Comparison of Scar Modified Radical Mastectomy Surgery Using Songket Technique and Standard Technique at Mohammad Hoesin Hospital in Palembang

Introduction. Lateral ear dogs and loss of anterior axillary fold are side effects of modified radical mastectomy (MRM) operations and are cosmetically unpleasant. Songket technique is expected to reduce the side effects of MRM surgery. This study compared the Modified Radical Mastectomy surgery scar using Songket and standard techniques. Methods. This research is a clinical randomized trial. With anterior chest thoracic data of postoperative patients and assessed by the patient's family and medical professionals using a likert scale on wound length, wound width, wound angle and armpit folding. This study was performed in the Department of Surgery Mohammad Hoesin Hospital Palembang from January 2020 to April 2020. Result. A total of 32 research subjects participated with the average Likert scale score on medical and family assessments between the Songket and standard technique groups with p values of 0.605 and 0.984, respectively. Conclusion. There was no difference in comparison of scar Modified Radical Mastectomy operations using Songket techniques and standard techniques at Mohammad Hoesin Hospital in


Introduction
Breast cancer is the most common cancer in women worldwide, with an estimated 1.67 million new cases in 2012. 1 Modified Radical Mastectomy (MRM) is the most commonly performed surgery for breast cancer. However, if the MRM incision is not well planned, it can cause lateral ear dogs and loss of the anterior axillary fold. 2,3 This is not only cosmetically unpleasant but also causes discomfort in the patient and impedes the range of motion of the arm.
The formation of lateral ear dogs after MRM is commonly conducted in obese patients. While the loss of anterior axillary fold almost always occurs due to axilla KGB dissection Lateral ear dog post-MRM and loss of anterior axillary fold are not only a cosmetic failure but also a source of discomfort in patients. The actual number of incidents is unclear but is a problem most often complained of in post-mastectomy patients. [4][5][6] The standard operating technique used at Mohammad Hoesin Hospital is using a Stewart incision design with an axis on the thorax midlevel and a semi-elliptical form of excision.
Furthermore, the design of this incision has the advantage of being easy to do but has the disadvantage of difficult axilla access, surgical scars, and loss of axillary fold and results in persistent folds of skin at the lateral end of the scar, giving the shape of ear dogs and disruption to the movement of the hands in the injured area. 7

Method
This study was used clinical randomized trial design. By collecting data that is an anterior chest thoracic postoperative patient. The patient's family, patients and medical professionals will assess all photos using a Likert Scale. The study population was breast cancer patients who performed modified radical mastectomy (MRM) at Muhammad Hosein Hospital in Palembang.
The sample was breast cancer patients who performed MRM at Palembang Hosein Hospital that met the inclusion criteria. In this study, the sample size was determined through a statistical approach. The independent variable was assessed as a photograph of a wound from a Modified Radical Mastectomy surgery. The dependent variable is the assessment of medical professionals using Likert scoring.
Inclusion criteria are patients with a diagnosis of breast cancer. Breast cancer is managed by MRM surgery. Willing to participate in research and sign informed consent. Exclusion criteria were that after MRM, the wound could not be closed or treated openly.
The study was conducted in the Department of Surgery of RSMH Palembang. The research starts by proposing until it finished in January 2020 to April 2020. Sampling was done by consecutive sampling according to the inclusion and exclusion criteria. The sample will then be grouped into two groups, namely the MRM Songket technique group and the standard MRM technique at Muhammad Hosein Hospital Palembang. Sample characteristics are presented in tabular form and narration. Data will be analyzed with SPSS, and significance was determined based on p <0.05.

Results
This research was conducted in the surgical division of the plastic surgery and reconstruction and oncology surgery department of Palembang RSMH with a sample of breast cancer patients who performed MRM at Palembang RSMH that met the inclusion and exclusion criteria from January 2020 to April 2020. A total of 32 research subjects met the criteria inclusion and exclusion. Characteristics of patients can be seen in Table 1.

Discussion
The use of drainage has become a common surgical practice to eliminate the space created The duration of treatment in patients with Modified Radical Mastectomy is determined by several factors, one of which is seroma. Seroma is the most common problem after mastectomy, and most surgeons see it as necessary rather than dangerous complications because it can usually be resolved within a few weeks. However, the excessive fluid buildup will stretch the skin and cause it to become loose, resulting in patient discomfort and extended hospital stays. Research conducted by Guneri found that there was no difference in length of treatment between groups with Modified Radical Mastectomy using a single drain and using a double drain with a value of p = 0.819. 13,14,15 The surgical approach to breast cancer has changed dramatically in the last 20 years. The goal of breast cancer surgery is to remove the tumour, ensure negative margins and excellent cosmetic results, and protect the breast if possible. Breast magnetic resonance imaging has become a vital imaging tool before surgery, diagnosing additional tumours and assessing tumour area.
Tumour to breast volume ratio is an essential predictor of breast conservation and can be measured by MRI and can change medical decisions. The ratio of tumour volume to breast correlates with the type of surgery. As measured on MRI, this ratio is an accurate way to determine the type of surgery that is most suitable for individual patients. It is recommended that the ratio of tumour volume to the breast determined by MRI become part of the surgical planning protocol for patients diagnosed with breast cancer. 16,17,18 It is known that there are differences in mean length of injury in the study subjects between groups with a value of p = 0.