CONTEXT AND OBJECTIVE: Modified radical mastectomy is widely utilized in breast cancer treatment. However, no prospective comparison has yet been made between the Madden technique (preservation of the pectoralis minor muscle) and the Patey technique (resection of this muscle). The aim of this work was to compare these two modified radical mastectomy techniques, by analyzing their degrees of difficulty and complications. DESIGN AND SETTING: Randomized trial at the Breast Unit of Hospital Araújo Jorge, Goiás; and Faculdade de Medicina da Universidade Federal de Goiás. METHODS: 430 patients with breast cancer with an indication for modified radical mastectomy were included in the program, of whom 426 patients were available for analysis (225 allocated to Patey and 201 to Madden). The chi-squared and Student t tests were used for analysis. RESULTS: The patients’ demographics were well balanced between the two groups. The mean duration of the surgical procedures was 105 (± 29.9) and 102 minutes (± 33), for the Patey and Madden groups, respectively (p = 0.6). Hospitalization duration was 2.3 days for both groups. The mean number of lymph nodes resected was 20.3 (± 7.6) for Patey and 19.8 (± 8.1) for Madden (p = 0.5). There were no differences in terms of vascular or nerve sections, hematomas or infections. The surgeons reported the same degree of difficulty for the two methods. CONCLUSION: The removal of the pectoralis minor muscle did not influence any of the variables studied. Therefore, either technique can be performed, at the surgeon’s discretion.

OBJECTIVE:This randomized clinical trial evaluated the possibility of not draining the axilla following axillary dissection.METHODS:The study included 240 breast cancer patients who underwent axillary dissection as part of conservative treatment. The patients were divided into two groups depending on whether or not they were subjected to axillary drainage. ClinicalTrials.gov: NCT01267552.RESULTS:The median volume of fluid aspirated was significantly lower in the axillary drainage group (0.00 ml; 0.00 – 270.00) compared to the no drain group (522.50 ml; 130.00 - 1148.75). The median number of aspirations performed during conservative breast cancer treatment was significantly lower in the drainage group (0.5; 0.0 - 4.0) compared to the no drain group (5.0; 3.0 - 7.0). The total volume of serous fluid produced (the volume of fluid obtained from drainage added to the volume of aspirated fluid) was similar in the two groups. Regarding complications, two cases (2.4%) of wound dehiscence occurred in the drainage group compared to 13 cases (13.5%) in the group in which drainage was not performed, with this difference being statistically significant. Rates of infection, necrosis and hematoma were similar in both groups.CONCLUSION:Safety rates were similar in both study groups; hence, axillary dissection can feasibly be performed without drainage. However, more needle aspirations could be required, and there could be more cases of wound dehiscence in patients who do not undergo auxiliary drainage.

A 60-year-old woman had a modified radical mastectomy (left breast). Histology showed a grade II infiltrating ductal carcinoma, measuring 6.5 cm, as well as 11 positive lymph nodes among the 26 removed. After surgical treatment she received eight cycles of chemotherapy (FAC: 5-fluorouracil, Adriamycin, and cyclophosphamide) followed by radiotherapy (5000 cGy) to the chest wall.After 14 months of follow-up, the patient had a new primary carcinoma in the contralateral breast. She then had a right modified radical mastectomy, followed by tamoxifen at 20 mg /day. Two years after the first operation, the patient presented with hyperemia and edema throughout the left upper limb with diffuse erythematous-bullous plaques ( Fig. 1), which appeared after the first left finger was injured, also affecting the anterior region of the thorax and abdomen (Fig. 2), and associated with fever and mild toxemia. The patient was admitted for clinical treatment and was administered antibiotic therapy, including cephalothin 0.8 g /day and amikacin 1 g /day. The patient responded well, and a total regression of the lesions was observed (Fig. 3).Erysipelas is a complication that occurs with some frequency after axillary clearance. It is usually acute and is caused by streptococci or, in the most severe cases, staphylococci or Pseudomonas. The case in question is worthy of note because of the unusual aggressiveness of the infectious agent, the extension of the cutaneous lesion, and the rapid onset of the condition. The differential diagnosis of a local recurrence associated with a secondary infection was also raised. In spite of the severity of the condition, the antimicrobial regimen elicited a good response and the patient regained normal function of the affected limb within a few weeks. Figure 1. Left forearm with hyperemia, edema, and diffuse erythematous-bullous plaques.