Ratio of volumes is calculated according to the formula
V fragm.
Vmam.
 100%,
где Vfragm. – volume of resected fragment of mammary gland,
Vmam. – volume of mammary gland.
Operations used in oncology at the breast cancer can be divided into several
types depending on the volume of resected tissues:
1) Halsted's mastectomy (HM) – mammary gland, greater pectoral muscle or
its fragment, regional cellular tissue with axillary, subclavicular and
subscapular lymph nodes are included in volume of resected tissues like a
single block. 100 % of volume of mammary gland tissue and
supplementary tissues of chest wall are resected.
2) Madden’s mastectomy (MM) – all the mammary gland with skin and
fascia of greater pectoral muscle and also regional cellular tissue with
lymph nodes are resected. 100 % of volume of mammary gland tissue are
resected.
3) Subcutaneous mastectomy (SCM) (also: skin-preserving mastectomy,
derma-preserving mastectomy) – all tissue of mammary gland with a
fragment of skin above the tumor and postoperative cicatrice after
diagnostic manipulations, после диагностических манипуляций (если
они проводились) and regional cellular tissue with lymph nodes are
resected. The greater part of skin is reserved. 90 % of volume of mammary
gland tissue are resected.
4) Subtotal resection (STR) – resection of 70–90 % of gland tissue with
fascia of pectoral muscles, cellular tissue with axillary, subclavicular and
subscapular and intermuscular lymph nodes like a single block.
5) Hemimastectomy (HMM) (also: biquadrantectomy) – resection of a half of
mammary gland tissue (50 %) and regional cellular tissue with lymph
nodes. Part of skin of mammary gland is reserved.
6) Quadrantectomy (QE) – quadrant or approximately quarter of mammary
gland tissue (25–30 %) with fascia of greater pectoral muscle, cellular
tissue with lymph nodes is resected.
7) Radical resection (RR) – sector of mammary gland (20 %) en bloc with
axillary, subclavicular and subscapular lymph nodes is resected.
N
Method of operative treatment of BC
Volume of resected tissues (%)
1.
Halsted's mastectomy
100 + chest wall tissues
2.
Madden’s mastectomy
100
3.
Subcutaneous mastectomy
90
4.
Subtotal resection
70–90
5.
Hemimastectomy
50
6.
Quadrantectomy
25–30
7.
Radical resection
20
As the foregoing list of operations shows, subtotal and total resection of
mammary gland tissue is realized at the resection of more than 70 % of gland
value. Organ-preserving operations on mammary gland are possible at the
resection of no more than 30 % of its value.
Therefore these two values – 30 % and 70 % – are taken as the liminal ones
for detection of volume of operative intervention at the breast cancer.
Thus, if the tumors of equal volume appears in mammary glands of different
volume (fig. 1) or the tumors of different volume appears in mammary glands of
equal volume (fig. 2), then ration of resected volume of tissues and volume of
mammary gland in every case will be different. This ration defines choose of type
of oncologic operation.
Fig. 1. Tumors of equal volume in mammary glands of different volumes.
Fig. 2. Tumors of different volumes in mammary glands of equal volumes.
Criteria of choose of type of operation depending on the ratio of resected
volume of tissues and volume of mammary gland were developed.
At the ration of resected volume of tissues and volume of mammary gland
less than 30 % radical resection or quadrantectomy are realized.
At the ration of resected volume of tissues and volume of mammary gland
more than 70 % subtotal resection, subcutaneous mastectomy, Madden’s
mastectomy and Halsted's mastectomy are realized.
At the ration of resected volume of tissues and volume of mammary gland
between 30 and 70 % hemimastectomy (biquadrantectomy) is realized.
All the premises can be presented in the form of algorithm:
Planned volume of resection of mammary gland
Less than 30 %
RR
QE
More than 70 %
From 31 % to 69 %
HMM
STR
SCM
ME