Breast surgery

Variations in sensitivity after sectioning the intercostobrachial nerve

The authors present a prospective study of the variations in sensitivity that appear in the armpit and arm after the intercostobrachial nerve has been sectioned in a modified radical mastectomy. Of a total of 208 patients studied between 1978 and 1987, the intercostobrachial nerve was sectioned in 139 patients, whereas in 30 it remained intact; in 39 patients only peripheral branches of the nerve were sectioned. The patients were examined at regular postoperative intervals in order to evaluate their sensitivity both to touch and to pain in the axilla and arm. Four hundred thirty-three examinations were carried out and the 3 operative groups were assessed accordingly. After the nerve was sectioned, there was increasing anesthesia in the armpit and hypoesthesia on the posterointernal face of the arm, while for the patients in whom the intercostobrachial nerve remained intact, these alterations were less intense and long-lasting. Significant statistical differences between the two groups also exist. In the absence of axillary lymphatic ganglia infiltrated by the tumor, the conservation of the intercostobrachial nerve is recommended.

The significance of cancer cells contaminating postoperative seroma

Sixth postoperative day seromae of 142 breast cancer patients were searched for the presence of malignant cells. They were found in 32 patients. These patients showed significant propensity of developing distant metastases or having an unfavourable outcome of their disease although the size of their tumours was smaller than in women whose postoperative seromae were malignant-cell free. At the same time TNM tumour staging and axillary lymph node analyses failed to prove any difference between these two groups of breast cancer patients. Finally, the analyses of the state of patients' menstrual cycles showed that cycling women whose postoperative seroma contained malignant cells are at high risk of developing metastases or dying.