to restore the anatomical and physiological structures of the lymphatic system, which was disturbed during the total axillary-subscapular-subclavian lymphadenectomy, but by eliminating the substrate for the development of post-traumatic and post-radiation fibrosis, which causes compression of the subclavian vein and subsequently aggravates the lymphatic impairment blood circulation. The method we developed is characterized by the fact that during a mastectomy in this patient population, the stage of removal of regional lymph nodes of the axillary fossa is carried out retrograde, by removing the clavicular part of the pectoralis major muscle and sternoclavicular fascia, which eliminates the possibility of subsequent postradiation tissue fibrosis and, as a result, compression of the subclavian vein.