Surgery to remove the mammary gland. Breast mastectomy What is mastectomy in women

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

Types of mastectomy surgery

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

With all types of radical mastectomy, it is possible to develop swelling of the arm due to impaired lymph outflow (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 carried out on the areas where the lymph nodes are located, the probability increases.

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

Depending on the volume of skin removed, any mastectomy can be performed in different ways, which changes its name:

• subcutaneous (preserving the nipple and areola);
• skin-preserving (together with the breast tissue, the nipple-areolar complex and the skin over the tumor are usually removed);
• with standard skin removal (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 an edematous-infiltrative form of cancer or a nodular form with secondary edema of the skin).

At the same time or some time after any type of mastectomy, reconstruction (restoration) of the mammary gland can be performed. The main three reconstruction methods are:

1. transverse rectoabdominal(transversal recto-abdominal muscle *, TRAM) flap;
2. thoracodorsal flap(flap based on the latissimus dorsi muscle) in combination with an implant;
3. two-step method, in which in the first stage an expander (a silicone reservoir that can be gradually inflated with the introduction of fluid) is installed to stretch the tissue, in 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 tissue, and it tolerates radiation therapy well.

* - that is, a transverse flap based on the rectus abdominis muscle.

Advantages of the technology used at the Frau Klinik

• Widespread use of preoperative drug treatment for stage II-III cancer (this improves treatment results, reduces the volume of surgery, reduces the risk of implant rejection, and 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 scope of the operation, timing and reconstruction options are selected in discussion with the patient.

Breast removal ( mammary glands), an operation that causes fear among women diagnosed with breast cancer.

What is important to know about this operation, and in what cases will it help eliminate the inevitability of developing breast cancer? When is breast removal performed?

Reasons for breast removal (mastectomy)

The first reconstructive surgeries after mastectomy were undertaken in the late 19th century. But a large number of complications made these operations unpopular until 1963, when a mastectomy was successfully performed, followed by breast reconstruction with silicone endoprostheses.

Over the next decades, plastic surgeons have been improving breast reconstructive technology. Today, a more popular operation is one-stage organ reconstruction after mastectomy.

Mastectomy, types and methods

A mastectomy is the radical removal of the breast and some adjacent tissue by surgical intervention. In accordance with the degree of spread of breast cancer and metastasis, the following types of operations are performed:

1. Patey method, which allows you to radically remove a mammary gland affected by cancer. In this case, not only the glandular tissue is removed, but also the axillary nodes and pectoralis minor (pectoralis minor muscle). This operation is indicated for a confirmed cancer diagnosis with the presence of metastases. Most mastectomies are performed using this method.
2. Halstead method- Same radical surgery, with excision of not only the gland, but also the axillary lymph nodes, and pectoral muscles with fatty tissue. The thoracic nerve is left. This method is indicated for severe stages of cancer, with deep metastases to the muscles adjacent to the mammary gland.
3. Madden method, a less radical operation, since only the mammary gland is removed. Nearby muscles and lymph nodes are left. This operation is prescribed for women diagnosed with ductal carcinoma. The Madden method is also used in preventive surgeries for patients with genetic indications.

Today, the newest technique is skin-preserving breast removal.

Plastic surgeon Heather Richardson

Today, there is more than one criterion for the volume of operations. This can be a lumpectomy (partial or segmental mastectomy).

It is defined as complete surgical resection of the primary tumor to achieve significant negative margins (ideally 1 cm).

This can be accomplished using specific palpation guidelines or imaging guidelines and is applicable to most patients with stage I or II invasive carcinomas.

There are relative contraindications, which are presented below.

CONTRAINDICATIONS

1. small breast size;
2. large tumor size (> 5 cm);
3. collagen vascular disease.

Absolute contraindications include the following situations.

CONTRAINDICATIONS

1. multifocal disease;
2. previous history radiation therapy in the field of treatment;
3. inability to undergo radiation therapy for invasive disease;
4. first or second trimester of pregnancy;
5. constant positive histological tests for the presence of tumor cells after attempts to preserve the organ.

You can have a mastectomy about six months after you have completely stopped breastfeeding.

Plastic surgeon Daniel Barrett

Breast reconstruction options after a partial mastectomy include the following:

1. Fasciocutaneous flaps for local tissue improvement.
2. Breast parenchyma flaps.
3. Myocutaneous flap from the latissimus dorsi muscle.

A total mastectomy for cancer involves the complete removal of all breast tissue.

Studies were conducted (in 2017) that showed that the risk of cancer recurrence after total breast removal and surgery with preservation of tissue, nipple, and areola is almost the same. That is why more and more surgeons are leaning toward the second option.

Plastic surgeon Kenneth Francis

The following options are available:

1. Modified radical mastectomy – mastectomy with axillary lymph node dissection (ALND).
2. Radical mastectomy – mastectomy plus en-block resection of the pectoral muscle with ALND.
3. Extended radical mastectomy – radical mastectomy with resection of the internal lymph nodes of the mammary gland.
4. Skin-sparing total mastectomy (SSM).
5. Areola-sparing mastectomy (NSM). During surgery, all breast tissue is removed, but the nipple remains in place.

Indications

The main indication for breast removal is a confirmed diagnosis of breast cancer. In addition, mastectomy is indicated if the BRCA1 gene is detected in the patient.

Today, preventive mastectomies are increasingly being performed on patients who have the BRCA1 gene in their body, which gives virtually no chance of avoiding the development of breast cancer.

How is breast removal surgery performed (step by step)?

To perform this surgical intervention, it is used. The duration of the operation is about 3-4 hours.

If lymph nodes are also removed, then the surgeon will need more time to work.

Initially, the doctor cuts the skin and eliminates the affected tissue.

These are complex manipulations that require highly qualified doctors. Finally, the surgeon sutures using absorbable sutures or staples.

To be able to pump out accumulated fluid, reduce swelling, and speed up recovery, a drainage is used that is placed in the chest.

There are different situations, so the nipple can be left or also removed. After some time, the patient may be referred for a biopsy. It will help check the operated area for the presence of cancer cells.

After surgery, the woman will need to stay in hospital for several days.

Recovery after surgery

After the breast tumor has been removed, the woman needs to recover. At first, the patient will feel pain. After breast removal surgery, it is necessary not to move sharply, not to carry heavy things, or to raise your arms up.

If a woman suffers from severe pain, then the doctor will prescribe painkillers.

Quite often, the doctor prescribes chemotherapy in conjunction with surgery. Radiation therapy may also be needed.

When drainage tubes are removed, a small amount of fluid may accumulate. But there were times when it was necessary health care. In such a situation, the doctor drains the excess “water” using a needle.

After surgery, you risk bleeding, infection, pain, swelling in the upper extremities, hardness in the scar area, hematomas, numbness (this happens when lymph nodes are removed).

Plastic surgeon Barbara Persons

In most cases, a woman is depressed after breast removal. Depression can last a long time and sometimes requires psychological treatment.

People in such a situation need to understand that life is not over, but they are given a chance to become healthy.

You need to try not to start developing complexes and withdrawing into yourself, but to find a way to hide your shortcomings. In addition, there is reconstructive surgery that will help create new breasts that are close to real ones.

A return to your previous life is possible after 6-8 weeks of recovery, if no complications arise. It is worth having sexual intercourse after 1.5-2 months.

If the breast is to be completely removed, the patient may be offered reconstruction. But not everyone agrees to it. In addition, some people do not have the opportunity to conduct it, because it is not cheap.

In this case, you can use prosthetics. What it is? Today, bras are produced that create the appearance of normal natural breasts.

To ensure a quick recovery without complications, you cannot:

• take a shower before;
• load your body, carry weights;
• go for any injection into the affected area;
• swim in a pool, river, or sea for about 2 months after surgery;
• engage in sexual intercourse for about 1.5-2 months.

Hand development after suture removal

When a woman's stitches are removed, she should start working on her arms. To do this, you need to perform certain exercises:

• raise your arms up and in different directions (you can be in a standing or sitting position), throw them behind your head;
• stand up, bend your elbows, place them in front of your sternum, then move them apart;
• try to clasp your hands behind your back.

All these exercises can be performed only after approval by the doctor.

Question answer

If you are concerned, then you should speak with a breast surgeon to review your risks, and if they are high, you should review surgical options.

Unfortunately, loss of nerve sensation is common after mastectomy and lymph node dissection. Only time will tell - nerves can take up to 2 years to fully return, so you need to be patient. If the situation does not improve in two years, most likely things will remain that way.

Most of the time, itching can be controlled with topical or oral steroids, cold compresses, or antihistamines after surgery. In more significant cases, neurologically active drugs such as Neurontin may be used.

Preventive mastectomy

Many women learned about the possibility of preventing the development of breast cancer from media reports. Hollywood celebrity Angelina Jolie, in order to avoid the risk of developing breast cancer, had a mastectomy (after which she had it inserted).

Other famous women followed her example. Now not only doctors know about preventive mastectomy.

To decide whether a preventive mastectomy is necessary, it is worth learning about its indications and all possible postoperative complications.

Indications for preventive mastectomy

In our country, preventive mastectomy began to be carried out officially in 2010. The basis for its implementation is the presence in the body of a diagnosed breast cancer mutagen (BRCA1 and BRCA2), or a malignant tumor of one of the mammary glands.

Also justified indications for preventive mastectomy are a family history of cancer, confirmed by genetic testing. The operation is indicated if there are signs of precancerous pathology of the organ.

In private clinics, such an operation can be performed even without a confirmed diagnosis, only guided by the wishes of the patient. In such cases, she is required to provide legal confirmation of her refusal to make further claims regarding the outcome of the operation.

Contraindications for preventive mastectomy

Breast removal is not performed for preventive purposes if the patient has certain contraindications.

CONTRAINDICATIONS

1. Mature age (over 65 years);
2. Lipomatosis grade 2-3;
3. Arterial hypertension;
4. Diabetes;
5. Cardiovascular pathologies;
6. Bronchial asthma;
7. Psychiatric diagnosis.

The decision to perform a preventive mastectomy on a patient is made collectively by several specialists. She gives written consent to the operation, which is legally certified.

Carrying out the operation

Simultaneous organ reconstruction after mastectomy is carried out in stages:

• Direct mastectomy - removal of glandular tissue without skin;
• Reconstruction of an organ is the transfer of a graft from its own tissues, or an implant, with the further formation of the contours of the gland.

Breast reconstruction methods

Restoring the mammary gland using tissue from the patient’s body, according to plastic surgeons, is the most relevant. During breast reconstruction, tissue flaps (skin, muscle, subcutaneous tissue) are used from various areas of the body: abdomen, thighs, buttocks.

They are transplanted to the site of the removed glandular tissue. And although from a technical point of view, this type of reconstruction is a more complex procedure, it is considered more reliable in terms of graft survival.

However, in 9 out of 10 cases, another reconstruction method is chosen - using implants. The fact is that when reconstructing with your own tissues, you have to carry out additional operations to correct the breast, since its aesthetics cannot be achieved immediately.

In my practice, the vast majority of women are inclined towards the method of reconstruction using implants (up to 80%).

Plastic surgeon Michael Zenn

Restoring breast shape using implants. To do this, first prepare a so-called “pocket” for the endoprosthesis, which consists of the pectoralis major muscle and an area of ​​skin stretched with an expander. There are other technologies that allow the use of artificial fabrics if there is a lack of skin.

The second reconstruction method, although less traumatic, also has disadvantages. This is a development after implantation of capsular contracture.

Which operation option gives a better result? A more reliable result and long-term effect is provided by the option of carrying out reconstruction with authentic body tissues. But technically this technique is more complex and requires high professionalism of a plastic surgeon.

As practice and research from 2014 show, most women do not undergo reconstruction after the intervention. This is 59% of patients in urban areas and 71% in villages.

Plastic surgeon Dallas Buchanan

Rehabilitation

A patient's recovery from mastectomy and breast reconstruction may vary in length.

This depends on factors such as the technique of reconstruction surgery, the individual characteristics of the patient, and the professional skills of the plastic surgeon.

Lasts longer postoperative period due to restoration by own tissues.

It takes place in several stages, since after the primary plastic surgery, after 3-5 months the patient requires correction of the volume and shape of the breast. Additional operations are also performed to create a new areola and nipple from your own tissue.

Complications

The most commonly observed complications after mastectomy include the following:

• Temporary swelling of the tissues located near the site of the removed organ;
• Postoperative wound pain;
• Infection of the wound cavity;
• Bleeding;
• Permanent swelling of the arm from the surgical intervention as a result of lymphostasis;
• Severe swelling of the arm due to surgery;
• Phantom pain in the area of ​​the removed breast;
• Seroma is an accumulation of serous tissue fluid in the postoperative cavity.

Complications after reconstructive surgery more often occur when installing endoprostheses. Suppuration of the wound cavity and implant rejection are possible. More severe complications are observed in the form of skin necrosis and contractures.

Cost of preventive mastectomy

The average cost of preventive radical mastectomy in Moscow is from 80,000 to 110,000 rubles. Modified version – 160,000 rubles. Surgery with endoprosthetics – RUB 31,790.

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

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

Types of mastectomy

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

• according to Halstead-Meyer;
• by Patey;
• according to Madden.

Important! The type of mastectomy surgery for breast cancer is selected by the doctor in accordance with the stage of the cancer process.

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

Madden mastectomy

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

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

When suturing the wound, drainage is placed, which lasts about 4-5 days. If the postoperative period is favorable, the woman is discharged home on the 4th day. The stitches are removed after 10 days.

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

Important! After Madden breast removal, chemotherapy and radiation therapy are necessary, because... There is a risk of preserving single tumor cells, which can relapse.

Peyti mastectomy

The indication for surgery to remove 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 pectoralis minor muscle.

After breast removal muscle intersects, which allows you to get deeper and more complete access to the subcutaneous fatty tissue and lymph nodes with metastases.

Important. This type of mastectomy is more traumatic than the previous one, because There is a partial disruption of movement in the shoulder joint due to the removal of the pectoralis minor muscle. Cicatricial changes may occur in the area of ​​the subclavian vein. Subsequent breast formation with an artificial implant is also difficult.

Halstead-Meyer mastectomy

This operation is the most traumatic and disabling. Used in stage 3 breast cancer. Recently its use has been limited.

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

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

Important! The only indication for performing a Halstead mastectomy is modern world is a tumor lesion of the pectoralis major muscle.

Complications

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

• Bleeding. During breast removal, the integrity of tissues and blood vessels is disrupted, which leads to some 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. Wound suppuration most often occurs by the end of the first week of the postoperative period. To prevent this complication during surgery, the rules of asepsis and antisepsis are strictly observed, and a course of antibacterial therapy is prescribed.
• Exudate. The intersection of lymphatic vessels during surgery leads to the accumulation of copious amounts of fluid in the area of ​​the postoperative wound. In the absence of adequate drainage routes, it can fester. To prevent lymph stagnation, drainage is used.

These complications are observed in the early postoperative period.

Late complications include:

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

Early initiation of rehabilitation (massage, gymnastics) reduces the likelihood of impairment of the upper limb.

What to do after breast removal?

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

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

Reconstructive operations are divided into two large groups:

• breast reconstruction using artificial implants;
• plastic with your 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 using one’s own tissues is used after more traumatic operations to remove a breast tumor (according to Patey and Halstead).

Important! The choice of one or another technique is made 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 the 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 established, and the postoperative period passed easily and without complications, it is necessary to comply with some requirements:

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

Breasts are a woman's adornment! However, it is not worth risking your life because of it. When the first symptoms of concern about breast cancer appear, you should immediately consult a doctor. A mastectomy can save your life. And subsequent plastic surgery will return its former beauty.

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

According to Madden

Radical mastectomy according to Madden involves preserving the major and minor muscles of the chest and third-level lymph nodes, which can significantly reduce the volume 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 Patey-Dyson

The volume of surgery is reduced by preserving the pectoralis major muscle. During surgery, the following is removed:

• mammary gland;
• pectoralis minor muscle;
• lymph nodes three levels.

This technique is used if complete removal is required. mammary gland and there are metastases in the lymph nodes of the first, second and third levels. It eliminates 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 you to reduce the volume of surgery by preserving the lymph nodes of the 2nd and 3rd levels along with the pectoral muscles. During the process, the mammary gland and level 1 lymph nodes are removed.

Simple mastectomy

The purpose of the operation performed using this technique is to remove (excise) the mammary gland with capsule and skin. The axillary tissue is not removed. According to indications, a subcutaneous mastectomy can be performed, which allows preserving the nipple-areolar complex if it is not affected by the disease.

According to Halsted-Meyer

This modification of mastectomy involves removal of:

• mammary gland;
• lymph nodes of three levels;
• pectoralis major and minor muscles;
• subcutaneous fat;
• fascia.

Purulent mastopathy and breast cancer are diseases that cannot be ignored. They require intense attention, examination and treatment. Among oncological diseases Among women, breast cancer ranks first, among other diseases - second. The consequences cannot always be predicted.

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

What is radical mastectomy

Radical, i.e., removing entirely, completely, from the roots. The concept of mastectomy has Greek origin- mastòs “breast” and ek tome “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 the existing problem.

There are three main types of mastectomy:

• according to Madden,
• by Patey,
• according to Halstead.

Radical mastectomy according to Madden is considered the most gentle.

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

Kinds

According to Madden

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

After removal of the mammary gland, all nerve endings and vascular links, which avoids blood loss. This type of operation has significant advantages: preservation of radicality, relatively low morbidity, low percentage of complications.

According to Halstead

Halstead-Meyer mastectomy is a classic operation. The mammary gland, skin, subcutaneous tissue, pectoral muscles, subcutaneous fatty tissue (subclavian, axillary and subscapular region), lymph nodes.

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

By Patey

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

According to Pirogov

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

Simple mastectomy

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

Technique using tram flap

A technique for breast restoration, which is performed simultaneously with a mastectomy or six months after surgery. In this case, the patient's own tissue is moved, which is called a TRAM flap, which is tissue with preserved blood flow. This may be an iliofemoral flap or a greater omentum flap. Sometimes a pedicled rectus abdominis muscle flap (along with skin) is used.

Subcutaneous surgery technique

A technique that allows you to maintain the radicality of surgical intervention and achieve the best possible aesthetic results. This is an extended method subcutaneous mastectomy, when the mammary gland with muscle fascia (sheath) and lymph nodes are removed, while preserving the muscles and fatty tissue. P

When using this technique, breast reconstruction surgery can be performed at the same time. This can be an operation using your own tissue or using an implant, for which a “pocket” is pre-formed.

Indications for testing

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

Contraindications

General contraindications:

• Severe cardiovascular failure,
• Kidney and liver failure,
• Decompensation of diabetes mellitus,
• Cerebrovascular accident.

Contraindications for tumor localization:

• Swelling of the mammary gland extends to the chest wall,
• Multiple metastases in the lymph nodes with edema of the upper limb,
• Invasion by a tumor of the chest.

Even more useful information about radical mastectomy surgery is in this video:

Carrying out the operation

Preparation

Preparation for surgery consists of several stages:

• Medical checkup, which is a fundamental point. The doctor examines the medical history and prescribes an examination,
• Survey, including a series of tests and tests: mammography (photography of breast tissue), breast biopsy, general analysis blood and urine, biochemistry, blood test for coagulation (coagulogram).
• The doctor prescribes gentle (light) diet, warns about limiting use (or stopping completely) medicines that thin the blood (aspirin, etc.). They are excluded a week before surgery. On the day of surgery, it is unacceptable to drink or eat.

Progress of the operation

The operation is performed under general anesthesia. Its duration ranges from 1 to 3 hours.

Algorithm:

1. Markers are used to mark the upcoming cuts.
2. The skin is cut in the necessary places,
3. Subcutaneous tissue and mammary gland are separated from the skin,
4. Removal occurs as a single block, including lymph nodes,
5. Depending on the method, the pectoral muscle, fatty tissue, etc. are sequentially removed.
6. Nerve endings and vascular links are traced,
7. A drainage is installed through a special hole, which is removed on the 5th - 6th day.
8. Stitches are applied and removed on days 10-12.

Installing drainage is an important point. The doctor monitors the outflow of fluid.

Rehabilitation

After a mastectomy, rehabilitation measures are extremely important. These include gymnastics, physical therapy, and 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 at the back,
• Circular movements of the arms, rocking, etc.

Physiotherapy

If there are no complications, then physical therapy can be prescribed a week after the operation. What can be done about this:

• Pool,
• Various exercise machines aimed at developing the shoulder joint,
• Massotherapy,
• Hydromassage,
• Red spectrum irradiation (used to restore lymphatic drainage),
• Magnetotherapy,
• Bandage,
• Therapeutic wrap.

Rehabilitation rules

• Using an elastic bandage
• Refusal to visit the bathhouse and solarium,
• You can't lift weights for a year,
• Stay 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,
• When flying by air, you must use a compression sleeve,
• An examination is required every six months,
• Wearing special underwear,
• If you feel worse, consult a doctor immediately.

Lipofilling of the mammary glands after RM

Fat grafting is a means of breast reconstruction after mastectomy, which uses the patient's tissue rather than implants. One session for the recovery procedure will not be enough; several will be required.

Lipofilling of the mammary glands is also a serious matter that requires thorough preparation.

• The surgeon determines the areas from which the necessary material can be taken,
• Prescribes an examination similar to that required for any plastic surgery,
• The operation is performed under general anesthesia,
• Before collecting adipose tissue, Klein's solution is injected into it,
• Selected fat cells are placed in a centrifuge, where they are separated into 3 parts,
• The middle part is used for direct reconstruction,
• The prepared fatty tissue is injected using 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, swelling and hematomas form, which persist for 3-4 weeks. Repeated surgery is possible no earlier than after 4 months. For a lasting result, 2 to 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 remain high today (from 20 to 87%), despite equipment and new technologies. Complications can be early or late.

Early

• Leakage of lymph, which may necessitate further surgery,
• Necrosis of tissue edges,
• Infection, suppuration.

Late

Late complications that are observed more often when using the Halstead method:

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

Price and clinics

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

Prices vary greatly, which is not surprising. Each operation has its own characteristics, apply different methods. Pricing also plays a role. The estimated minimum price threshold is 35 thousand rubles. It is possible to perform a simple mastectomy at a lower cost, but this is unlikely. Average prices for surgery range from 60 to 120 thousand rubles.