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radical mastectomy. Features of the mastectomy and its varieties

term "mastectomy" for more than 100 years, in translation from ancient Greek it means: “mastos” - chest, “ek tome” - I remove. That is, a mastectomy is the removal of the breast. "Radix" - in Latin - this is the root, the operation proposed by W.S. Halsted claimed to be radicalism, removal of the tumor with "roots". To do this, along with the mammary gland, pectoralis major and minor muscles, lymph nodes of 3 levels were removed. This volume of operation corresponds to the name "radical mastectomy". Currently, it is rarely used, it is indicated when a breast tumor grows into the pectoralis major muscle or when metastases grow into the pectoralis major muscle located in the lymph nodes of the 2nd level; or when performing palliative operations. Accompanied by deformity of the anterior chest wall due to tissue deficiency in the subclavian region.

Types of mastectomy surgery

Patey & Dyson Modified Radical Mastectomy. The modification implies a reduction in the volume of the operation compared to a radical mastectomy due to the preservation of the pectoralis major muscle. That is, with a modified radical mastectomy according to Patey & Dyson, the mammary gland, pectoralis minor muscle, and lymph nodes of 3 levels are removed. This technique of operation is used when it is necessary to remove the entire mammary gland and the presence of multiple metastases in the lymph nodes of 1-3 levels. It does not lead to such a pronounced deformation of the chest wall, as with a radical mastectomy according to W.S. Halsted, however, when the pectoralis minor muscle is removed, small nerve branches intersect, innervating the outer part of the pectoralis major muscle, which leads to atrophy of the latter.
Modified radical mastectomy according to Madden. The modification implies a reduction in the volume of the operation compared to a radical mastectomy due to the preservation of the pectoralis major and minor muscles and the preservation of level 3 lymph nodes. That is, with a modified Madden radical mastectomy, the mammary gland and lymph nodes of 1-2 levels are removed. The most commonly used type of surgery for breast cancer is currently in Russia.
Modified radical mastectomy according to Auchincloss H. The modification implies a reduction in the volume of the operation compared to radical mastectomy due to the preservation of the pectoralis major and minor muscles, and the preservation of lymph nodes of 2-3 levels. That is, with a modified radical mastectomy according to Auchincloss, the mammary gland and lymph nodes of the 1st level are removed.
Radical mastectomy with preservation of the pectoral muscles. The operation involves the removal of the mammary gland and lymph nodes of 1-3 levels. Both pectoral muscles are preserved. Allows you to remove all 3 levels of lymph nodes, when necessary, save both pectoral muscles and the innervation of the outer part of the pectoralis major muscle.

With all variants of radical mastectomy, edema of the arm may develop due to a violation of the outflow of lymph (lymphostasis). The probability of developing lymphostasis is 10-40%. If the operation was on the side of the working hand (for right-handers - on the right, for left-handers - on the left) and if radiation therapy was performed on the areas of the location of the lymph nodes, the likelihood increases.

Mastectomy - removal of only the breast is one of the earliest operations in breast surgery.

Depending on the amount of skin to be removed, any mastectomy can be performed in different ways, this changes its name:

subcutaneous (with preservation of the nipple and areola);
skin-preserving (along with the breast tissue, the nipple-areolar complex and the skin over the tumor are usually removed);
with standard removal of the skin (usually 4-5 cm from the palpable edge of the tumor with excision of the nipple-areolar complex);
with total removal of the skin (with edematous-infiltrative form of cancer or nodular form with secondary skin edema).

Simultaneously or some time after any type of mastectomy, breast reconstruction (restoration) can be performed. The main three reconstruction methods are:

transverse recto-abdominal(transversal recto-abdominal muscle *, TRAM) flap;
thoracodorsal flap(flap based on the latissimus dorsi muscle) in combination with an implant;
two-step method, in which at the first stage an expander (a silicone reservoir that can be gradually inflated by the introduction of liquid) is installed to stretch the tissues, at the second stage the expander is removed and a permanent implant is installed.

The first method is more traumatic, but has its undeniable advantages: the TRAM flap consists only of the woman's own tissues, and it tolerates radiation therapy well.

* - that is, a transverse flap at the base of the rectus abdominis muscle.

Advantages of the technology used in the Frau Klinik

Widespread use of preoperative drug treatment in stage II-III cancer (this improves the results of treatment, reduces the volume of surgery, reduces the risk of implant rejection, increases the likelihood of preserving axillary lymph nodes when using sentinel lymph node biopsy technology).
The volume and technique of performing operations combine maximum radicalism and the minimum possible injury.
The volume of the operation, the timing and options for reconstruction are selected in discussion with the patient.

Mastectomy is a common operation, which is prescribed by doctors. The main indications for its implementation are breast cancer or its possible development, which exceeds 51%. You should understand what this is, since there are several types of operations that are assigned to the target.

Only in extreme cases, a mastectomy is prescribed, when the mammary gland with all the affected areas is removed from the breast. With the possibility of developing cancer or already with an existing pathology, women put an end to themselves. If the disease does not kill them, then the operation will deprive them of external attractiveness. This approach is negative in treatment.

As the site shows, a mastectomy involves further plastic surgery for breast reshaping. At the same time, the disease will recede, which will allow the woman to enjoy life for many more years.

Types of mastectomy

There are types of mastectomy (surgery to remove the mammary gland), which depends on the severity of the disease and the age of the patient:

Indications for various types of operations

Doctors do not have one solution to the problem. It all depends on the state of health, the age of the patient, the severity of the disease and its prevalence, the nature of the tumor, etc. All this is an indication for various kinds operations, which will be discussed below:

Subcutaneous mastectomy is performed with a tumor located near the nipple, with a diameter of 2 cm and pain in the chest. An incision is made. Chemotherapy is not applied. After the operation, rehabilitation lasts from 1 year, while massages, Tamoxifen and wearing a bra are prescribed.
Bilateral mastectomy is prescribed for stage 2-3 cancer and pain in both glands. Chemotherapy and complete removal of the mammary glands are carried out. Rehabilitation lasts 2 years, and there may be swelling of the upper limbs.
Mastectomy according to Patty is prescribed for a tumor that has reached 4 cm, with pain and burning sensation. The operation consists in removing the breast, fiber and pectoral muscle without chemotherapy. There is swelling after the operation. Rehabilitation lasts 1-2 years, massage, exercise and wearing a bra are recommended.
Mastectomy according to Madden is prescribed for grade 2 cancer, lymphedema, or pain in the left side of the chest. An operation is prescribed to remove the gland with lymph nodes without chemotherapy. Insertion of implants instead of mammary glands is recommended. Massage is prescribed, taking Tamoxifen and wearing a bra.
Mastectomy according to Pirogov is prescribed for stage 1-2 cancer and affected tissue. Part of the mammary gland and part of the muscle is removed. There may be lymphostasis of the limb. Massage, Tamoxifen, exercises and a special bra are prescribed.
Radical mastectomy is indicated for grade 3 cancer and chest pain. The chest and all muscles are removed without chemotherapy. Observed after surgery lymphostasis. You can have a breast augmentation. A massage and wearing a special bra are prescribed.
Radical extended mastectomy is prescribed for stage 4 cancer, unbearable pain and chest damage. The operation removes the mammary glands, all muscles, lymph nodes, chest skin. After the operation, there is swelling of the hand and lymphostasis. Gymnastics, exercises and special underwear are prescribed.
Hemimastectomy is prescribed for stage 3 cancer, pain in the chest, swelling of the glands. The operation removes half of the glandular and adipose tissue. After that, lymphostasis and swelling of the hand are observed. It is possible to carry out one-stage plastic surgery. Massage and exercises are prescribed.
Lymphadenectomy is prescribed for cancer or an abscess with the size of a tumor. During the operation, part of the adipose and glandular tissue is removed while preserving the muscle. Perhaps the development of lymphostasis and swelling of the hand. Tamoxifen is prescribed.
Quadrantectomy is indicated for end-stage localized cancer. Chemotherapy is not prescribed. The glands and fasciae of the serratus muscles are removed. It is possible to carry out one-stage plastic surgery of the breast. There is swelling. Diet and exercise are prescribed.
Preventive mastectomy is prescribed to rule out the development of cancer.

Operations are prescribed when there is a possibility of developing cancer (from 70%). To avoid complications, part of the breast is removed.

Postoperative period

The operation may not be accompanied by various symptoms that disturb the patient in the postoperative period for a short time:

Pain radiating to arms and back.
Gymnastics.
Swelling of the legs and arms.
Long term treatment.
Difficulty in breathing.
Carrying out exercise therapy.
The need to insert prostheses.
Restrictions on movement and work.
Diet, special food.
Carrying out plastic surgery.
Treatment of a psychologically unbalanced state.
Massage and exercise.
The need to wear a bandage, exoprostheses, a bra.
The need to purchase exoprostheses, bras and special swimwear.
Opportunity to return to normal life.

After a mastectomy, pain is usually noted everywhere: in the head, back, chest, even in the heart due to the load. Joints and muscles hurt. This requires wearing special underwear, doing exercises and undergoing massages, and following a diet. Often plastic surgery is required to restore the shape of the breast.

Among the special underwear in the postoperative period, there are:

Compression underwear.
Dentures and underwear through the sleeve.
Dentures and underwear with pockets.
Linen with cold fabrics.
Prostheses and clothing for sports.
Prostheses and sleepwear.
Prostheses and clothing for everyday life.
Sewn-in exoprostheses and underwear.
Sleep bandage.
Exoprostheses and bandage.
Removable dentures and bandage.
Ancillary products.

The bandage has a sleeve on one side, where exoprostheses are not inserted. There is no bandage on both sides.

The main psychological problem that arises during the period of mastectomy is the fear of losing a man or men's attention to himself. Here you should follow the advice for a psychological mood, as well as help yourself to heal.

Mastectomy should not be abandoned. It is better to subsequently resort to plastic surgery and wearing a special bra. In the summer, swimsuits are suitable, which are sold in special stores, hiding all the seams and changes in the chest.

Since it is difficult for men to imagine what a woman feels during a period of illness and what hardships (diets, exercises, etc.) she goes through, one should remain self-confident here. Men should not be made responsible for their own happiness. At the same time, partners should be told about what happens to you at each stage. This will help your loved one understand what you're going through and make it easier to deal with some changes in appearance.

Forecast

A mastectomy is a treatment option when a woman is forced to take the drastic step of removing part or all of her breasts. To save your life, you have to give up something. In this case, the prognosis becomes favorable, since mastectomy helps in the cure.

Significantly life expectancy is affected by the absence of an operation to remove the mammary gland. In this case, the disease develops and leads to death. Is the beauty of life worth choosing only for a woman?

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 age and general condition woman's health.

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 procedure, 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 makes an oval incision under the breast with a scalpel from the inside at the sternum to the armpit, 12-16 cm long. The breast tissue is removed along with the 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;
With 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 practice physical therapy in the pool, hydrokinesiotherapy or just walking 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.

Purulent mastopathy, breast cancer - diseases that cannot be dismissed. They require intense attention, examination and treatment. Among oncological diseases in women, breast cancer ranks first, among other diseases - the second. Consequences are not always predictable.

Prevention and timely treatment are important. In some cases, an operation is inevitable - a radical mastectomy.

What is a radical mastectomy

Radical, i.e., removing entirely, completely, with a root. The concept of mastectomy is of Greek origin - mastòs "breast" and ek tome "I remove". The term is over 100 years old.

Several types of mastectomy are practiced. Each of them is effective, they differ in the degree of trauma. Radical mastectomy is a complex operation, but sometimes only it can solve an existing problem.

There are three main types of mastectomy:

by Madden,
by patey,
according to Halsted.

Madden's radical mastectomy is considered the most sparing.

What is a radical mastectomy, you will learn from this video:

Kinds

By Madden

The method involves the preservation of both pectoral muscles, which makes it as gentle as possible. The mammary gland is removed en bloc lymph nodes and subcutaneous fat layer.

After the extraction of the mammary gland, all nerve endings and vascular links can be traced, which helps to avoid blood loss. This type of operation is endowed with a significant advantage: the preservation of radicality, relatively low trauma, and a low percentage of complications.

According to Halstead

The Halsted-Meyer mastectomy is a classic operation. A single complex removes the mammary gland, skin, subcutaneous tissue, pectoral muscles, subcutaneous fatty tissue (subclavian, axillary and subscapularis), lymph nodes.

The method often causes complications, the main of which is the restriction of mobility of the shoulder joint. It is used extremely rarely, when other methods will not help to cope with the problem, for example, extensive metastases affecting the pectoral muscle, lymph nodes, etc.

By Pati

Patey's mastectomy is a modification of the previous type and has the full name - modified radical mastectomy. Its founder, Dr. Patey, proposed a wide excision of the skin and preservation of the pectoralis major. During the operation, only small muscle, which makes the method more gentle and avoids serious complications.

According to Pirogov

The mammary gland and fiber of the axillary region are removed.

Simple mastectomy

The mammary gland and fascia of the pectoralis major muscle are removed.

Tram-flap technique

A method of breast restoration, which is carried out simultaneously with a mastectomy or six months after the operation. In this case, the patient's own tissue is moved, which is called the TRAM flap, which is a tissue with preserved blood flow. This may be an iliac-femoral flap or a greater omental flap. Sometimes a flap of the rectus abdominis muscle on the leg (together with the skin) is used.

Subcutaneous surgery technique

A technique that allows you to save the radicalness of the surgical intervention and achieve the highest possible aesthetic results. This is a method of extended subcutaneous mastectomy, when the mammary gland with muscular fascia (sheath) and lymph nodes are removed, while maintaining muscle and fatty tissue. P

When using this technique, it is also possible to perform a breast reconstruction operation at the same time. This can be an operation using one's own tissues or using an implant for which a "pocket" is previously formed.

Indications for holding

Malignant tumor of the mammary gland of varying degrees,
Purulent mastopathy (in rare cases),
Correction of previous treatment,
Individual indications (prevention, etc.).

Contraindications

General contraindications:

Cardiovascular insufficiency in severe form,
kidney and liver failure,
Decompensation of diabetes mellitus,
Violation of cerebral circulation.

Contraindications for tumor localization:

Breast edema extends to the chest wall,
Multiple metastases in the lymph nodes with edema of the upper limb,
Germination of a tumor of the chest.

For more useful information about the operation of radical mastectomy - in this video:

Operation

Training

Preparation for the operation consists of several stages:

Medical checkup, which is fundamental. The doctor examines the history and prescribes an examination,
survey, including a number of tests and tests: mammography (photograph of breast tissue), breast biopsy, general blood and urine tests, biochemistry, blood clotting test (coagulogram).
The doctor prescribes sparing (light) diet, warns of limiting the intake (or complete cessation) of drugs that thin the blood (aspirin, etc.). They are excluded a week before the operation. On the day of the operation, it is unacceptable to drink and eat.

Operation progress

The operation is carried out according to general anesthesia. Its duration is from 1 to 3 hours.

Carrying out algorithm:

Marking is applied with a marker for upcoming incisions,
The skin is cut in the necessary places,
Subcutaneous tissue and mammary gland are separated from the skin,
Removal occurs in a single block, including lymph nodes,
Depending on the method, the pectoral muscle, fatty tissue, etc. are sequentially removed,
Tracing nerve endings and vascular links,
Drainage is installed through a special hole, which is removed on the 5th - 6th day,
Stitches are applied, which are removed on the 10th - 12th day.

Drainage installation is important point. The doctor monitors the outflow of fluid.

Rehabilitation

After a mastectomy, rehabilitation measures are extremely important. These include gymnastics, physiotherapy, taking medications.

Gymnastics

Gymnastics, some examples of exercises:

Squeezing a rubber ball
hair combing,
Putting your hands behind your back, as if you are trying to fasten a button from behind,
Circular movements of the hands, swaying, etc.

Physiotherapy

If there are no complications, then physiotherapy can be prescribed as early as a week after the operation. What can be done from this side:

Swimming pool,
Various simulators aimed at developing the shoulder joint,
Massotherapy,
Hydromassage,
Irradiation with a red spectrum (used to restore lymph flow),
magnetotherapy,
Bandage,
Medical wrap.

Rehabilitation rules

Using an elastic bandage
Refusal to visit the bath and solarium,
You can not lift weights during the year,
Staying in an inclined position for a long time
Try to avoid injuries, do not use traumatic objects (bracelets, etc.),
Increase the amount of fluid you drink
Compression sleeves must be worn during air travel.
An examination is required every six months
Wearing special clothes
If you feel unwell, contact your doctor immediately.

Lipofilling of the mammary glands after RM

Lipofilling is a means of breast reconstruction after a mastectomy, for which the patient's tissue is used, not implants. One session for the recovery procedure will not be enough, they will definitely need several.

Lipofilling mammary glands It is also a serious moment that requires thorough preparation.

The surgeon determines the areas from which the necessary material can be taken,
Assigns an examination similar to that required for any plastic surgery,
Surgery is performed under general anesthesia
Before taking adipose tissue, Klein's solution is injected into it,
Selected fat cells are placed in a centrifuge, where they are stratified into 3 parts,
The middle part is used for direct reconstruction,
The prepared adipose tissue is injected with a syringe in small portions into the targeted areas.

The operation is performed under general anesthesia and lasts from 2 to 5 hours. After lipofilling, edema and hematomas are formed, which persist for 3-4 weeks. Repeated operation is possible not earlier than in 4 months. For a stable result, 2-5 procedures are required.

Lipofilling involves the use of a special system (BRAVA), which protects the transplanted cells from external influences. This system is put on and worn for 7 to 14 days.

Consequences and complications

The number of complications after mastectomy continues to be high today (from 20 to 87%), despite the equipment and new technologies. Complications may be early or late.

Early

Lymph leakage, which may necessitate a second operation,
Necrosis of tissue edges
Infection, suppuration.

Late

Late complications that are more common when using the Halsted method:

Lymphostasis (impaired lymph flow),
Violation of the venous outflow of blood as a result of narrowing (blockage) of the lumen of the subclavian or axillary vein,
The formation of rough scars with the involvement of the axillary nerves in them,
Pain in the shoulder area
Loss of mobility of the shoulder joint, which leads to disability.

Price and clinics

Mastectomy is a serious operation that is performed exclusively in large or specialized centers. There are such centers in Moscow (for example, the MAMMOLOGY CENTER), St. Petersburg, Obninsk, Yekaterinburg, etc. The medical center in Israel - Assuta and the Center for Medical Diagnostics in Germany are often mentioned in connection with this operation.

Prices vary a lot, which is not surprising. Each operation has its own characteristics, different methods are used. Pricing also plays a role. Approximately the minimum price threshold is 35 thousand rubles. It is possible to have a simple mastectomy at a lower cost, but this is unlikely. Average prices for an operation range from 60 to 120 thousand rubles.

The diagnosis of breast cancer for most women sounds like a death sentence – more for lifestyle than for life itself. However, in recent years, this “sentence” has been softened more and more often. Doctors have learned to detect cancer on early stages sometimes even when the patient herself is unaware of it.

In turn, such an early diagnosis of cancer makes it possible to avoid severe surgery in all plans - mastectomy. There is hope for more economical interventions that are easier to tolerate by the woman herself and leave more chances for the restoration of previous forms. One such operation, which differs from a radical mastectomy, is subcutaneous mastectomy.

The name alone speaks for itself! Of course, as with all other economical operations, subcutaneous mastectomy there are strict indications. The tumor should be no larger than 2 cm and located at least 2 cm from the nipple. In addition, such a tumor should not be close to the surface of the breast.

Like many other breast surgeries, subcutaneous mastectomy has several modifications, which differ in the method of cutting. The surgeon chooses which particular modification of the subcutaneous mastectomy is appropriate in this particular case. After all, the incision must also be wide enough to allow the surgeon to remove part of the cancerous gland along with the surrounding fatty tissue and the lymph nodes located in it, and at the same time allow the skin incision to heal well, since subcutaneous mastectomy allows a woman to resort to reconstructive breast surgery, that is, to restore the shape of the breast.

During subcutaneous surgery, the entire mammary gland with lymph nodes from the axillary, subclavian and subscapular regions is removed, while the nipple area with the areola remains intact.

Some patients may have a question - why then remove the entire mammary gland if the tumor is so small? The answer is to get radical! Until now, in the treatment of cancer - this is the most important thing! Well, besides, such an operation allows you to immediately restore the lost shape and volume of the breast, using your own tissues or implants, or both.

So the advantage subcutaneous mastectomy lies in the fact that the surgeon can immediately perform a plastic surgery without making additional incisions, without resorting to an additional operation, using the patient's own muscle tissue. In this case, the muscles move, and their blood supply is preserved. Well, if there are not enough own tissues to form the shape of the breast, then an implant is used. It is usually placed under the pectoral muscle.

As seen, subcutaneous mastectomy allows you to "kill two birds with one stone" - that is, to solve two problems at once - medical and cosmetic. True, there is a disadvantage in the form of a large scar after the operation, but a professional surgeon can always avoid or minimize this problem. Also, if you just leave the reconstructive surgery for later, it will add more scarring!

Note that subcutaneous mastectomy- this is not a radical intervention, therefore, after the operation, radiation therapy is mandatory. Its goal is the complete destruction of cancer cells that could remain in the breast. In radiation therapy, radiation passes through healthy breast tissue to a site where there are potential cancer cells. In most cases, these tissues, despite irradiation, retain a good ability to recover.

Usually, radiation therapy begins immediately after the healing of the surgical wound (it is not carried out during healing, as it can disrupt the healing process itself), and the course of radiation lasts from four to six weeks, several sessions a week. In addition, with subcutaneous mastectomy, intraoperative radiation therapy with the Intrabim apparatus is also possible.

In this case, in a short period of time, the entire required dose is delivered to the intended place at once. This allows you to preserve healthy tissues as much as possible and significantly reduce the duration of treatment, and, of course, avoid many side effects associated with conventional postoperative radiotherapy.