FEATURES OF RADICAL MASTECTOMY FOR BREAST CANCER IN OBESE PATIENTS
Breast cancer is registered annually in more than 1,300,000 women worldwide and over 55,000 women in the Russian Federation and is important for clinicians due to high mortality and increasing morbidity. Obesity is a recurrent polyetiological disease, the main pathophysiological mechanism of which is a violation of insulin resistance. In 1974, obesity was observed in 20% of men, 30% of women; in 1990, 63% of women aged 55-65 years were overweight. In obese patients, breast cancer flows noticeably more aggressively, tumors of large sizes, axillary lymph nodes are more often affected. Radical mastectomy remains a commonly used operation in both obese and non-obese patients. Despite screening and detection of breast cancer in the early stages, the number of organ-preserving operations does not exceed 40%. After radical mastectomy in obese patients, the postoperative period is often complicated by prolonged lymphorrhea, the formation of an axillary fossa lymphocele, as well as the formation of lateral «dog ears». Stages of obesity: I (body mass index 30 34.9 kg/m2) 8 (20.5%), II (body mass index 35 39.9 kg/m2) 13 (33.3%), III (body mass index ≥40 kg/m2) 18 (46.1%). All patients had hypertension, 15 had metabolic syndrome, 5 had coronary heart disease, 3 had bronchial asthma, 3 had cholelithiasis, and 2 had postthrombotic cardiopathy. In all patients, the mammary glands are hypertrophied with stage 3 ptosis according to Regnald. According to our study, the frequency of lateral «dog ears» reaches up to 74% after radical mastectomy in obese patients. Standard incisions used in radical mastectomy do not give the proper effect for the prevention of lateral «dog ears». New approaches are needed.