Chest Wall Muscle Changes after a Mastectomy: Findings of Chest CT

Park, Woo Chan; Kim, Jin Ho; Kim, Hak Hee; Seo, Young Jin; Choi, Seung Hye; Cho, Won Il; Kim, Chung Soo; Oh, Se Chung; Jung, Sang Seol; Chun, Chung Soo; Lee, Jai Hak; Kim, In Chul

Abstract

BACKGROUND: Chest CT after a mastectomy in breast cancer patients is usually performed to detect recurrence or metastasis. It is essential for surgeons and radiologists to know the appearance of the chest wall in a postmastectomy state. Especially, muscle atrophies of the chest wall, such as that of the pectoralis major muscle, indicate whether modified radical mastectomy (MRM) was properly performed or not.
METHODS
We performed a retrospective analysis of chest wall changes in mastectomy patients with follow-up chest CT findings to evaluate the results of MRMs. The medical records and CT findings of chest wall atrophy for a total 38 patients who were treated at Kangnam St. Mary's Hospital, the Catholic University of Korea, were reviewed. The mean age was 58.3 yeras, and the interval between operation and follow-up CT was 6.6 years. The operations performed were a radical mastectomy (RM) in 3 patients and a MRM in 35 patients: Patey in 28 patients, Auchincloss in 6 patients, and Scanlon in 1 patient.
RESULTS
In the RM, muslce atrophies were noted at the m. subscapularis in 3 patients (100 %), the m. serratus anterior in 2 patients (66.7%) and the m. lattisimus dorsi in 1 patient (33.3%). In MRM, the Patey and Auchincloss operations showed m. pectoralis major atrophies in 22 patients (78.8%) and 5 patients (83.3%) respectively. Additionally m. pectoralis minor atrophy was noted in all 6 patients (100%) who underwent the Auchincloss operation. However, there was no muscle atrophy in patients who received scanlon operation.
CONCLUSIONS
These results suggests that lateral pectoral nerve injury is the main cause of m. pectoralis major atrophy in MRM. The scanlon operation which preserves the nerve by dividing of pectoralis minor m. at its origin is a suitable operation for chest-wall muscle preservation. We hope that by the future study, we can confirm the best way of preventing chest-wall muscle atrophy in MRMs.