Indications for mastectomy. Elective and preventive mastectomy: what is it, indications and result of treatment, reconstructive plastic surgery after surgery

With active growth malignant tumor in the chest, a severe purulent lesion of the gland, the detection of sarcoma or nodular mastopathy, often degenerating into cancer, the patient is prescribed a mastectomy. What it is? Resection of the affected breast and nearby lymph nodes is performed at a high risk of metastasis and tumor growth.

Is it necessary to remove the mammary glands? How is the recovery period going? How to eliminate a cosmetic defect? What is a preventive mastectomy? Answers in the article.

general information

The operation involves the removal of the affected gland, if indicated, the excision of the axillary lymph nodes and pectoral muscles in combination with fatty tissue. The type of surgery depends on the size and stage of the tumor, the presence or absence of metastases, and the type of neoplasm.

Important nuances:

• timely removal of ductal carcinoma, sarcoma, and other types of tumors reduces the risk of an extensive pathological process and the formation of distant foci with atypical cells;
• when a mutated BRCA1 gene is detected, prophylactic mastectomy is effective - removal of the mammary glands in a precancerous condition, the presence of a family history of oncopathologies. After a preventive mastectomy, the risk of developing a malignant process is reduced from 90 to 3-4%. It is important to take into account the indications and limitations, to learn about the possible complications and consequences, the advantages and disadvantages of the operation;
• referral to a mammologist early stage oncopathology makes it possible to dispense with an organ-preserving operation. In advanced cases of cancer, the active process of metastasis requires excision of the affected mammary gland;
• you should not refuse a complete radical mastectomy if the mammolgog insists on this type of operation: the sooner the tumor stops its negative impact on the body, the more favorable the prognosis of therapy.

Breast removal requires highly qualified mammologist surgeons. A complex operation is performed under general anesthesia, duration - 3 hours or more. The duration of surgical intervention increases during reconstructive plastic therapy.

Lifestyle

Helpful Hints:

• eat right, sharply limit the amount of fat and salt to reduce swelling. Get food with the optimal amount of proteins, vitamins, carbohydrates. Fats - vegetable, food is not spicy, almost unsalted, not very sweet, without preservatives. It is necessary to limit baking, pastries, white bread, fast food. Pickles, marinades, mayonnaise, coffee, alcohol, fried foods are prohibited. You can not gain extra pounds;
• psycho-emotional balance, support of loved ones, overcoming depression, reducing the frequency of stress - important elements of recovery, prevention of complications;
• with the permission of the mammologist, after the complete healing of the scar, you can visit a sanatorium for a speedy recovery after the operation;
• useful lungs physical exercise. Be sure to develop hands, perform special exercises selected by a rehabilitation doctor. You can not overload the muscles, but the lack of movement in rehabilitation period leads to congestion, swelling, poor movement of lymph. Perform all exercises strictly with the permission of the mammologist, at the time specified by the doctor.

Possible Complications

Application modern methods resection of the affected mammary glands in combination with complex rehabilitation reduces the likelihood inflammatory process and spread of metastases. Exact adherence to the recommendations given by the mammologist reduces the strength of negative sensations after a mastectomy.

After the operation, some patients experience complications:

• the hand swells in violation of the outflow of lymphatic fluid;
• phantom pain in the area of ​​the operation;
• bleeding and poor wound healing;
• skin necrosis, contractures;
• reduced mobility shoulder joint;
• erysipelas of tissue with further degeneration into more severe forms: abscess, sepsis;
• depressive states, especially in the absence of desire or opportunity for breast plastic surgery;
• curvature of the spine, provoking pain in the cervical area and impaired posture.

An important factor that reduces the risk of complications is cooperation with a qualified mammologist-oncologist and surgeon. Mastectomy is a complex operation. Inaccuracies during the removal of the gland, the choice of an inappropriate method surgical treatment excluding individual features patients can lead to dangerous complications. You need to find a high-level clinic and an experienced doctor. Most medical institutions that use the latest equipment and an effective set of measures during the rehabilitation period offer women plastic surgery to eliminate a cosmetic defect.

Breast reconstruction

To reduce psychological discomfort, eliminate the defect after a complete mastectomy, the mammologist offers the patient to restore the shape and size of the breast after the operation. With a high qualification of a plastic surgeon, the difference between natural glands and restored organs disappears.

Two methods are applied:

• use of authentic (own) tissues of the patient. The doctor selects flaps of skin, fatty tissue and muscles from the buttocks, thighs, and abdomen. The technique is used less frequently than the second method of breast reconstruction;
• installation of implants- modern technique with high result. The doctor inserts a silicone implant into a special "pocket" to mimic the natural shape of the mammary glands.

Which method is more efficient and safe? Doctors are sure: method number 1 using their own tissues, but not every plastic surgeon will undertake such complex operation. Installation of implants is a simpler and less traumatic method. For this reason, artificial fillers are more often used.

If there are indications for a radical mastectomy, do not panic: Removing a breast often means starting life without the pain and fear of developing or progressing to breast cancer. With a genetic tendency to oncopathology, the detection of the BRCA1 mutagen, you can consult an experienced mammologist about preventive mastectomy.

Find out more useful information about the types of mastectomy and lifestyle after the intervention after watching the following video:

When doctors raise the question of the need for a breast mastectomy operation in front of a woman, many female mammologists panic and try to delay the issue and delay the operation as much as possible.

Meanwhile, in the dilemma whether or not to do a mastectomy, the time of the decision depends on the positive prognosis of the cure, and the quality of further rehabilitation and recovery.

It is necessary to understand what a mastectomy is, how dangerous it is with complications, what are its consequences, and how comforting the prognosis for a woman’s future quality life is.

The concept of mastectomy.

Mastectomy is the removal of the breast and part of the surrounding tissues by a surgical method. There are several types of mastectomy surgery, when, along with the affected mammary gland tumor, nearby muscle tissue, fatty tissue deposits and The lymph nodes.

Depending on the degree of damage to the breast cancer and the spread of metastases through the lymph nodes, one of the main types of mastectomy may be indicated.

Types and methods of mastectomy.

Mastectomy surgery is a partial or complete (radical) removal of the mammary gland. surgical methods. There are three main types or, in other words, the method of mastectomy operations:
1. Method Pati, or modified radical mastectomy. involves the complete removal of the mammary gland, plus the removal of the axillary lymph nodes of the 1st and 2nd order, along with the removal of the pectoralis minor muscle. This Patey mastectomy method is indicated for diagnosed breast cancer, when metastases have not yet penetrated deeply. This method is the most common, more than half of all mastectomy surgeries are performed with it.

2. Halsted method, or complete radical mastectomy. Mastectomy according to Halsted implies the most complete removal of the mammary gland, which is why it is called radical. This method of mastectomy removes all the axillary lymph nodes, as well as the small and large pectoral muscles, all fatty tissue. Only the thoracic nerve remains. Now the Halsted mastectomy is used only in severe last stages of cancer, in which deep penetration of metastases into adjacent muscles is diagnosed. This type of mastectomy is highly invasive and entails a forced extensive removal of the surface of the woman's body.

3. The Madden method, when the mammary gland itself is removed, and the nearby muscle tissue of the gland and axillary lymph nodes remain. Although often, during a mastectomy using the Madden method, the lymph nodes located directly in the mammary gland are removed along with it. Usually, a Maden mastectomy is a surgical procedure indicated for those women who have ductal carcinoma. This method is also used for prophylactic operations with a high probability of cancer on genetic grounds, such as the detection of a mutated BRCA1 gene.

4. Mastectomy can be performed with a part skin breast if the tumor has not spread to the skin. This is done when the patient is scheduled for further recovery operations mammoplasty for breast reconstruction with the introduction of breast implants - endoprostheses. If a woman does not want to wear an exoprosthesis and is ready to undergo additional plastic surgery for breast reconstruction, then this should be declared before the mastectomy. Then the surgeon - mammologist will be able to leave part of the skin. Such a decision on further reconstruction of the mammary glands is relevant for mastectomy using the Madden and Patey method. Now plastic surgeons They work just wonders and restore not only the shape and size of the breast, but also increase the areola and nipple.

Prophylactic mastectomy.

Since the Madden mastectomy is the most easily tolerated of all types of mastectomy, it can be done at the reasonable request of a woman to prevent and prevent the development of breast cancer when this mutagen is diagnosed. For example, such a mastectomy was performed by Hollywood actress Angelina Jolie, Miss America Helen Rose, Russian journalist Masha Gessen and some other famous women, for the purpose of prevention.

Apparently, for them, in the choice to do or not to do a mastectomy, the justified fear of getting cancer won out, because the statistics are relentless and predict the development of a cancerous tumor with a 90 percent probability if the BRCA1 gene is present in the body. To understand whether or not to do this operation, and even more so for a preventive purpose, you need to decide on possible complications after mastectomy and indications for its use.

Indications for mastectomy.

In the question of whether or not to do a mastectomy, the answer, as a rule, is unequivocal - to do. For a cancerous tumor has a tendency to progressive development and metastasis, which in most cases leads to death. In some cases, treatment with radiation and chemotherapy is possible to stop the cancer, with careful monitoring of its results. More often, such therapy is carried out as a preparatory or final stage for a mastectomy. The number of positive outcomes after mastectomy is steadily increasing, and gives the most guaranteed result. Therefore, mastectomy is the preferred method for fighting breast cancer.

1. So, as explained above, the indication for mastectomy surgery may be the presence of a mutated BRCA1 gene, but the decision whether or not to have the operation remains with the woman.
2. Purulent inflammation of the mammary gland, when no therapy helps, may be an indication for mastectomy.
3. Gynecomastia also has indications for mastectomy. Here, the focus is more on the cosmetic effect than on medical indications.
4. The main indication for mastectomy surgery, of course, is the detection of a cancerous tumor during the diagnosis of the mammary glands, no matter sarcoma, carcinoma or other types of cancer.

Complications from mastectomy.

Complications after mastectomy are divided at the psychophysical level.
1. Complications immediately after surgery are associated with the wound healing process.
- Profuse bleeding from the wound. Usually happens on the first postoperative period mastectomy. Stops bleeding with coagulant drugs. With prolonged non-healing of the wound, repeated excision may be required.
- The healing of the wound left by the mastectomy operation in the axillary region depends on general condition health of the patient and the presence or absence of chronic diseases. A disease like diabetes greatly increases the overall healing time.
- The healing process can be complicated by suppuration of the postoperative wound, antibiotics are used to combat this complication.
- At the last stage of the mastectomy operation, a drainage tube, to ensure the outflow of blood residues, tissue and lymphatic fluid, in common parlance, ichorus. Complications include profuse lymphorrhea.
- Lymphostasis and lymphedema is swelling of the arm after a mastectomy.

Swelling of the hand occurs due to violations of the circulation of blood and lymphatic fluid, its stagnation. Since during a mastectomy, lymph nodes are removed from the body of the mammary gland and the axillary region, the outflow of fluids in the parts of the body adjacent to the operated breast is disturbed. Lymphostasis usually affects the entire arm on the side of the operation. Treatment of swelling of the hand after a mastectomy comes down to special gymnastic exercises and breaststroke swimming. There are also various devices - expanders and lymphatic simulators, compression sleeves and bandages.

2. The second type of complications after mastectomy is associated with the woman's psychosexual experiences, often leading to a state of depression. This is facilitated by many factors, among which the most common are:

- suspiciousness and fears about the outcome of mastectomy
- a feeling of inferiority and inferiority and, as a result, difficulties and limitations in social contacts
- imaginary and real difficulties in the sexual sphere, due to insufficient attention of loved ones, with full preservation of libido
- fear of a possible recurrence of the disease

Treatment after mastectomy.

Treatment of the patient immediately after a mastectomy is mainly reduced to regular high-quality dressings and aspiration of the fluid formed in the wound. The postoperative period is not complete without antibiotic treatment. In the future, with the addition of secondary complications such as edema of the hand, treatment involves the addition of therapeutic gymnastics, swimming, wearing compression sleeves and bandages. Sometimes when wearing exoprostheses, there is a need to treat skin irritations, but this does not apply directly to the mastectomy operation itself.

O useful properties tinctures, extracts and. Thyme and thyme against colds.

Content

Breast cancer is a devastating disease modern world wide use. 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, useful to women 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 elimination 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 appointed, according to the results, the method of the operation is selected. Preoperative measures include:

• general, biochemical analysis blood;
• mammography of the breast;
• urine test;
• tissue biopsy;
• computed tomography;
• blood clotting test;
• research on tumor markers;
• prescribing a light diet;
• reception restriction medicines 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 adipose 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 calls serious complication- limited mobility of the shoulder joint due to muscle removal and nerve damage. As a result of the elimination a large number tissues, there are problems 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 growth rate of the tumor, and the hormonal state. 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 surgery, it is necessary to perform 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 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;
• appearance in lower limbs blood clots;
• 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

The women go to plastic surgery for breast reconstruction due to psychological discomfort. In addition, there are problems at the physical level associated with an imbalance of loads on the spine. After mastectomy observed:

• posture change;
• omission of the shoulder on one side;
• rachiocampsis;
• dysfunction 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 breast that is natural in appearance and sensations, transplantation of own tissues is used, which are taken from the back, front 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 shape, size, symmetry, reconstruction of volume, elimination of depressions is carried out using silicone implants.

Price

Mastectomy in Moscow is performed in specialized clinics, oncology centers. Surgical intervention 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

What types of breast removal surgeries are there?

Breast removal or mastectomy involves two elements: removal of the breast and removal of the axillary fat that surrounds subclavian vein. The operation may also involve the removal of muscles. It is for this element that all operations are divided into three types:

• radical mastectomy according to Halsted involves the removal of the large and small pectoral muscles, axillary fiber and mammary gland. Currently, this operation is performed very rarely.
• Patey modified radical mastectomy(“Patey mastectomy”) involves the removal of only the pectoralis minor muscle, axillary tissue and the mammary gland. It is currently the most widely used.
• modified radical mastectomy according to Madden(“Mastectomy according to Madden”) involves the removal of the breast and axillary tissue. Given the fact that this operation is the most functionally sparing, it is becoming more and more widespread.

As shown by numerous studies, the effectiveness of all these interventions is the same.

How is the operation selected?

Usually, at stage 1-2 of a breast tumor, a mastectomy according to Madden is performed, at stage 3, a mastectomy according to Pati is usually performed.

What is the course of the operation?

After the patient has fallen asleep, the surgeon uses a marker to mark the skin, along which the scalpel subsequently moves. Sequentially, the skin is exfoliated from the mammary gland, and the mammary gland is separated from the muscles. Then the surgeon "cleanses" the subclavian vein - this is the most dangerous moment of the operation. The accuracy of its implementation determines the quality of the operation. That is why I only use German-made personal instruments (Aesculap, Marina Medical). The high quality steel in the scissors will not corrode or dull for decades. Clips and tweezers made in Germany are neat and delicate with regard to fabrics.

After the removal phase is completed, bleeding is stopped from small vessels that are present on the skin and muscles.

A drainage tube is installed, which is subsequently connected to the "accordion" vacuum tank. Drainage is necessary in order to eliminate the remnants of blood from the wound, as well as to eliminate lymph from it, which inevitably accumulates in the wound.

Applied to the wound sterile dressing and sealed with medical glue or a special plaster.

The drainage is removed 3-5 days after the operation.

What stitches are applied?

I almost always put cosmetic sutures. The advantage of such sutures is that the wound heals much faster. Cosmetic sutures do not need to be removed. The threads used (I usually use the threads of the company B BRAUN, made in Germany or Johnson & Johnson, Covidien) dissolve on their own in the tissues and leave no traces behind. In addition, cosmetic sutures look more neat, and I hope that this is a small, but still joy for the patient after such a traumatic operation.

What complications can be?

Complications from mastectomy are rare. This operation is one of the safest in oncology. However, you should be aware that the following early complications exist:

• bleeding. To prevent bleeding, I use a special power tool that stops bleeding from small vessels. The use of a hemostatic solution - a solution of aminocaproic acid - has proven itself well (it is placed in the wound during surgery, then evacuated through drainage). And, of course, the main element in the prevention of bleeding is bandaging - after the operation, an elastic bandage is applied around the patient's body. If blood accumulates in the wound, then this requires a second operation, during which the bleeding is stopped.
• infections. They can appear 7-8 days after the operation. The main source of microbes is the patient's skin. For prevention, skin treatment with a special disinfectant solution is used. I also use the “minimal skin injury” surgical technique, which involves minimal trauma to the skin. To prevent infection, the introduction of antibiotics before surgery (on the operating table before the operation) is used. If an infection occurs, antibiotics are prescribed. Within 2-3 days, the manifestations of the infection disappear.
• accumulation of fluid in the wound. Due to the intersection of the lymphatic tract, fluid begins to accumulate in the wound. First, it is evacuated through the drainage, then it is evacuated by puncture. The accumulation of fluid in the wound is a fairly frequent and natural phenomenon. Usually accumulation occurs within 3-4 weeks, which requires regular punctures (needle prick and fluid evacuation). The use of Unovak drains, which can be installed on long time, allows the patient not to apply regularly for dressings.

Late and quite natural complications of the operation include:

• impaired mobility in the shoulder joint
• decreased muscle strength in the arm on the side of the operation

Is it possible to restore the mammary gland immediately after a mastectomy or after a while?

Yes, with stage 1-2 breast cancer, it is possible to perform simultaneous breast reconstruction using an expander (temporary prosthesis-stretcher), own tissues (thoracodorsal flap, TRAM). At stage 3, it is optimal to perform a delayed reconstruction (after the completion of the main treatment).

The course of the operation of a radical mastectomy depends on how it is performed. There are several modifications aimed at reducing the volume of the operation, in accordance with the characteristics of the development of pathological processes.

By Madden

Radical mastectomy according to Madden provides for the preservation of the large and small muscles of the chest and lymph nodes of the third level, which can significantly reduce the amount of surgical intervention. Today, this technique is the most common in Russia. During the operation, the following are subject to removal:

• breast;
• lymph nodes of the first and second levels.

By Patty Dyson

The volume of the operation is reduced due to the preservation of the pectoralis major muscle. During surgery, remove:

• breast;
• small pectoral muscle;
• lymph nodes of three levels.

This technique is used if there is a complete removal of the mammary gland and there are metastases in the lymph nodes of the first, second and third levels. It allows you to exclude a pronounced deformation of the chest wall, but can also cause atrophy of the outer part of the large chest muscle.

By H. Auchincloss

This modification allows to reduce the volume of the operation by preserving the lymph nodes of the 2nd and 3rd levels along with the pectoral muscles. In the process, the mammary gland and lymph nodes of the 1st level are removed.

Simple mastectomy

The purpose of the operation carried out according to this technique is the removal (excision) of the mammary gland with a capsule and skin. The fiber of the armpit is not removed. According to the indications, a subcutaneous mastectomy can be performed, which allows you to save the nipple-areolar complex if it is not affected by the disease.

According to Halsted-Meyer

This modification of the mastectomy involves the removal of:

• breast;
• lymph nodes of three levels;
• pectoralis major and minor;
• subcutaneous fat;
• fascia.