radical mastectomy. Complications after mastectomy Breast mastectomy

This variant of radical intervention is possible at any stage of the disease, except for a metastatic or initially inoperable infiltrative-edematous process that extends beyond the gland into the chest wall tissue. As a rule, for all resectable tumors, RME is performed at the first stage of treatment.

Dr. Shapovalov D.A. performed a radical resection of the left breast with reconstructive plastic elements for cancer of the left breast T1N1M0, stage IIA. Removed regional lymph nodes I-III levels according to Berg. Photo on the left - dressing the next day after the operation; right - view after 25 days:

A year ago, RME was performed on the right with preservation of the pectoral muscles for cancer of the right breast T3N1M0. The next photo is the second stage of reconstruction (replacement of the expander on the right with an endoprosthesis and reduction mammoplasty on the left). The photo on the left is before the operation; on the right — one week after the operation (the sutures were removed). Further, in this patient, it is planned to perform the formation of the nipple on the right with a tattoo of the areola.

In the case of the primary spread of the tumor outside the gland, the so-called infiltrative-edematous form of the tumor, chemotherapy is performed at the first stage, and after the reduction of the carcinomatous lesion, a radical operation is performed with the complete removal of the gland and axillary lymph nodes.

The difference between mastectomy and radical resection

Mastectomy is performed at any stage of cancer and any size of the cancer node, in contrast to radical resection - removal of part of the gland with a small tumor.

With a small breast, resection is problematic already at a node size of 3 cm, since it is necessary to retreat a few centimeters from the primary focus in all directions in order to minimize the possibility of recurrence.

The immediate aesthetic result after resection is undoubtedly better than after RME, but the subsequent obligatory irradiation thickens the tissues, with the passage of time the scarring process is aggravated, which significantly changes the shape of the breast and its size. Subsequently, the deformation will require the use of special pads in the bra; it is extremely problematic to smooth out the lack of tissues in other ways.

Feedback from our patients

The patient Lyubov Vasilievna was admitted to the clinic in a critical condition. The underlying disease (stage 4 breast cancer) was accompanied by bone metastases. The patient was unable to move independently. Lyubov Vasilievna notes the high professionalism of the attending physician, Petr Sergeevich Sergeev. She talks about how, first of all, she was given hope for a fulfilling life. "This is the first time I've been to a doctor...

“Special thanks to our doctor, Akhov Andemir Olegovich, firstly, for the treatment. Secondly, for being attentive to patients and their relatives, who ask many different questions. He answers them in great detail. We really enjoyed. Therefore, many thanks to all the staff of your clinic.” The patient was admitted a week ago. She was fully examined within three days. Diagnosis,...

Tamara Petrovna went to the clinic for stage 4 breast cancer with metastatic foci in other organs. Surgical treatment was not indicated for the patient. To reduce the volume of the tumor, the doctors of the clinic prescribed radical chemotherapy. From March to September Tamara Petrovna underwent 16 courses of chemotherapy. According to subjective sensations, the patient notes a significant decrease in the volume of the tumor. An MRI study should show what dynamics ...

Cancer is always a very scary diagnosis, both for the patient and for his relatives. Especially when the disease is detected at stage 4 and most medical institutions refuse treatment. Our patient found herself in such a situation: “The children brought me here in a very terrible condition. I have stage 4 breast cancer with metastases<...>Right now I feel great: I'm going through chemotherapy...

A patient with suspected breast cancer turned to the head of the surgical department of the clinic "Medicine 24/7", oncogynecologist Dmitry Alekseevich Shapovalov, Ph.D. After a comprehensive examination, the doctor confirmed the diagnosis and prescribed surgical treatment. “When my mother found out that she had a very, very serious and terrible illness, our local doctor from Dmitrov advised us to consult with another oncologist. Through acquaintances, we found Shapovalov ...

Clinical case Patient: V., 46 years old Diagnosis: lobular breast cancer. Combined treatment 2007. Progression 2017. Anamnesis: 2007 combined treatment of stage I breast cancer. 10 years of observation. The appearance of ascites (fluid in the abdomen), shortness of breath. Diagnostic laparoscopy. Discrepancy in diagnoses based on cytological and histological examination (3 different diagnoses). Denial of treatment. Symptomatic therapy locally...

Iraida Alekseevna was admitted to the clinic "Medicina 24/7" with severe pain and difficulty in mobility due to metastases in the pelvic bones against the background of stage 4 breast cancer. The main metastasis of breast cancer squeezed large nerve trunks in the region of the spine, causing pain syndrome that could not be controlled conservatively, and also led to impaired function of the corresponding nerves....

Is radiotherapy given after surgery?

Clinical studies have demonstrated equal life expectancy of patients after mastectomy and radical resection, but the recurrence rate in the remaining breast tissue after resection is much higher, therefore, in all 100% of cases, resection is necessarily supplemented with postoperative radiation therapy.

Complete removal of a breast with a tumor up to 7 cm does not require postoperative radiation. The question of additional radiation therapy is raised only for initially inoperable cancer, when preoperative chemotherapy reduced the size of the neoplasm to operable.

Content

Breast cancer is a terrible pathology that is widespread in the modern world. Advances in medicine with such a diagnosis help save patients' lives. Mastectomy is a surgical way to solve the problem. What are the indications for operations, what is the difference between the methods used, how does postoperative recovery occur - information that is useful for women of any age.

What is a mastectomy

A tumor found in the breast becomes a physiological and psychological female problem. To resolve it, a mastectomy is used - an operation to remove the mammary gland, which has options for performing. Surgeons, trying to save a woman's breasts, choose the least traumatic method in all respects. Tasks of doctors:

• eliminate a dangerous disease;
• create conditions for the subsequent restoration of the breast;
• improve women's quality of life.

During surgery, depending on the type of technique, the removal of the mammary gland, large, small pectoral muscles, fatty tissue containing lymph nodes is performed. A cancerous tumor is dangerous because of the rapid growth of metastases. Surgical intervention has features that depend on the stage of development of the pathology, the age of the woman. Indications for breast removal are:

• the risk of oncology is more than 51%;
• sarcoma;
• purulent inflammation;
• genetic predisposition to cancer;
• gynecomastia.

There are restrictions for the removal of the mammary glands. Contraindications for performance:

• violation of cerebral circulation;
• hepatic, renal failure;
• decompensated diabetes mellitus;
• swelling in the gland, passing to the chest;
• severe form of cardiovascular insufficiency;
• multiple metastases in the lymph nodes with swelling of the hands;
• germination of the tumor in the tissue of the chest.

Types of mastectomy

The earlier a woman is diagnosed with breast cancer, the less traumatic the surgery will be. The subsequent measures for breast reconstruction also depend on this. Several techniques have been developed for mastectomy. In addition to the removal of the mammary gland, they mean:

The most minimally invasive method with the possibility of subsequent breast reconstruction is subcutaneous mastectomy. The affected glandular tissue is scraped out through a small incision. Modified types of radical intervention are used together with the removal of the mammary gland:

Indications

Before performing a mastectomy, doctors assess the condition of the woman, the degree of tumor development, and the structure of the cancer. This is taken into account when choosing a method of surgical intervention. Each has its own indications:

Oncologists choose a modification of mastectomy in accordance with the indications for carrying out, the degree of severity of the process:

The choice of the method of surgical intervention is a crucial moment for surgical oncologists. The need for chemotherapy is determined by the doctor. Common types of mastectomy:

A tumor in the last stage with metastases is treated with a surgical operation performed according to the following methods:

Preparing for the operation

Before proceeding with the mastectomy, the doctor conducts an initial examination of the woman, collects an anamnesis. An examination is scheduled, and the method of the operation is selected based on the results. Preoperative measures include:

• general, biochemical blood test;
• mammography of the breast;
• urine test;
• tissue biopsy;
• computed tomography;
• blood clotting test;
• research on tumor markers;
• prescribing a light diet;
• limiting the intake of drugs that promote blood thinning;
• prohibition on the operational day of drinking, eating.

Operation

When choosing a surgical intervention scheme, it is taken into account that it is carried out according to the plan - the removal of one mammary gland (unilateral mastectomy) - or both are removed. The operation is performed under general anesthesia. The duration is from one to three hours, depending on:

• the patient's condition;
• stages of cancer;
• tumor localization;
• the presence of metastases.

There is a general algorithm of actions when performing the removal of the mammary glands in women:

• anesthesia is performed;
• rifling is marked with a special marker;
• skin incision is performed;
• subcutaneous tissue, mammary gland is separated from it;
• tissue is removed, including, if necessary, lymph nodes;
• in accordance with the method of operation, excision of fatty tissue, pectoral muscles is carried out;
• traced vascular links, nerve endings;
• a drain is installed for the outflow of fluid;
• stitches are applied, which are removed after 12 days.

According to Halstead

This type of mastectomy is considered a classic option, used for stage 1-3 cancer. The method bears the names of the doctors who developed it - Halsted-Meyer. For the patient, this is the most traumatic method of intervention, which is used in case of extensive metastasis of the lymph nodes, chest muscles. During the operation, simultaneously remove:

• mammary gland;
• small, large pectoral muscles;
• subcutaneous fatty tissue - subscapular, axillary, subclavian;
• lymph nodes;
• nipple;
• skin.

The Holder-Meyer mastectomy is used when other methods are powerless. Contraindications for surgery must be taken into account. The technique causes a serious complication - limited mobility of the shoulder joint due to muscle removal and nerve damage. As a result of the elimination of a large number of tissues, problems arise during the plastic reconstruction of the breast:

• restoration of the symmetry of the glands;
• correction of volume, shape;
• reconstruction of the nipple-areolar complex.

Radical mastectomy according to Madden

The type of surgery developed by Madden is considered more gentle and less traumatic. Mastectomy is used to treat women with nodular cancer. During the event:

• the mammary gland, axillary, subscapular, subclavian lymph nodes with subcutaneous tissue are removed;
• all muscle groups are preserved;
• there is no heavy bleeding;
• vascular and nerve endings are preserved.

As a result of the Madden mastectomy behavior due to the reduction in the volume of surgical intervention, the reduction in trauma, complications rarely occur. After operation:

• there is a rapid healing of wounds;
• the mobility of the shoulder joint is not disturbed or restoration is carried out with the help of special gymnastics, massage;
• successful plastic reconstruction of the mammary glands;
• there is a possibility of recovery in a short time.

Amputation of the breast

When choosing a method for performing an operation, oncologists take into account the stage of the disease, the degree of cancer activity, the rate of tumor growth, and the hormonal state of the female body. Amputation of the breast is a simple mastectomy. It does not apply to radical interventions. It is supposed to remove the mammary gland and fascia of the pectoralis major muscle, nipple and areola. Indications for carrying out are:

• cancerous tumor stage 4;
• decaying malignant neoplasms;
• pathology of 2-3 degrees when it is impossible to perform a radical surgical intervention.

This type of surgery is used for preventive purposes in the presence of a genetic predisposition to the development of breast cancer. Indications are the large size of the neoplasm. Features of surgical intervention:

• a biopsy of nearby lymph nodes is mandatory;
• with a cancerous tumor size of up to two centimeters, the areola and nipple are not removed;
• followed by radiation and chemotherapy.

By Pati

During the operation according to the method of this doctor, the pectoralis major muscle is not removed. The Pati method contributes to the preservation of the functions and cosmetic appearance of the remaining tissues. During surgery:

• the mammary gland, fascia of the pectoralis major muscle is removed;
• the small one is excised, providing access to the axillary lymph nodes;
• they are removed;
• subcutaneous tissue is cut out, the skin around the malignant neoplasm;
• drainage is installed;
• stitches are applied.

Patey's technique - a modified radical mastectomy - is considered to be less traumatic, and is widely used in oncology. After the operation, there is a minimum number of complications. The disadvantages include:

• the appearance of scars in the subclavian vein;
• difficulties in breast formation with artificial implants;
• a slight but quickly recoverable limitation of the mobility of the shoulder joint.

Postoperative period

In order for a woman to quickly restore her shape after the operation, it is necessary to carry out rehabilitation measures prescribed by the doctor. This will help relieve pain syndromes, increase the mobility of the shoulder joint, restore lymph flow, and eliminate complications. In the postoperative period it is necessary:

• refuse to visit the solarium, baths;
• avoid lifting weights;
• use an elastic bandage;
• wear special soft clothes;
• drink more fluids;
• avoid injury;
• get regular check-ups with a doctor.

The postoperative condition requires careful attention to health. A woman is recommended:

• limit working hours;
• reduce movement;
• perform a special complex of exercise therapy;
• visit the swimming pool;
• use a bandage;
• exclude exposure to heat;
• wear specialized underwear - bra, swimsuit;
• do gymnastics;
• do not inject into the arm from the side of removal;
• conduct a course of psychological recovery;
• see a doctor if you feel unwell.

During rehabilitation after a mastectomy, you will need:

• normalize nutrition - use a low-calorie diet;
• carry out physiotherapy;
• perform massage, hydromassage;
• use simulators to restore mobility of the shoulder joint;
• limit prolonged stay in an inclined position;
• use a compression sleeve for air travel;
• use a healing wrap;
• drink the drug Tamoxifen to exclude relapses;
• perform reconstructive plastic surgery.

Complications

Having a mastectomy can have serious consequences. Complications appear after surgery and in the subsequent, remote period. After the operation, the occurrence of problems is not ruled out:

• suppuration of the postoperative wound;
• bleeding;
• breathing problems;
• the appearance of blood clots in the lower extremities;
• lymphorrhea - prolonged outflow of lymph as a result of injury to the lymph nodes;
• drug allergy;
• marginal tissue necrosis;
• damage to the nerve endings of the muscles of the back, arms, chest;
• infection of the abdominal cavity.

During the recovery period after a mastectomy, long-term complications may appear:

• pain, stiffness in the hands;
• problems of mobility of the shoulder joint;
• lymphostasis - swelling of the hands caused by a violation of the outflow of lymphatic fluid;
• rough postoperative sutures;
• proliferation of connective tissue;
• disorder of outflow of venous blood due to overlap during the operation of the lumen of the axillary, subclavian vein.

The most serious for a woman are postoperative psychosexual problems. Breast removal causes:

• depression;
• feeling of own inferiority, inferiority;
• difficulties in communicating with the opposite sex;
• restriction of social contacts;
• fear of recurrence of the disease;
• fictional and real difficulties of sexual life;
• the difficulty of establishing new acquaintances;
• problems in family relationships.

Breast reconstruction

Women go for plastic surgery to restore their breasts because of the psychological discomfort that has arisen. In addition, there are problems at the physical level associated with an imbalance of loads on the spine. After a mastectomy, there are:

• change in posture;
• omission of the shoulder on one side;
• rachiocampsis;
• violation of the lungs, heart.

Often, reconstruction is carried out in conjunction with a mastectomy, or six months after the operation. As a result of activities at the site of removal of the mammary gland, restoration is carried out:

• the volume of subcutaneous adipose tissue, skin;
• cut tissues located nearby, chest muscles;
• nipple-areolar complex;
• in addition to the operated breast, the second mammary gland to adjust the size and shape.

There are several reconstruction techniques that differ in execution and results. One of the most popular methods is the use of endoprostheses. Features of plastic surgery:

• performed after subcutaneous mastectomy;
• an expander is inserted through the incision - a special device;
• stretching of the skin occurs, the formation of a cavity for the subsequent installation of the implant;
• advantages - low trauma;
• disadvantages - the unnaturalness of the breast to the touch and outwardly, the risks of tissue necrosis, the presence of restrictions on the installation of the implant.

To create a natural in appearance and sensations of the mammary gland, transplantation of one's own tissues is used, which are taken from the back, anterior abdominal wall. This technique - the TRAM patchwork method - is characterized by:

• the complexity of the operation;
• high trauma;
• the need for prolonged anesthesia;
• the presence of a possibility of tissue rejection;
• long recovery period;
• no problems associated with implant displacement.

Another reconstructive method is the use of vacuum devices. When using them:

• a domed cup is placed on the chest;
• a vacuum is created under it;
• stretching of the skin occurs;
• its excess is formed;
• a place is formed for the subsequent installation of a silicone implant, transplantation of adipose tissue;
• the disadvantage of the method is that it requires a long wearing of the device, the appearance of stretch marks is not excluded, it is difficult to stretch to a large implant size.

Often, a combined breast reconstruction technique is used. Breast plastic surgery includes a combination of methods:

• replenishment of tissue deficiency by transplanting flaps of the patient's own muscles, subcutaneous tissue, skin of the patient;
• correction of the shape, size, symmetry, reconstruction of volume, elimination of cavities is carried out using silicone implants.

Price

Mastectomy in Moscow is performed in specialized clinics, oncology centers. Surgery includes only removal of the breast or simultaneous plastic reconstruction. The cost depends on the stage of cancer, the specifics of the implementation process, the qualifications of specialists, the status of the clinic. Operation price in rubles:

Video

Surgical treatment of breast cancer has come a difficult and long way from cauterization of the pathological focus to complete removal of the gland.

Until a few decades ago, the Halsted-Meyer radical mastectomy was the only method of surgical intervention that provided sick women with at least some hope. But new methods of examination, early detection of malignant forms, radiation and chemotherapy allow the use of more gentle methods of treatment.

Options for surgical intervention depend on the size of the node, germination in neighboring tissues, and the presence of metastatic foci. If the neoplasm is no more than 2.5 cm, and the stages of cancer are 1-2, then surgeons try to preserve the tissues of the organ as much as possible. If the formation is large, then the operation is supplemented with one-stage endoprosthesis of the mammary gland. At stages 2B and 3 resort to radical mastectomy.

It's important to know that the surgeon's knife is still the only means of a complete cure breast cancer.

Contraindications

• Infiltration with cancer of the chest wall;
• advanced cancer;
• Metastatic lesion of many lymph nodes with the development of lymphostasis in the arm from the affected side;
• Numerous ulcers in the region of the gland;
• Erysipelatous formation;
• Severe swelling of the affected organ with the spread of edema to the chest.

In addition to specific, there are general contraindications that affect the entire body as a whole. The most significant: severe cardiovascular, renal, hepatic insufficiency, stroke, in the stage of decompensation.

Surgical Options

There are several main options for surgical treatment, we will consider each in detail.

Lumpectomy

This type of treatment involves the excision of a cancerous growth without the mandatory capture of healthy tissue. During lumpectomy, a cytological examination is performed directly during the operation to exclude the presence of tumor cells along the resection margin. The scope of the intervention depends on the previous diagnostic measures and the histological conclusion.

The choice of access depends on the location of the breast cancer. The incision can be made in three ways: above the neoplasm, within the areola, or in an arcuate manner in the area of ​​the fold under the affected gland. The last two incisions are the most aesthetic in terms of cosmetics; after a couple of years, the woman will not even find a scar from the operation.

During the operation itself complete excision of the tumor, the doctor conducts a thorough revision of the incision edges to be sure that there is no tumor tissue in the resection area.

This intervention is advisable to carry out in the presence of very small neoplasms that are detected only with the help of special research methods.

Sectoral resection

Already from the name it becomes clear that this technique involves the resection of a specific sector in the affected gland with the neoplasm itself and the main milk ducts. Sometimes surgeons call this intervention a radical resection.

If the cancer has struck the upper outer quadrant, then the removal of the lymph nodes and the pathological focus is carried out in one block. Such an excision is possible by lengthening the incision in the area of ​​the pectoralis major muscle.

With a sectoral resection, at least 2/3 of the gland is preserved so that a reconstructive operation can be performed. This technique in some cases allows you to perform an intervention while preserving the nipple-areolar complex, which will subsequently allow a young woman to breastfeed her baby.

To resort to such an organ-preserving operation, it is important to correctly assess the nature of the tumor process. You can use sectoral resection in case of slow progression of the disease and small sizes (up to 2.5 cm).

Nipple resection

The technique is rarely used. as a diagnostic measure for suspected Paget's cancer. A wedge-shaped excision is performed and cosmetic sutures are applied. When Paget's disease is confirmed, more radical interventions are performed.

Radical mastectomies

There are several techniques for mastectomy, the choice will depend on the commitment of the surgeon and the school of oncology.

By Madden

Volumetric surgical intervention that allows you to save the pectoral muscles from the side of the affected organ. During this operation, the following structures are excised:

• underlying fascia;
• Subclavian, axillary and subscapular lymph nodes;
• Fiber between the muscles.

The operation allows you to almost completely preserve the functions of the hand, which is important for the patient. But this surgical treatment is suitable for the most part only for nodal forms of malignant tumors.

By Pati

This operation differs from the previous one by the removal of the pectoralis minor muscle. With the help of this mastectomy, access to the lymph nodes under and above the pectoralis minor is improved.

Thanks to the preservation of the pectoralis major muscle the degree of disability of a woman is reduced.

This technique is fraught with scarring near the subclavian vein.

According to Halstead

A very traumatic operation, not only physically, but also psychologically for the patient. With this technique, excised:

• the affected gland;
• Both pectoral muscles (large and small);
• Subclavian, subscapular, axillary lymph nodes;
• Fiber in the area of ​​the excised lymph nodes.

Surgery is used when cancer has spread to the pectoralis major muscle. Sometimes, it is not completely excised and a part is left in which there is no tumor process.

The incisions are carried out in a variety of ways, it all depends on the type of neoplasm and its size.

Expanded axillary-sternum

A similar variant of mastectomy is used when the tumor is located in the central or internal parts of the gland. During the operation, not only the affected organ with the pectoral muscles and subcutaneous fat, but also the peristernal lymph nodes with the thoracic vessels are removed as a single block. To carry out such an operation, 2 or 3 costal cartilages are removed.

If during the intervention the surgeon revealed in the axillary lymph nodes, then they are not removed, since this will no longer affect the course of the disease.

Extended Modified

Surgery is used for edematous forms of the tumor process, large ulcerative defects, in the presence of an erysipelas-like neoplasm. Mastectomy is used in rare cases when a recurrence of the growth of the cancerous process is suspected.

During the operation, the affected gland and skin with fiber, which is adjacent to the neoplasm, are removed. The skin defect will begin at a distance of 5 cm from the edge of the mammary gland. Its boundaries will be approximately the following:

1. superior in the second intercostal space
2. from the side of the armpit along the posterior axillary line,
3. down the fold under the organ,
4. in the region of the sternum - on the opposite side of the affected gland.

Since the surgical wound is very large, it is quite difficult to close the defect. For this, a skin-subcutaneous flap from the abdomen is used, which is moved to the area of ​​the defect on the feeding vascular pedicle.

Simple mastectomy

This operation is used as palliative care when other methods would be unnecessarily traumatic and meaningless. The surgeon excised the affected mammary gland with the capture of the shell of the pectoralis major muscle.

simple mastectomy used in the last stages of the malignant process when tumor decay is observed. Also, palliative intervention is resorted to in severe chronic diseases and in the elderly, when other radical measures are more likely to harm than prolong the life of a sick person.

Reconstruction after mastectomy

Breast removal is extremely difficult for women, even if a partial resection has been performed. Reconstructive interventions are urgently needed so that a woman can socialize normally and return to her usual way of life.

Cosmetic reconstruction can be performed both directly during the operation itself, and some time after the operation. Such operations are very complex and require high skill of a plastic surgeon, since after a mastectomy it is necessary to re-create a woman's breasts.

During reconstructive interventions, the shape of the organ, size is restored, the nipple-areolar complex is re-created. Despite the efforts of doctors, a pronounced postoperative scar often remains on the organ.

Most often tissue the defect can be repaired with an autograft. To do this, a skin flap with a vessel supplying it is taken from the back or abdomen, gradually this graft is brought to the operated area, and only then the defect is closed. Such a complex manipulation takes a long time, so a woman should tune in to a long-term recovery stage.

If the reconstruction was successful, then the woman recovers much faster and stabilizes psycho-emotionally.

Postoperative period

After the operation, the sutures are treated with iodine, and after 10 days, in the absence of complications, they are removed.

It is extremely important that the hand on the operated side is not loaded, even the usual measurement of pressure can become a threat to the infectious process. The woman is warned that it is better not to disturb the limb at all for some time and manage with a healthy hand.

The patient is necessarily consulted by a psychologist, since some patients have a high risk of suicide. If necessary, the doctor prescribes the necessary medications.

Since the recovery process is difficult and lengthy, a woman should receive adequate nutrition with enough vitamins and minerals. Without fail, the diet should contain meat and fish products, vegetables, fruits.

The patient is issued a disability certificate, she also undergoes MSEC and, if necessary, she is issued a disability.

After discharge, the woman should be observed by a gynecologist or mammologist, and undergo routine examinations. In the first year, she should visit him every 3 months, for 2-3 years every six months, and then annually.

Important! Every month, a woman should independently palpate the mammary glands. Not only the operated mammary gland, but also a healthy one should be examined!

Every year, the patient undergoes a mammogram.

If the doctor suspected a recurrence of the malignant process, then the woman is referred for a consultation with an oncologist, who will select the necessary therapy.

* modified radical mastectomies are distinguished by a decrease in volume: with a mastectomy according to Patty, the pectoralis major muscle is not removed (but the pectoralis minor muscle is removed), with a mastectomy according to Maden, the pectoralis major and small muscle and axillary fiber of the 3rd level are not removed.

* amputation of the mammary gland - removal of the mammary gland without removing the axillary tissue.

2. Axillary lymphadenectomy - removal of tissue containing lymph nodes located along the subclavian vein, in the intermuscular space, subclavian region, subscapular region.

2. Avoid exposure to ultraviolet radiation (sun, solarium) on the arm on the side of the operation

3. Try to avoid injuries (corns, abrasions, etc.) of the hands, take good care of your nails.

4. When working with soil and other objects containing germs, use gloves.

5. Regularly massage your hand (raise your hand, put it on the wall and stroke your hand with light movements from the hand to the armpit).

6. Be sure to develop your hand. After the operation, ask the doctor on what day to start gymnastics (usually it is 7-10 days). Ignoring gymnastics often leads to a significant decrease in the range of motion in the shoulder joint, which in turn leads to a decrease in working capacity.

Types of mastectomy

There are several options for breast removal surgery:

1. The Patty method is a surgical operation during which the mammary gland, axillary lymph nodes of the 1st and 2nd order and the pectoralis minor muscle are removed.
2. The Halstead method is a type of intervention that involves the complete excision of the breast.
3. The Madden method is a type of mastectomy in which the gland is removed, and its muscle tissues and lymph nodes are not affected.
4. Subcutaneous mastectomy - removal of breast tissue with a small incision, that is, from the inside. During such an operation, the skin on the chest is not excised, but an endoprosthesis is inserted under it, which gives the mammary gland a natural volume. Here it is appropriate to clarify that not all patients like the end result of such a surgical intervention.

Mastectomy according to Madden

This method can be called the most gentle, because in the process of its implementation, doctors preserve the pectoral muscles of both breasts. Here, the breast is removed along with a layer of fat located under the skin, subclavian, axillary and subscapular lymph nodes.

Although the Madden mastectomy is a radical operation, it is less traumatic, less blood loss and relatively fast healing of wounds.

One of the main advantages of this method is that the method allows to reduce the number of patients with limited functional movement of key joints and achieve a good cosmetic effect.

Due to these facts, this type of mastectomy is considered the most gentle.

At present, there is a feature of reducing the number of operations that preserve radicalism regarding oncology. This is all explained by several indicators:

• Detection of the disease in the early stages.
• New technologies and methods in the diagnosis of the disease.
• The use of a combination of operations with hormonal, radiation and chemotherapy treatment.
• A more careful study of the nature of the manifestation of the malignant process. Here, the stages of the course of cancer and their activity, the hormonal background of patients, the growth of tumors and their cells are taken into account.

All these factors make it possible to predict the disease, possible complications and treatment options.

Operation on Halsted

This surgical intervention is a traditional radical operation, which is based on the growth of cancer cells from the initial tumor to the lymph nodes through the vessels and collectors.

The meaning of the intervention is that the mammary glands are removed along with the skin, subcutaneous tissue and pectoral muscle. At the same time, the lymph nodes are also affected.

The type of skin incision depends on the location of the tumor. Most often, specialists perform an oval-shaped transverse incision, which makes it possible to easily tighten the wound along the edges with a skin suture. The method is used at any stage of oncology.

It is worth clarifying that such a mastectomy can lead to severe complications, characterized by limited mobility of the shoulder. That is why such an operation is appropriate only in the following cases:

1. If the tumor has grown into the pectoralis major muscle.
2. When the disease affected the lymph nodes located behind this muscle.
3. If cancer needs to be treated only surgically.

Patey's radical mastectomy

Such an operation is called radical, because in the process of its implementation, doctors cut out both the mammary gland and the pectoralis minor muscle. It is worth noting that the large muscle and fiber are not affected.

If the disease is detected at an early stage, specialists use methods due to which only one lymph node affected by the tumor is cut. It is carefully studied, and when no lesions are found, all other lymph nodes remain untouched.

What is mammoplasty: types, indications and consequences in our article.

Possible Complications After a Mastectomy

Although modern techniques are constantly being improved, there are no fewer complications after surgery. Problems that arise in the early stages of the operation make it possible for connective tissue to develop at the site of the former tumor, which is why late complications appear.

There are several main risk factors:

1. Retirement age.
2. Excess weight.
3. Large breast size.
4. Chronic diseases: diabetes, hypertension, lung and heart disease.
5. Treatment with hormones or chemotherapy.

Early complications include:

1. Lymphorrhea, which occurs in every patient who has undergone radical surgery.
2. Necrosis characterized by divergence of tissue at its junction.
3. Various infections and pus on the wound.

The following are considered late complications:

1. Lymphostasis - poor outflow of lymph.
2. The narrowing of the lumens in the axillary veins, as a result of which there are problems with the outflow of venous blood.
3. Big scars.

Complications arise due to frequent swelling of the limb and limitation of movement of the shoulder joint.

Do they give disability after a mastectomy?

Sadly, mastectomy is an essential basis for establishing disability of the third group. In addition, such a disability does not need to be re-examined, because it is given for life.

To register a disability, a woman must contact the attending physician in a timely manner and present the necessary documents.

So, in order for the doctor to be able to adequately assess the situation and choose the appropriate method for performing a mastectomy, a woman should go to a medical institution immediately after the first alarming symptoms appear. The final result and prognosis depends on the timely treatment of the problem.

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Rehabilitation after mastectomy

Posted By: admin 02/16/2017

Breast cancer is the second leading cause of death among women after cardiovascular disease. The annual increase in the incidence of breast cancer fluctuates at the level of 1-2 percent. If the breast tumor is not more than two centimeters, and the presence of metastases in the nearest lymph nodes is not confirmed by all available diagnostic methods, and the tumor does not differ in multicentric growth, then oncologists most often tend to perform organ-preserving operations, when only the pathological focus is removed while preserving the healthy tissues of the affected breast disease. Surgical treatment of this type can be performed according to two main principles:

• without providing for the replacement of the defect - in the form of a radically performed resection, lumpectomy with simultaneous axillary lymph node dissection;
• assuming replacement of the defect, which is performed by means of a small tissue flap of thoraco-dorsal origin or endoprosthesis replacement.

In the event that diagnostic methods prove the spread of the disease to the regional lymph nodes and pectoral muscles, then radical-type operations are performed. Among them are the author's methods of mastectomies: according to Halsted-Meyer, according to Patty-Dyson, according to Madden. The latter is preferred today. Its advantages are the following features:

• Allows you to save muscle structures, which minimizes the possibility of subsequent complications associated with limited mobility of the shoulder joint.
• The radical nature of the operation is achieved due to the simultaneous removal, together with the structures of the mammary gland, of the surrounding fatty tissue, various groups of lymph nodes, which is not as traumatic as in other types of surgical treatment.
• It is characterized by a less significant amount of blood loss and better healing of the postoperative wound.
• The cosmetic effect after this type of operation is more acceptable.

Another type of radical treatment for breast cancer is subcutaneous mastectomy. This type of surgery involves the complete removal of the structures of the breast, but with the preservation of the skin over it. Predominantly, this operative method is used when further breast reconstruction after a mastectomy is implied. For the same purpose, various variations of this technique have been developed, when the integrity of the nipple-areolar region is maintained. The only drawback of this technique is that its use is largely limited by the size and location of the tumor.

Mastectomy, possible complications

Surgical techniques for the treatment of breast cancer do not stand still, the constant search for new surgical approaches is aimed at minimizing the trauma and undesirable consequences of the operation. But despite all this, the number of complications after a mastectomy is quite large and is at the level of twenty to eighty-seven percent. Factors affecting this indicator:

Like all postoperative complications, the consequences of a surgical technique for the treatment of malignant breast diseases of the radical type may include early manifestations:

• Lymphorrhea is the spontaneous flow of lymph. As a rule, it occurs in the vast majority of patients, but in varying degrees of severity, which is determined by the amount of intervention and the individual characteristics of each organism. This condition is caused by the removal of the lymph nodes and the suppression of the lymph vessels. It can last for a month, and sometimes more. Permanent maceration in the area of ​​the postoperative suture increases the risk of infection and partial necrosis of the wound edges, delaying the start of other stages of anticancer therapy and the formation of seromas - capsule-limited cavities filled with lymph, the treatment of which requires additional surgical intervention.
• Necrotic changes in the edges of the postoperative wound with further divergence of the suture area. It occurs due to excessive tension of the edges of the seam with a deficiency of soft tissues.
• Infection of the postoperative wound.

Complications in the late postoperative period are observed with all types of surgical treatment, but when performing a mastetomy according to Halsted-Meyer, they can be more pronounced and last an average of three months to a year. Among them:

Difficulty outflow of lymphatic fluid in the upper limb on the side of surgery (lymphostasis).

As a result of a decrease in the diameter of the subclavian or axillary vein (a combination of complications is possible) or its complete closure, the outflow of venous blood can be significantly hindered or stopped completely.

In the postoperative area, rough scars may form, extending to the axillary nerves.

Such complications underlie a distinct swelling of the upper limb, which can be long-term and sometimes permanent; sixty percent of patients have an adductor contracture of the muscle groups of the upper limb, which leads to limited mobility in the shoulder and frequent pain in this area when trying to actively actions. As a result, the ability to work is lost to such an extent that a woman cannot fully perform household and work tasks.

What are the ways to solve the problems that arose after a mastectomy

Cosmetic discrepancy after radical surgical treatment of breast cancer can be corrected surgically, by simultaneous or delayed endoprosthesis replacement or wearing of a breast exoprosthesis. For patients who have undergone a mastectomy, the production of underwear (bra) containing a prosthesis of the removed organ, according to individual sizes, and compression sleeves is organized to solve the problem of the initial degree of lymphostasis.

Breast reconstruction after mastectomy using surgical methods consists of the following methods:

• Surgical reconstruction using the patient's own tissues, by transferring a tissue flap that retained blood flow and taken from the inner part of the ilio-femoral zone, the greater omentum, part of the rectus muscle in the abdomen, together with the skin in a free form or on a leg. There are other options for extracting your own tissues for transplantation.
• Installation of silicone implants after temporary use of expanders.
• The use of combined techniques, including the use of elements from the first two groups, when the lack of tissues in the operation area is compensated for by a small flap taken from the superficial part of the back, while various implants are used to correct the volume, the required shape and the desired symmetry.

Issues of lymphostasis and limited mobility of the shoulder joint are solved through rehabilitation measures, where gymnastics plays a major role. A very important condition for its implementation is the earliest possible start of its implementation, in the first postoperative period. Special gymnastics makes it possible to avoid further contracture of the shoulder, prevent stoop and curvature of the spinal column, relieve tension in the muscle groups of the cervical zone, and minimize pain. In addition, regular physical activity allows you to organize the correct daily routine, get rid of the negative perception of life and depressive mood, believe in yourself and feel like a participant in a full life.

Physical rehabilitation begins in the hospital, with the permission of the attending doctor and under the supervision of a rehabilitation specialist. You need to perform gymnastic exercises regularly and after warming up the muscles, which will give them the right tone, prevent injury and ensure better training efficiency. Gymnastic exercises should be performed with regular frequency and in full, but with a gradual increase in intensity. It is best if the classes will be given a specific time in the daily routine and it will be strictly observed. If gymnastics causes temporary difficulties or provokes too intense pain, then it is strictly forbidden to interrupt classes. In this case, it is recommended not to increase the intensity of the exercises, but to fix it at this level or even slightly reduce it, and after getting used to it, gradually increase it again. Gymnastics shown to patients after radical breast removal surgery mostly includes exercises that imitate combing hair, squeezing movements of the brush, rotating and swinging the limbs, placing both hands behind the back using a towel, performing actions reminiscent of fastening a bra. Proper breathing is of the utmost importance. It should be rhythmic without delays and pauses, which will ensure the active work of muscle fibers and improved supply of oxygen and nutrients, activates immune responses.

Swimming is a very important and effective method in terms of rehabilitation. The only limitation on its use is the complete healing of the postoperative suture. With its help, you can prevent stiffness of the shoulder joint, incorrect position of the spine and its curvature. Water helps to relax the muscles of the neck and shoulder girdle, relieves tension in them. A light massaging effect of water contributes to the normalization of the outflow of lymphatic fluid. In addition, swimming has a beneficial effect on ligaments and joints, has a general strengthening effect on all organs and systems of the body, and promotes proper posture.

If, due to the individual characteristics of physiology or lifestyle, the lymphostasis of the upper limb on the side of the mastectomy is stable or prone to increase, other rehabilitation measures are used in the form of magnetic therapy and the use of drugs that strengthen the vascular wall and reduce the volume of fluid circulating in the body, limited consumption of certain products .

How to quickly eliminate complications in the hand after a mastectomy?

The hand after mastectomy is deprived of a full-fledged lymphatic drainage, which is the cause of the main postoperative complications.

Hand after mastectomy: consequences and their elimination

The consequences of a radical operation to remove a malignant tumor of the breast occur in four main forms:

Lymphostasis of the hand after mastectomy

This is an acute violation of the outflow of lymph, which is accompanied by the accumulation of fluid in the soft tissues. Lymphostasis after removal of the mammary gland in the first year after mastectomy is completely safe for the patient's life.

• Causes of violations of the lymphatic drainage of the hand:

Radical surgery for excision of neoplasms of the breast includes the removal of lymphatic vessels and lymph nodes. Depending on the localization of the tumor, the surgeon removes the nodes of the first or third level, which is reflected in the intensity of the clinical symptoms of the disease.

• Clinical picture of lymphostasis of the hand:

Patients after mastectomy may feel a feeling of "heaviness and fullness" in the upper limbs. In some cases, patients experience periodic attacks of pulling pain. The key symptom of hand lymphostasis is considered to be progressive swelling of the soft tissues. Diagnosis of such a lesion consists in clarifying the patient's complaints, visual examination and a finger test (pressure on the skin during edema causes the formation of a persistent depression in the skin).

For the treatment of the hand after a mastectomy, a special course of physiotherapy is indicated, which includes a set of gymnastic exercises and massage.

In the postoperative period, oncologists recommend that patients avoid infectious lesions, exposure to ultraviolet radiation and ultra-low temperatures. Patients should also avoid injections in this area and measure blood pressure. In the event of primary edema, a tight bandage and holding the arm in an elevated position have a positive effect.

Inflammation of the hand after a mastectomy

This is the process of erysipelas of the skin of the hand. This complication occurs as a result of microcracks in the skin in combination with a decrease in the level of local immunity. Inflammation usually accompanies swelling of the hand after mastectomy.

The area of ​​introduction of a bacterial infection has a bright red color with raised edges. Palpation of this area causes sharp pain.

Treatment of erysipelas consists in prescribing a course of antibiotic therapy. The selection of a pharmacological agent is recommended after determining the sensitivity of microflora to different types of antibiotic. Along with antimicrobial agents, the patient takes immunostimulants to activate tissue resistance.

• Prevention of inflammatory complications of the hand after mastectomy:

To prevent such postoperative complications, the patient should observe the rules of personal hygiene, avoid acute injuries of the upper limbs and engage in moderate physical activity.

Postoperative pain syndrome

Hand after mastectomy - photo of secondary lymphostasis

Pain in the hand after mastectomy is associated primarily with soft tissue injury during the surgical incision and post-traumatic swelling of the hand. In addition, an oncologist-surgeon, when removing a malignant tumor, performs surgical procedures, which over time can cause pain attacks.

Surgical intervention on the mammary gland is associated with damage to small nerve endings and removal of axillary lymph nodes. The healing of such injuries, in most cases, is accompanied by pain and a feeling of "numbness" in the upper limb. At this stage, it is advisable for the patient to take painkillers and anti-inflammatory drugs.

• Pain after radiotherapy:

In 70% of operations on the section of breast neoplasms, the arm after mastectomy is exposed to highly active X-ray radiation. Radiation therapy in such cases is necessary as a prevention of the spread of cancer cells in this area. Ionizing radiation provokes irritation of nerve endings, which stimulates the onset of pain. Such pain does not require specific therapy and disappears a few weeks after the last course of radiation exposure.

Restriction of organ function

The hand after a mastectomy, especially in the case of removal of the pectoralis major muscle, is limited in movement for several months. During this period, patients resort to the help of a physiotherapist. This specialist develops an individual course of gymnastic exercises to strengthen the muscular system of the upper shoulder girdle. Regular and moderate physical activity can restore the motor activity of the upper limbs after surgery.

For the rehabilitation of cancer patients after surgery, it is also recommended to undergo regular preventive examinations and follow a balanced diet.

It is also important to know that the hand after a mastectomy is very often subject to inflammation and other complications in those operated on who are overweight or obese.

It's important to know:

comments 4

Rectal mastectomy of the left mol. wish. I was held in 2006. First year

after the operation, I was on the 2nd working group, the 2nd degree of labor restriction.

Erysipelas 1 time per year. The next two years - in the 3rd group. I was obliged

fulfill the hourly labor rate. Erysipelas 2 times for the second and third

year (I don’t count mild forms with a temperature below 38 degrees). 3 years after

the group was removed from operations, there are no restrictions on work. The very next day when I

brought to work a certificate about the removal of the group, I was asked the question - “so we have

the right to put you on a day?” I work in a government agency, with children

disabled people under 5 years old, who I care for completely together with another

group staff: feeding children (up to 1 year old and children, severely disabled, strictly in my arms, and since I am right-handed, it is difficult for me to hold the child in my right hand, it comes -

Xia to strain a sore hand), washing (it is difficult to hold a child who is already gaining

weight, but not yet leaning on his legs, or a disabled person over 1 year old who is on his legs

does not rely on his disease and often has a good weight). In healthy

I tried to hold the child in my hand 1 time, as I was advised by the ITU commission, when

we decided on the removal of the group, but I barely kept him, I’m not going to do this anymore, let the advisers experiment on their children, It’s very difficult

cut children's nails, as they either pull their arms (legs) towards themselves or jerk

foot (small children), and I, as a right-hander, can only hold scissors in my right hand,

and with a sick hand, it is necessary with great difficulty to fix the leg or arm of the child.

After removing the band, erysipelas with high fever and obligatory

a course of antibiotics and sulfa drugs increased first to 4,

and then up to 8 times a year. The hand is disfigured so that you cannot disguise it even with a long

sleeve, And most importantly, it is all like a sponge soaked in liquid, heavy as a log, it constantly hurts. So how can you save it? A little more load on the hand, on it

pink spots or vesicles appear, which then merge, Simultaneously

It is with rashes that general intoxication appears: severe headache,

severe muscle pain throughout the body, chills, skin pain (it hurts even when

touching the scalp). And personal hygiene has nothing to do with it.

this is a necessity in my work. Insect bites have nothing to do with it, mosquitoes

this hand is not bitten, because under the skin there is not blood, but lymph.

Now I began to leave medicines a little in reserve. You never know.

And at first I was very tormented, since the disease often begins late

in the evening, or at the end of the working week, maybe on the eve of holidays and doctors on

the polyclinic does not accept, and in the pharmacy, if you find an on-duty, without a prescription, anti-

biotics are not given. And erysipelas proceeds rapidly, after 3-4 hours

the temperature rises from normal to 38 - 39 degrees C. And what, wait for the doctor?

There are no specialists in the city, the city phlebologist prescribed me pills about 5 years ago

from thrombophlebitis, and whispered that it was impossible to work with such a disease. Precinct

each time he directs me either to an infectious disease specialist, or to a surgeon, or to both at once. They are

they diagnose either allergies, or rubbing, or diaper rash, but only I will hint at

cancellation of a course of antibiotics under their responsibility, they do not want to take responsibility,

indicate that the treatment is prescribed by the district doctor, and they do nothing more to help

One more note. Treat with antibiotics for erysipelas and

it does not make sense to work at the same time at any stage of the disease, since

treatment becomes ineffective, in vain. The hand during treatment needs

In the meantime, work is being optimized at work. This means that on

vacation time and sick leave, deputies will not be given to the group, neither from their own

groups from none of the others may leave the staff at half strength. If the next

the employee fell down with a temperature, unable to withstand such a load, they tell him–

"For God's sake", wallow, You don't need to look for anyone in his place, and savings in payment, because

those who remain do not get paid for it either. And let them work somehow, but with

this savings to the salary will be large criteria (instead of bonuses), as a percentage

(interest, of course, depends on the size of the salary) and criteria are accrued for all

employees, including the entire "beau monde".

THIS IS WHY CANCER HAPPENS.

Dear women, there is a simple method to relieve these swellings. This is taping for lymphostasis.

You can learn about specific examples of this technique.

RECTAL mastectomy? As for the rest of the text, I really sympathize with the author ...

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The information on this site is provided for informational purposes only! It is not recommended to use the described methods and recipes for the treatment of cancer on your own and without consulting a doctor!

Mastectomy: types of surgery, complications, rehabilitation

The main therapeutic tactic for breast cancer is its surgical removal (mastectomy), both as an independent option and in combination with radiation, hormonal and chemotherapy. The surgical strategy of modern treatment is aimed at ensuring the solution of two main tasks - the reliability of a cure for a dangerous disease and the creation of conditions that allow for the restoration of the breast after mastectomy and improve the patient's quality of life.

Radical methods of surgical treatment

Among all oncological diseases in women, breast cancer (BC) ranks first and second after diseases of the heart and blood vessels - among the causes of death. The number of patients with breast cancer each year increases by an average of 1-2%. This testifies in favor of the need to prefer the most radical methods of treatment.

At the same time, in the initial stages, the proportion of which has increased in the last 10 years, it is possible to perform organ-preserving operations with reconstructive plastic elements or even without them, and advances in the field of endoprosthetics can significantly improve the quality of life of those who have undergone such operations even at later stages of the disease.

Mastectomy according to Halsted-Meyer

Classical radical operation. It is based on the principle of staged spread of cancer cells from the primary tumor to the regional lymph nodes through the vessels and collectors of the same name.

Therefore, the essence of the operation is to remove the mammary gland with skin and subcutaneous tissue as a single complex with pectoral muscles (small and large), as well as with lymph nodes and subcutaneous fatty tissue located in the subclavian, axillary and subscapular regions.

The nature of the skin incision during surgery depends on the site of tumor localization. An oval transverse incision is mainly used, which allows, without much tension, to connect the edges of the wound with a skin suture at any localization. This method was used in all stages of breast cancer, but led to the development of serious late complications in most patients, especially in the form of limited mobility in the shoulder joint (in 60%). Currently, the Halsted-Meier technique is performed only in cases of:

1. Germination of the tumor in the pectoralis major muscle.
2. Involvement in the malignant process of the lymph nodes located on the back surface of this muscle.
3. The need for palliative surgery in a qualitative single solution.

Patty Dyson Mastectomy

It is the result of a search for more benign solutions for surgical intervention, which is a modification of the previous type. The author of the technique was based on the fact that lymphatic capillaries and vessels abundantly penetrate the skin and subcutaneous fat layer, but are almost absent in the fascia of the pectoral muscles. Therefore, D. Patey proposed to keep the pectoralis major muscle along with a wide excision of the skin and subcutaneous tissue around the cancer. In order to remove the subclavian and apical axillary lymph nodes, they were asked to confine themselves to removing only the pectoralis minor muscle. This technique made it possible to somewhat reduce the percentage and severity of late postoperative complications.

Mastectomy according to Madden

An even more gentle method in which both pectoral muscles are preserved. Removal of the mammary gland is carried out in a single block with the subcutaneous fat layer, subclavian, axillary and subscapular lymph nodes. The operation is characterized by no less radicalism, but is accompanied by significantly less trauma (compared to the previous ones), less blood loss and better and faster wound healing.

But most importantly, as a result of the application of the Madden modification, muscle preservation makes it possible to exclude or significantly reduce the number of patients with the development of limited functional mobility of the shoulder joint and obtain a more acceptable cosmetic effect. Due to this, operational modifications of this type are considered functionally sparing.

In recent years, there has been a trend towards a decrease in the volume of surgical intervention, while maintaining radicalism in oncological terms. The possibility of moving away from aggressive tactics that have persisted for decades is explained by:

• a significant increase (among all patients with breast cancer) of women with early stages of the disease;
• improvement of instrumental and diagnostic methods;
• development and application of effective combinations of surgical treatment with targeted, hormonal, chemotherapeutic and radiation types of exposure;
• revision of the biological and clinical concepts of the development of malignant processes - they take into account not only the stage of cancer, but also the degree of its activity, the rate of tumor growth, cell heterogeneity, the hormonal state of the body and its reactivity.

All this allows predicting the course of the disease, the likelihood of complications and choosing the tactics of treatment.

The listed types of radical mastectomy make it possible to quite successfully solve the problems of a therapeutic nature. However, after their implementation, the reconstructive possibilities associated with:

1. The need to restore the deficit of soft tissues in the absence of their reserve.
2. Creation of a transitional fold and a nipple-areolar complex.
3. Creation and correction of the shape and volume of the gland.
4. Restoring the symmetry of the mammary glands.

Subcutaneous mastectomy

This is a technique that allows you to optimally solve the main tasks of treatment:

1. Preservation of a sufficiently radical surgical intervention and oncological safety.
2. Significant facilitation of the primary reconstruction of the gland in order to achieve the best possible aesthetic results.

This technique consists in almost complete separation from the skin and removal of the glandular and adipose tissue of the mammary gland. At the same time, the nipple-areolar complex is also removed, which significantly worsens the expected aesthetic results of the operation. Therefore, many oncological surgeons strive to preserve it, for which various modifications are used.

Unfortunately, this is not always possible. Preservation of the nipple and areola depends on:

• the size of the primary node;
• localization of the tumor and its distance to the nipple-areolar apparatus;
• the severity of intraductal components;
• cell type of the tumor and the nature of its growth;
• the degree of involvement of the nipple-areolar apparatus in the cancer process (according to various sources, it ranges from 5.6 to 31%).
• status of regional lymph nodes.

In subcutaneous mastectomy, various incisions are used to provide wide visual access. Depending on the conditions, an extended subcutaneous mastectomy can be used, which involves an incision under the gland from the parasternal line to the middle axillary line. It allows you to remove the gland tissue along with the muscular fascia at the base, expose the excretory ducts of the nipple, and in the armpit - it is easy to isolate and remove the processes of the mammary gland along with the lymph nodes.

Subcutaneous mastectomy makes it possible to simultaneously perform a reconstructive operation of the mammary gland by moving its own tissues or to form a pocket under the pectoralis major muscle for implant placement.

The choice of any of the listed methods largely depends on the stage of the prevalence of the tumor process.

Approaches for radical mastectomy

Complications after mastectomy

Despite the constant improvement of surgical treatment methods, the number of complications remains quite high - from 20 to 87%. Complications in the immediate postoperative period contribute to the intensive development of connective tissue in the surgical area and the occurrence of late complications. Risk factors are:

1. Old age (after 60 years).
2. Obesity and even just overweight.
3. Significant volume of mammary glands (from the 4th size).
4. Concomitant diseases, especially diabetes mellitus, chronic diseases of the lungs and heart, arterial hypertension.
5. Additional preoperative radiation and/or hormonal therapy.

Major early complications

• lymphorrhea (lymph leakage) that occurs after radical mastectomy in all patients;
• marginal necrosis with subsequent divergence of tissue flaps at their junctions; this occurs mainly due to excessive tension of soft tissues with their deficiency;
• accession of infection and suppuration of the wound.

The causes of lymphorrhea, regardless of the volume of the operation, are the removal of lymph nodes and the inevitable intersection of the lymphatic vessels connecting them. Ligation of all vessels during the operation is impossible, since most of them remain invisible. The duration of abundant lymphorrhea can be 1 month or more, which creates conditions for infection and the development of marginal necrosis, delaying the timing of additional anticancer therapy, the formation of a seroma (lymphocele) in the axillary zone, which is a cavity surrounded by a capsule and filled with lymph. Its formation requires repeated surgical intervention.

Late complications after mastectomy

They occur in all patients and with any technique, but they are especially pronounced when using the Halstead-Meier method. The complex of the most typical complications, called post-mastectomy syndrome, includes:

1. Violation of the outflow of lymph from the tissues of the limb (lymphostasis).
2. Narrowing or complete closure of the lumen of the subclavian and / or axillary veins, as a result of which the outflow of venous blood is disturbed.
3. The development of rough postoperative scars involving the axillary nerves.

These complications are the cause of prolonged or even permanent pronounced edema of the limb, the development of adductor contracture of the shoulder (in 60%), which limits mobility in the shoulder joint and is accompanied by frequent pain, and permanent disability.

Gymnastics

A certain positive result has gymnastics after a mastectomy, recommended by the US Association for Breast Cancer and Mastectomy. Gymnastics includes exercises such as combing hair, squeezing a rubber ball with a brush, rotating and swinging arms, putting them behind your back with a towel and fastening a bra.

Breast reconstruction

Breast reconstruction after a mastectomy is carried out simultaneously with the main operation or, if this is not possible, approximately six months after it. Many different reconstructive techniques have been developed, which are conventionally divided into 3 groups:

1. Reconstruction by the tissues of the patient himself, which is the movement of a tissue flap with preserved blood flow - the iliofemoral flap, the greater omentum flap, the rectus abdominis muscle flap with skin (TRAM flap) on a leg or free, and others.
2. Use of expanders and silicone implants.
3. Combined methods - the use of methods of the first and second groups. For example, tissue deficiency is filled with a flap from the back of the back, and silicone implants are used for additional volume, shape and symmetry correction.

Reconstructive methods in terms of their capabilities and effectiveness are arranged in the following sequence:

1. The maximum use of organ-preserving techniques is possible, followed by volume replacement by moving local tissues. This option in most cases allows you to recreate the volume, shape and even symmetry of the mammary glands.
2. Reconstruction of the gland using endoprostheses after subcutaneous mastectomy with preservation of the nipple-areola complex. It is also possible to combine the same mastectomy method with a muscle (without skin) flap from the back and the addition (if necessary) of an endoprosthesis.
3. TRAM-patchwork method, which is used when it is impossible to apply the above options, since its technical implementation is much more difficult. In addition, it causes significant damage to the donor area.

Scheme of breast reconstruction using a musculocutaneous flap

Scheme of breast reconstruction TRAM - flap

Scheme of breast reconstruction with a DIEP flap

Treatment of breast cancer is planned by an oncologist surgeon with the participation of other specialists - a morphologist, a chemotherapist and a radiologist, which allows for the optimal choice of the method of surgery, systemic treatment and postoperative rehabilitation.

What is a mastectomy? This is an operation to remove the breast. The main indication is breast cancer. Sometimes this surgical intervention is resorted to with an intractable inflammatory process or trauma to the mammary gland.

The purpose of this operation is to prevent the spread of the oncological process. Removal of the breast in women is achieved by complete removal of the tissue of the gland itself, the surrounding subcutaneous fat and lymph nodes. Therefore, a mastectomy is considered a radical operation.

Types of mastectomy

There are many ways to remove the breast, but the main techniques are:

• according to Halsted-Meyer;
• by Patty;
• by Madden.

Important! The type of mastectomy operation for breast cancer is chosen by the doctor in accordance with the stage of the oncological process.

Stages of breast cancer: 1st - the oncological process is localized within the breast tissue; 2nd - the spread of tumor cells occurs in the thoracic lymph nodes; 3rd - axillary lymph nodes are affected; 4th - metastases in other organs.

Mastectomy according to Madden

This modification of the operation is considered the most gentle, because. when it is performed, only the gland itself is removed with subcutaneous fat and lymph nodes. However, its implementation is possible only at 1-2 stages of the oncological process.

After the incision, the wound expands, the glandular tissue is separated from the surrounding and removed. The next step is excised subcutaneous fat, thoracic, subclavian and supraclavicular lymph nodes. The pectoral muscles are preserved.

When the wound is sutured, drainage is performed, which lasts for about 4-5 days. With a favorable course of the postoperative period, the woman is discharged home on the 4th day. The stitches are removed after 10 days.

Thanks to the preservation of muscles, this operation does not impair the mobility of the shoulder joint.

Important! After the removal of the breast according to Madden, chemotherapy and radiation therapy are necessary, because. there is a risk of retaining single tumor cells that can relapse.

Mastectomy by Pati

The indication for surgery for the removal of breast cancer with this modification is the presence of tumor cells in the axillary nodes (stage 3).

The difference between this operation and the Madden modification is the removal of the axillary lymph nodes and the pectoralis minor muscle.

After removal of the breast, the muscle tissue is intersected, which allows you to get a deeper and more complete access to the subcutaneous fat and lymph nodes with metastases.

Important. This type of mastectomy is more traumatic than the previous one, because. there is a partial violation of movement in the shoulder joint due to the removal of the pectoralis minor muscle. Perhaps the occurrence of cicatricial changes in the subclavian vein. The subsequent formation of the breast with an artificial implant is also difficult.

Mastectomy according to Halsted-Meyer

This operation is the most traumatic and disabling. It is used in the 3rd stage of breast cancer. Recently, its use has been limited.

1. A fringing incision is made around the gland, and it is removed.
2. The wound expands to the axillary region.
3. Subcutaneous fat and lymph nodes are removed there.
4. The pectoralis major and minor muscles are excised.
5. The chest wall is cleaned of the remaining fiber.
6. Drainage is installed, the wound is sutured.

This type of mastectomy leads to a violation of the mobility of the arm. The postoperative period and rehabilitation stretch for a long time.

Important! The only indication for performing a Halsted mastectomy in the modern world is the defeat of the tumor process of the pectoralis major muscle.

Complications

Mastectomy, like any operation, has a number of complications that can lead to negative consequences up to the death of the patient:

• Bleeding. During the removal of the breast, the integrity of tissues and blood vessels is violated, which leads to a certain blood loss. In order to minimize it, a special device is used in surgery - an electrocoagulator. In the postoperative period, tight bandaging and aminocaproic acid are used to stop bleeding.

• Infection. Suppuration of the wound occurs most often by the end of the first week of the postoperative period. To prevent this complication during the operation, the rules of asepsis and antisepsis are strictly observed, and a course of antibiotic therapy is prescribed.
• Exudate. The intersection of the lymphatic vessels during the operation leads to the accumulation of copious amounts of fluid in the area of ​​the postoperative wound. In the absence of adequate outflow tracts, it can suppurate. Drainage is used to prevent lymph stasis.

These complications are observed in the early postoperative period.

Late complications include:

• violation of the functioning of the shoulder joint;
• lymphostasis in the hand;
• muscle weakness on the affected side.

Early onset of rehabilitation (massage, gymnastics) reduces the likelihood of upper limb dysfunction.

What to do after breast removal?

Breast plastic after mastectomy is possible! The timing of this operation varies. For tumors of small sizes of stage 1-2, removed by Madden's modification, reconstruction is possible simultaneously with mastectomy.

If the oncological disease was operated on at stage 3, between the removal of the mammary gland and the installation of the implant, an average of six months to several years passes. This time will be required for a full chemotherapy and radiation therapy.

Reconstructive operations are divided into two large groups:

• breast reconstruction with artificial implants;
• plastic with own tissues.

The use of artificial implants is possible only if a sufficient amount of tissue is preserved at the site of the removed mammary gland. Most often they are used after Madden surgery.

Plastic surgery with own tissues is used after more traumatic operations for the removal of a breast tumor (according to Patey and Halstead).

Important! The choice of this or that technique is carried out by the attending physician, because. it is he who decides which of them will achieve the best cosmetic result. During the reconstruction process, some surgical correction of a healthy gland is possible. This will achieve maximum symmetry.

They achieve reconstruction of the nipple by using their own tissues, and the areola is recreated using dermopigmentation, or simply permanent makeup

In order for the result of plastic surgery to be fixed, and the postoperative period to pass easily and without complications, some requirements must be observed:

• exclusion of any physical activity for six months;
• strict control of one's own weight (with rapid weight gain, asymmetry may occur due to increased fat deposition in a healthy breast);
• exclusion of smoking and alcohol;
• full nutrition with a normal content of meat and vegetables in the diet;
• refusal of drugs that affect the blood coagulation-anticoagulation system;
• obligatory wearing of supporting bandages or underwear for six months.

The chest is a decoration of a woman! However, it is not worth risking your life because of it. When the first symptoms of anxiety about breast cancer appear, you should immediately consult a doctor. A mastectomy can save a life. And the subsequent plastic will return the former beauty.