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1. A CURIOUS CASE OF CHYLOUS LEAK POST LEFT MODIFIED RADICAL MASTECTOMY PRESENTOR:DR. C.V.ARUNESHWAR , Junior resident GUIDE: Prof. Dr. S. P. GAYATHRE M. S. D. G. O. Department of Ge neral surgery, Government Stanley medical college, Chennai. Unique reference number – P.1.M.A.G-12

2. CASE REPORT: 52/F- postmenopausal, Lump in left breast x 1 year. No h/o pain nipple retraction, nipple discharge.Newly diagnosed T2DM/HTN on Rx. No family h/o cancer On Examination Left breast : 2 x 2 cm lump in the upper inner quadrant, firm , mobile, moving with breast tissue.Not fixed to chest wall, no skin fixity. Bilateral axillae free. Other system examination- normal INTRODUCTION: Post axillary dissection chylous leak is very rare with an incidence of 0.36to 0.84 percent . Approximately 75% to 92% of cases of chylous leakage after breast surgery occur in the left breast. A large amount of fluid can be lost with chylous leakage after breast cancer surgery, and patients are prone to complications, such as dehydration, electrolyte disturbances, and nutritional disorders USG BREAST WITH AXILLA : Left Breast :Irregular hypoechoic lesion with spiculated measuring 14 x 15 mm, 3 mm from the skin surface, 4 cm from the nipple, noted in the 10’o’ clock with posterior shadowing. NAC – Normal. Left axilla – Subcentimetric lymph nodes with preserved fatty hilum HPE : Invasive ductal carcinoma NST Grade 2 ER +, PR +, Her2Neu Negative, Ki67 – 40 to 50 %

3. PROCEDURE DONE: Patient taken up for Left modified radical mastectomy. Intraoperatively - Lump 3 x 3 cm, left upper inner quadrant. No intraoperative complications. Pectoral and axillary DT were placed.

4. DISCUSSION : Chyle is a milky liquid consisting of emulsified fat and lymph
The thoracis duct opens into the left brachiocephalic vein
Follows Left modified radical mastectomy > right
Post axillary dissection chylous leak - 0.36 to 0.84% - very rare.
Usually occurs after 48 hrs during POD #3
Diagnosis of chyle leak is clinical. If DT Fluid lipid profile reveals
TG - >110 mg/dl
Cho - < 200 mg/dl - suggestive of chylous leak. MANAGEMENT :
Low fat diet with medium chain triglcerides . If non resposive – 10 days – Fat free diet.
Compression dressing
Drain care Inj Ocreotide Inj Meglumine diatrizoate causes local dehydration and decreases drain output
If conservative management Fails or if the leak is high output > 2 weeks – Sclerotherapy , Surgery is carried out.

5. CONCLUSION : Although chyle leakage is a rare phenomenon, surgeons should be cautious while performing axillary lymph node dissection, especially on the left side. Most chyle leaks after mastectomy are manageable using conservative treatment for at least 3 to 4 weeks. This may require keeping the drainage tube in place for a longer period, in which case the risk of infection must be considered. Surgical treatment should be considered if conservative management fails or to avoid a delay in further treatments .