[Autologous fat transplantation into post-lymphadenectomy cavity for prevention of lymphorrhea after total mastectomy].

Abstract

Objective. to e: Valuate the effectiveness of autologous fat transplantation into post-lymphadenectomy cavity for prevention of lymphorrhea after total mastectomy with three-level lymphadenectomy in patients with breast cancer.

Material and methods: A single-center retrospective-prospective non-randomized study was devoted to prevention of post-mastectomy lymphorrhea using autologous axillary lipofilling in patients with breast cancer who underwent total mastectomy with three-level lymphadenectomy. The main group consisted of 78 patients who underwent autologous fat transplantation into post-lymphadenectomy cavity, the control group - 69 patients who underwent total mastectomy with subsequent vacuum drainage. We analyzed lymphorrhea, integration of adipose tissue using ultrasound and lymph drainage using hybrid method of radionuclide scintigraphy.

Results: Surgery time was similar in both groups. Postoperative hospital-stay was 5 [3; 6] and 7 [4; 14] days, respectively. Total volume of in-hospital lymph output through the drainage tube in the control group was 1330 [1020; 1750] ml. In the main group, the volume of lymph removed through puncture was 170 [115; 225] ml. The number of outpatient visits including lymphocele puncture was 14 [9; 23] and 15 [11; 23], respectively. After a year, density of integrated adipose tissue in shear wave elastography was less than 3.1 kPa. Radionuclide lymphoscintigraphy a year after lipofilling indicated functional normalization of lymphatic system with increased accumulation of 99mTc in regional lymph nodes, recovered kinetics of 99mTc from injection site and no accumulation of isotope in lymphocele. The last one persisted in the zone of autologous adipose tissue integration for the first 1.5-2 months.

Conclusion: Autologous fat transplantation into post-lymphadenectomy cavity in patients with breast cancer after total mastectomy with three-level lymphadenectomy is a simple and safe procedure. This method does not prolong surgery, reduces in-hospital lymphorrhea and simplifies outpatient puncture due to autologous fat tissue integration and restoration of collateral lymphatic drainage pathways.