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What is a breast mastectomy. Mastectomy: what is it, how is it performed

The method of removing pathological tissues from the female breast with minimal trauma to healthy muscle and fatty tissue is called a mastectomy. Scientists around the world are striving to create an optimal method of treatment that will reduce the degree of damage to this organ with the least damage to its tissues and the final deformation of the shape of the breast. After all, the operation to remove the mammary gland, which was performed earlier with maximum tissue damage, caused a strong psychological shock in a woman, significantly lowering her self-esteem.

What is a mastectomy

Surgical removal of pathological mammary gland tissues with the least trauma to the breast when diagnosing this organ, while there is no effect on the subscapular and sternal muscle tissues, undamaged subcutaneous fatty tissue is not removed, which makes it possible to keep the woman’s breast practically unchanged. The surgeon also does not affect The lymph nodes in this area, which allows you to maintain health and not change the functioning of the breast.

Preservation of the halo of the nipple and breast muscle tissue is an important step in the procedure for removing pathological breast tissue, because 10 years ago this operation was performed with the complete removal of the organ, leaving a completely flat chest. This became a serious obstacle to the psychological comfort of the woman, and there were no methods for breast reconstruction. Thanks to the mastectomy operation, it became possible to most effectively rid the woman's body of actively multiplying pathological cells and maintain the shape and appearance chest.

Prophylactic mastectomy at risk of developing breast cancer is the topic of this video:

Her types

Today, modern surgery offers some of the most effective methods to remove cancer cells from breast tissue, which allows you to stop tumor growth even for early stage, preventing the active growth of pathology, preventing the occurrence of a danger to the health and life of the patient.

The following types of mastectomy will be applied today to the methods of removing cancer cells in diagnosing the development of breast cancer:

simple mactoectomy, or the Maden method. This method consists in the complete removal of the mammary gland with no impact by the surgeon on the adjacent muscle and adipose tissues, as well as on the sternal, subscapular lymph nodes. The Madena method is recommended for detecting pathology at an early stage, as well as as a preventive measure in the presence of a genetic predisposition to the oncology;
Patey's method, or for the removal of pathological breast tissue in the diagnosis of early and advanced stages of cancer of this organ. The Pati method consists in removing the infected mammary gland along with cartilaginous tissues at its ends, which allows you to completely remove pathological cells from the body, preventing them from spreading to adjacent tissues. Part of the sternum with subscapular lymph nodes can also be removed - this is recommended if spread of metastases to the lymph nodes is suspected;
Halstead method, which is used in the detection of cancerous pathology at the most advanced stage, when other methods are not effective and pathological cells have spread deep into adjacent tissues. The Holsten method is considered radical, since it involves a complete excision of the mammary gland itself, adjacent fatty and muscle tissues. For the correction of the breast and the maximum possible preservation of its volume and shape, modified types of this operation can be used.

Also, women who are diagnosed with oncological lesions of the breast are offered to undergo reconstructive surgery in parallel with the performance of a mastectomy. This can be done with the use of one's own fatty tissues, as well as with the help of silicone implants, which reconstruct the shape of the breast and give a woman hope for a normal future life with minimal psychological losses. This type of surgery for the treatment of breast cancer is chosen by about 75% of women with advanced cancer.

Lightweight silicone prosthesis ACTIVE 1054X after mastectomy (photo)

Indications for holding

An operation to remove breast tissue affected by cancer cells by mastectomy is indicated when both neglected and initial stage oncological disease of this organ, as well as in the presence of a hereditary tendency to cancerous lesions of the body.

Usually this method is considered the most suitable for women with this disease who have a small breast size. This is due to the fact that when an oncological tumor, especially a large one, is detected, the surgeon may be offered an iron-sparing operation, which allows you to save most of the breast tissue. In this case, after the removal of the pathological parts of the organ, a course of irradiation should be performed, which often causes breast deformity. In each case, the surgeon recommends a certain type of operation.

The indications also include her, if they are not amenable to conservative treatment.

Exoprostheses after mastectomy are discussed in this video:

Contraindications

However, there are a number of contraindications that should be taken into account by the doctor when choosing the method of exposure when diagnosing breast cancer. The most important situations and conditions in which it is not recommended to perform any type of mastectomy include the following:

early childhood when the breast tissue is not yet fully formed;
inflammatory processes in the affected area - before performing a mastectomy, they should be completely cured;
infected wounds on the surface of the skin of the chest;
heavy forms , and .

Recovery after surgery

The process of rehabilitation and recovery damaged after a mastectomy of any kind may vary in its duration in different cases. For example, with parallel breast modeling using own tissues and silicone prostheses, it will take a slightly longer time for the complete restoration of breast tissues, since the body needs to adapt to foreign bodies, while the doctor monitors the entire process of the patient's rehabilitation.

After the mastectomy, the patient is in the ward of the clinic, she is released from anesthesia, which is used for this type of surgical intervention. With the full restoration of indicators such as pulse, the woman no longer needs the constant attention of a doctor. In the absence of pronounced deterioration in general well-being, she can be allowed to go home to continue recovery at home, however, even there the woman must fully comply with all the requirements of the attending physician.

These include:

the absence of significant physical and psychological stress in the period after the mastectomy;
bed rest is a prerequisite for the recovery period;
getting out of bed is allowed only for 3-5 days, depending on the woman's well-being;
a full return to the usual way of life is permissible on the 20th day from the date of the operation.

Since the operation of a mastectomy is serious for the whole body, you should avoid stress for six months from the moment it was carried out, perform a light massage of the armpits with preserved lymph nodes. In the process of recovery, when working in the garden, use rubber gloves, prevent even minor abrasions and cuts from appearing on the hands, developing the hand from the side of the body where the mastectomy was performed.

Healing time may vary depending on general condition patients, the use of silicone prostheses, the use of which slows down the recovery process. The doctor may give additional recommendations to speed up the recovery process.

Prostheses

In the case of a significant amount of removed parts of the mammary gland with an advanced form of the disease, the impossibility of using one's own tissues to correct the shape and volume of the breast, the doctor may recommend the use of silicone prostheses, which avoid psychological problems in the operated woman. Their shape is determined before the operation, for which women wear such prostheses for some time before the mastectomy, determining how comfortable one or another of their shape and size is.

After the removal of pathological tissues, the doctor installs the selected prosthesis, which is evenly distributed in the chest and then left there. The healing process during its installation is somewhat lengthened, since the body needs to adapt to its presence and not cause rejection.

To prevent the occurrence of congestion, the doctor may recommend conducting special exercise, which will stimulate blood circulation in the operated area, will not create places for lymph stagnation. It usually takes about 4-5 weeks for a full recovery after a mastectomy, but with the use of breast prostheses, it may take longer. During the recovery period, constant medical supervision is recommended, especially when installing prostheses and performing surgical correction of the breast.

How to perform a mastectomy, see this video:

(BC) affects women of any age group, but more often this disease is recorded in those who have crossed the 40-year mark. There is also a genetic predisposition to breast cancer: approximately 10% of such patients from the total number established diagnoses. At the same time, patients with altered BRCA1 and BRCA2 genes, as well as those who have a history of family cases of breast cancer or ovarian cancer, are recommended bilateral prophylactic mastectomy, as the only effective remedy prevention of the development of the disease.

When is a prophylactic mastectomy necessary?

Currently, doctors know more than 15 genes, the change of which significantly increases the risk of developing breast cancer. The mutation of the BRCA1 and BRCA2 genes, which are inherited (familial forms of breast cancer) and in 87% of cases cause malignant processes in the mammary glands and ovaries, is the best studied. Women with a burdened family history of breast cancer should regularly undergo preventive examinations:

In the period from 25 years to 50 years - 2 times a year ultrasound of the mammary glands or once a year chest MRI;
After 50 years - mammography screening at least once a year.

A defective BRCA1 gene mainly “triggers” breast cancer after the age of 35, while carriers of a mutated BRCA2 gene develop the disease mainly at the age of over 40 years. Moreover, even if a unilateral breast resection has been performed in the past, the risk of tumor formation in the second gland remains extremely high. To prevent the development of breast cancer, women at risk are recommended bilateral prophylactic mastectomy, which reduces the likelihood of developing the disease in 89-100% of cases.

In order to prevent unreasonable removal of the mammary glands, all patients must undergo DNA examinations, after which a geneticist can assess the risk of developing breast cancer. Next, a possible tactic of action is discussed with the woman:

Monitoring the state in dynamics.
Prescribing drug therapy.
Removal of both ovaries with a preventive purpose.
Prophylactic bilateral mastectomy.

In cases where a woman chooses the latter option, an additional consultation is held with a breast surgeon, and, if necessary, with a specialist in plastic surgery to discuss the issue of subsequent reconstruction of the mammary glands.

Before and after

Prophylactic mastectomy technique

Bilateral prophylactic mastectomy with simultaneous breast reconstruction, a 33-year-old patient.

The essence of the operation and the recovery period

Bilateral prophylactic mastectomy is performed under general anesthesia, while only the mammary gland tissues are subject to removal. Axillary and intrathoracic lymph nodes remain.

Tissue incisions are made in a semi-oval shape under the breast or through the areola (depending on the chosen technique):

Subcutaneous resection is performed in such a way that the integrity of the areola and nipple is preserved, and in the future it was possible to perform breast plastic surgery.
The skin-preserving technique involves the removal of the nipple-areolar complex, however, the necessary conditions for further breast reconstruction are observed.

At the last stage of the operation, after all the glandular tissue has been excised and the bleeding has stopped, the wound is sutured in layers and drainage is introduced into it for 3-14 days to drain the secreted fluid.

Considering that bilateral prophylactic mastectomy is performed not to treat an existing disease, but to prevent it, there is no need for additional therapeutic measures (radiation or chemotherapy, hormone therapy).

Bilateral prophylactic mastectomy (removal of the mammary glands) can be performed with or without simultaneous reconstruction. In the first case, it is possible to perform both a skin-sparing mastectomy (the nipple-areolar complex is removed) and a subcutaneous mastectomy (that is, with preservation of the areola and nipple). Due to the convincing evidence of the high efficiency of prophylactic mastectomy, this type of operation is included in a number of national and international recommendations, including recommendations:

Association of Oncologists of Russia,
European Society mastologists,
National Comprehensive Cancer Society (USA).

To date, we have extensive experience in performing such operations, which reduce the risk of developing breast cancer by 90%. The first such operation in Russia was performed by our specialists on January 23, 2007.

Rehabilitation

Rehabilitation of the patient after the operation is quite fast:

In the evening on the same day, you can get up, move around within the ward. The next day, with good health and condition, you can go home. In the future, visits for dressings 2-3 times a week and classes physical therapy.
On the 3-14th day, the drainage tubes are removed, on the 10-20th day, the sutures are removed. 2-3 weeks after the operation, a woman can return to her usual life.
After 2-3 months, it is possible to visit saunas, baths, swimming pools, solariums, as well as perform any physical activity.

In the case of simultaneous reconstruction of the mammary glands, additional manipulations are possible, depending on the reconstruction option (bandaging on the abdomen and wearing a bandage during reconstruction with tissues transferred from the abdomen; expanding the expander if it was used for reconstruction, etc.) No less important during the entire during the recovery period, wear compression hosiery, which promotes faster wound healing, improves blood circulation in the chest and protects the sutures from possible damage.

The main features of our technology are:

Total removal of breast tissue, including tissue behind the areola.
Skin incisions and intradermal suture to achieve maximum aesthetics.
Careful histological examination breast tissue (undiagnosed tumors may be hiding there).

Breast pathologies are found in both women and men. Most of them pose a threat to health and require mandatory medical intervention. When conservative therapy diseases is ineffective or impossible, surgical treatment is performed - a mastectomy. What it is, in what cases it is prescribed and what you need to know about the postoperative period, we will find out further.

What it is

A mastectomy is a surgical operation to remove the breast. Together with it, adjacent lymph nodes and subcutaneous fatty tissue are excised. Depending on the type of intervention, the small and/or large pectoral muscles are also removed.

The purpose of the operation is to prevent the spread of pathological processes in the mammary gland.

This is a serious traumatic procedure associated with risks and possible postoperative complications, but for some breast diseases, only a mastectomy performed gives a chance for life.

Indications for mastectomy

Radical intervention in the treatment of diseases of the mammary glands is carried out mainly in women (97% of all cases) and is prescribed:

in the presence of ;
at ;
with multiple;
at ;
with its complications (phlegmonous or gangrenous forms);
to prevent the development of breast cancer, if the patient is at risk for a genetic predisposition.

Mastectomy is less commonly performed in boys and men. An indication for its appointment is gynecomastia - an increase in the mammary glands associated with hormonal disorders in the body.

Types of Surgery

Even in the recent past, mastectomy was performed in one standard way - radically according to Halsted-Meyer. During the operation, the affected mammary gland was completely removed along with the muscles, lymph nodes and subcutaneous fat located in the axillary, subclavian and subscapular regions.

Advances in surgery have expanded the possibilities of surgical intervention in the treatment of breast diseases - more gentle (but no less effective) solutions have been found.

Currently, several types of mastectomy are used:

partial;
radical (classical and modified);
preventive.

The choice of intervention depends on the stage and degree of breast pathology, as well as on the age and general health of the woman.

Partial mastectomy

With a partial mastectomy, only the part of the breast where the tumor is found is removed. Such an operation is possible at an early stage of cancer, with purulent forms of mastitis, fibrocystic mastopathy.

In cancer, a course of radiation therapy is mandatory to prevent further spread of malignant cells. After the operation, constant monitoring of the condition of the breast is necessary, and in case of recurrence, a radical removal of the gland is indicated.

Radical mastectomy

The classic version of the radical mastectomy (according to Halsted) is still used today. The operation is performed in the following cases:

involvement in the process of spreading the tumor cells of the pectoralis major muscle;
metastasis to lymph nodes located on the posterior surface of the muscle;
in palliative medicine to alleviate the patient's condition.

The method often leads to postoperative complications, especially the limitation in the mobility of the shoulder joint.

If a woman does not have indications for a classic radical mastectomy, the choice is made in favor of more gentle modified intervention options:

according to the Patty-Dyson method with the removal of the mammary gland, lymph nodes, adjacent tissues and pectoralis minor muscle;
according to the Madden method, in which both chest muscles are preserved.

Operations are accompanied by significantly less blood loss and faster healing of sutures. The main advantage is the reduction of postoperative complications.

Prophylactic mastectomy

Mastectomy to prevent the onset or development of breast cancer is prescribed for women with a genetic predisposition to the disease (if a BRCA gene mutation was detected in the tests) or for those who already had cancer of one breast.

The intervention is carried out both radical and partial with preservation of the nipple and areola of the breast. It can be one-sided or two-sided. During a mastectomy, it is possible to simultaneously reconstruct the mammary glands.

Analyzes and preparation for surgery

Mastectomy is prescribed only if the relevant diagnoses are confirmed after laboratory tests, analyzes and hardware examinations of the patient.

Before the operation is assigned:

general and clinical analysis blood;
x-rays of the breast and armpits (mammography, axillography);
Magnetic resonance imaging;
breast biopsy.

The preparation before surgery also includes the passage of an ECG, fluorography. A personal examination of the patient by a specialist is required. The doctor must be informed of the following:

about accepting all medicines or dietary supplements, even if they are herbal tinctures or vitamin complexes;
about existing chronic diseases and previous serious illnesses;
about a possible allergic reaction to drugs or general anesthesia.

In the presence of inflammatory processes in the body, 2 weeks before surgery, the patient should undergo a course of antibiotic therapy.

One week before a mastectomy, if you use blood thinners, you must stop taking them.

Before the operation, you can not eat (12-16 hours) and drink (2-4 hours), it is recommended to do a cleansing enema the night before.

In addition, it is necessary to take care of who will pick up from the hospital and take care of postoperative care.

Risks associated with a mastectomy

Like any other surgical intervention, a mastectomy is associated with risks and possible complications during the procedure:

risk of pulmonary embolism (formation and detachment of a blood clot);
breathing problems;
allergy to anesthesia or medications;
bleeding and blood loss;
heart attack.

Complications can be prevented if the doctor is warned in advance about allergic reactions and past illnesses and carefully follow the recommendations for preoperative preparation.

How is the operation performed

Mastectomy is performed under general anesthesia, the duration is 2-3 hours, depending on the type of intervention. The operation time will increase if reconstructive surgery is performed at the same time.

The surgeon uses a scalpel to make an oval incision under the breast from the inside of the sternum to the armpit, 12-16 cm long. Breast tissues are removed along with subcutaneous tissue, subclavian, subscapular and axillary lymph nodes, if necessary with the pectoral muscles.

Then the incision is sutured, absorbable sutures or staples are applied, which are removed by the doctor after 12-14 days. To remove excess fluid and accelerate wound healing, drainage is installed under the skin of the chest - one or two plastic tubes.

At the end of the operation, the woman is transported to the ward, where she is under the close supervision of medical personnel for the first 36-48 hours.

Postoperative period

Mastectomy is one of the most complex surgical interventions. The postoperative recovery period lasts 2-3 months. Within the walls of the medical institution, you will have to spend no more than 4 days, if it was done - about a week. During the first month, you will have to regularly visit the hospital for dressings and examination.

The next day after the operation, you can get up and start walking slowly. It is recommended to start rehabilitation measures as soon as possible, which will be prescribed by the doctor. This will prevent the risk of complications and speed up recovery.

Immediately after the withdrawal from anesthesia and the next 3-4 days, intense pain in the chest area. To reduce their severity, the doctor will prescribe painkillers.

Discharged home with drainage tubes, they are removed after 5-7 days during the follow-up examination. The nurse should teach you how to handle the drain and tell you about the rules for maintaining body hygiene without damaging the dressings and the drain.

Consequences of a mastectomy

After the removal of the mammary gland, a woman has an extensive wound surface in the chest area, which requires proper care. Such interference rarely passes without a trace for the physical and mental health women.

Experts identify several of the most common consequences of a mastectomy.

early and late complications;
relapses of diseases;
psychological trauma associated with loss of attractiveness, disability.

Knowing about possible consequences operations and methods of overcoming them in advance, panic can be avoided and it is easier to deal with them.

Complications after mastectomy

Despite the fact that the methods of surgical intervention are constantly being improved, the number of various complications remains high.

Patients most at risk:

the elderly (over 60 years old);
with overweight;
from chronic diseases(of cardio-vascular system, diabetes, hypertension);
having breasts big size(from the 4th);
after radiation or chemotherapy.

Preoperative preparation of this group of patients should be carried out even more carefully, and rehabilitation procedures - more carefully.

Allocate early and late postoperative complications. Early (arising within the first 3-4 days) include:

bleeding due to poor blood clotting, divergence of seams;
leakage of lymph (lymphorrhea);
marginal necrosis with divergence of sutures;
infection and suppuration of the wound surface (occurs when aseptic and antiseptic rules are violated during surgery or during the dressing process).

In addition to early complications, women often experience long-term consequences of a mastectomy:

violation of the outflow of lymph from the hand, which leads to stagnation of the lymphoid fluid and a strong increase in the limb in volume (lymphostasis);
violation of venous circulation due to damage to the subclavian or axillary veins;
erysipelas provoked by lymphostasis and the addition of streptococcal infection;
the appearance of keloid scars that cause pain when moving;
swelling of the shoulder area, loss of skin sensitivity;
limited mobility of the upper limb;
phantom chest pains.

Prevention of the development of complications and the duration of the recovery period after surgery largely depends on the qualifications of the surgeon and on the patient herself.

Relapses after mastectomy

Even after a successful operation to remove the mammary gland, relapses of cancer sometimes occur. They occur 6-12 months after surgery and are more aggressive and more difficult than the first time.

The reasons for relapses are:

insufficient diagnosis (during the examination, it was not possible to identify individual malignant cells, so they were not removed);
operations performed in the later stages of the disease;
metastasis to regional lymph nodes;
lack of radiation or chemotherapy after mastectomy;
poorly differentiated form of the tumor.

If within five years after the operation no relapses of the disease were detected, the cancer is considered defeated.

Psychological trauma

For some women, the most serious complication after a mastectomy is depression associated with the realization that they have become sexually unattractive, inferior, flawed. Also, stress can be caused by a forced change in lifestyle, which occurs in the postoperative period due to the weakening of the body and the inability to perform the usual household chores and work.

In overcoming psychological trauma, the support of family and relatives, friends, and attending physicians is important. In severe cases, it is recommended to seek help from specialist psychotherapists. In order not to complete due to the lack of a breast, it is necessary to purchase special corrective underwear or resolve the issue of breast reconstruction.

Problems with stitches after mastectomy

Slow healing of postoperative wounds (inflammation of the sutures, pain) is a problem that half of women face after a mastectomy for cancer. This is due to the inhibition of metabolism in cancer. The situation is complicated by postoperative treatment using medicines that inhibit or completely suppress cell division (chemotherapy).

To heal the sutures, it is necessary to treat them with antiseptic, anti-inflammatory and wound healing ointments:

Baneocin;
Solcoseryl;
Stellanin;
Methyluracil;
Eplan;
Vulnazan.

Compliance with the rules of hygiene and treatment regimen will contribute to the speedy tightening of the seams.

Lymphostasis and swelling of the hand

Stagnation of lymphatic fluid in the arm (lymphostasis) after a mastectomy occurs as a result of the removal of lymph nodes during the operation, as a result of which the lymph circulation is disturbed. In this case, there is swelling and pain in the limb, a decrease in muscle tone. The hand can increase in size several times compared to a healthy one.

To eliminate lymphostasis, a whole range of measures is used:

massage and self-massage;
wearing a compression sleeve;
photodynamic therapy (using a monochromatic emitter);
taking medications (diuretics and venotonics);
metabolic therapy (use of natural antioxidants);
diet;
physiotherapy.

Swelling of the hand usually disappears a month after the onset of the pathology, but can persist for several years without responding to treatment.

Contraindications after surgery

A complex of rehabilitation measures helps to avoid postoperative complications and shorten the recovery time. But the success of rehabilitation therapy is greatly influenced by the implementation of the doctor's recommendations on the rules of behavior and regimen after mastectomy.

It is necessary to avoid crowded places, injuries. Due to disruption of the lymphoid system and weak immunity, any infection or scratch can lead to serious health consequences.
Within three years after the operation, you can not lift more than 1 kg with your hand from the side of the removed breast, more than 3 kg with the other.
Do not raise your arms, bend low, mop floors or hand wash.
The first three months should refrain from sexual activity.
You can not visit baths or saunas, take hot baths.
If the operation was performed to remove cancerous tumor, it is not recommended to become pregnant for 2-3 years - hormonal changes in the body can lead to a relapse of the disease.
Within three years it is not recommended to change the climatic zone of residence, go on vacation to hot countries.
Smoked meats and canned food should not be present in the diet. It is best to switch to a salt-free diet.
You can not smoke and drink alcohol.

It is impossible to do without the help of relatives and friends in the postoperative period. Relatives should take over all the housework (gardening) to ensure that the mastectomy patient has the conditions for a speedy recovery. The care of relatives and the common sense of the woman herself are the key to a full recovery in a short time.

How to hide stitches after mastectomy

After removal of the mammary gland, any woman experiences discomfort about the changed appearance, is embarrassed by postoperative scars and scars. In this case, underwear for women who have undergone a mastectomy can help improve the psycho-emotional state. Its main task is to maintain the exoprosthesis of the mammary gland and mask the sutures.

Corrective bra

After a mastectomy, it is recommended to use a bra with a special pocket for the exoprosthesis. It can be worn immediately after the drainage is removed. The special design of underwear does not cause discomfort while wearing and contributes to an even distribution of the load on the spine.

Swimwear after mastectomy

To hide the seams and lack of breasts, you can purchase a corrective swimsuit. It is convenient to do physiotherapy exercises in the pool, hydrokinesiotherapy or just go to the beach.

The swimsuit sits comfortably on the figure, has a pocket for the prosthesis, does not compress or squeeze the chest.

Before choosing special underwear, you should consult with your doctor about the type, size and shape, especially if breast reconstruction is planned.

Breast reconstruction after removal

After a mastectomy, women often resort to reconstructive surgery to restore the volume and shape of the breast - mammoplasty. The operation allows patients to return to a full life and has a positive effect on their psychological state.

Reconstruction is carried out according to different methods, the timing of the possible operation also varies. The choice of breast reconstruction method depends on the type of surgical intervention to remove the mammary gland, the presence of postoperative complications and the wishes of the woman herself. One-stage mammoplasty is possible with subcutaneous and prophylactic mastectomy. After a radical removal of the mammary gland, it is necessary to wait 8-12 months to restore the previous shape.

Modern plastic surgery offers several methods of breast reconstruction.

Endoprosthesis method. Involves the placement of silicone or saline prostheses in the space between the muscles and chest. To perform this type of breast reconstruction, a sufficient amount of own tissue is needed at the site of the removed breast. Most often, it is used after a subcutaneous mastectomy or according to the Madden method and is carried out in several stages.
Thoracodorsal transplantation. This method is suitable for breast reconstruction after radical mastectomy. It is based on cutting off a section of one's own skin and adipose tissue from the abdomen, back or buttocks and sewing it to the area of the mammary gland.
Reconstruction with a pedunculated SEIA flap. The latest achievement in plastic surgery. To form the future breast, abdominoplasty is performed (excess fat is cut off from the abdomen along with the skin) and a blood vessel is isolated, which is pulled inside the abdomen and then sutured into the thoracic artery. Thanks to this, the flap takes root well, and the new breast will feel as warm to the touch as your own. Over time, it is even possible to restore the sensitivity of the skin.

Each method has its own nuances and contraindications, so the choice of reconstructive surgery should be entrusted to a qualified specialist. It is recommended to consult several plastic surgery clinics and choose the best option for yourself.

A mastectomy should not be taken by a woman as a life tragedy. Successfully carried out postoperative rehabilitation and subsequent mammoplasty will become the basis for starting a new full life.

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. going on partial violation 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.

A fringing incision is made around the gland, and it is removed.
The wound expands to the axillary region.
Subcutaneous fat and lymph nodes are removed there.
The pectoralis major and minor muscles are excised.
The chest wall is cleaned of the remaining fiber.
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 small size Stages 1-2, removed by Madden's modification, reconstruction is possible simultaneously with mastectomy.

If oncological disease was operated on at 3 stages, 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 plastic surgery fixed, and the postoperative period passed easily and without complications, it is necessary to comply with some requirements:

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.

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 a large and small muscles 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:

mammary gland;
small pectoral muscle;
three levels of lymph nodes.

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