Early Postoperative Complications following Mastectomy with Level I and II Axillary Dissection

Abstract

Introduction: Breast cancer is the most common cancer in women. The modern approach to breast cancer management is multi-disciplinary. The different surgical treatment options include simple mastectomy, modified radical mastectomy and breast-conserving surgery. Modified radical mastectomy or wide local excision with axillary dissection are standard treatment options for most patients with breast cancer. For this study, early postoperative complicationsare considered as most commonly occurring within one month following the operation.Aim of the study:The aim of the study was to assess the early postoperative complications following mastectomy with Level I & II axillary dissections. Methodology: The study was a prospective observational study conducted at the Department of Surgery, Bangladesh Medical College and Hospital, Dhanmondi, Dhaka. The study period was from July 2019 to December 2019 and the study population consisted of 40 patients admitted for a routine mastectomy with level I & II axillary dissections. The collected data were analyzed using SPSS software, Version-23.0 Descriptive inferential statistical analysis was performed to obtain the results of this study.Results: The mean age of the patients in this study was 46.8 years with a standard deviation of ± 13.8 years. The age range is from 26 to 75 years. All patients presented with a breastlump, followed by six (15.0%) patients who complained of pain, two (5.0%) had a history of lumpectomy, two (5.0%) had nipple retraction, and one

(2.5%) had skin puckering over the lump respectively. Twenty-eight (70%) patients had stage II breast cancer, while twelve (30%) patients presented with stage III. According to the histopathological diagnosis, thirty-two (80%) patients had invasive ductal cell carcinoma, four (10%) had invasive lobular carcinoma, three (7.5%) had medullary carcinoma, and one (2.5%) had papillary carcinoma. Regarding complications, thirteen (32.5%) patients experienced altered sensation over the medial upper arm, eleven (27.5%) patients developed minimal seroma formation, four (10%) patients had wound infection, two (5%) patients had skin flap necrosis, two (5%) sustained an injury to the nerve to Serratus Anterior and one patient (2.5%) developed a hematoma.Conclusion: In conclusion paresthesia, seroma formation, hematoma, wound infection, skin flap necrosis and injury to the nerve to Serratus Anterior were early complications after mastectomy with axillary dissection. Paresthesia over the medial arm was the most frequent complication observed at one month. Adequate surgical skills and proper pre-operative planning and assessment play an important role in attaining a better outcome for the patient and surgeon.