Mastectomy: what it is, how it is performed. Breast removal (mastectomy) and reconstructive plastic surgery After mastectomy

Women are susceptible to various breast diseases. Sometimes conservative treatment is impossible, so you have to resort to surgery. A mastectomy—breast surgery that removes tissue—can be preceded by severe illness. Sometimes surgery is also performed on men. They are less likely, but still susceptible to breast diseases. Therefore, this operation is not so uncommon.

Indications for mastectomy

During this procedure, the mammary gland is removed. During this procedure, the breast and subcutaneous fat are amputated. This is necessary to eliminate the risk of metastases in the lymph nodes.

During amputation, the pectoralis major or minor muscles are removed. Sometimes it may be necessary to remove both of them.

In women, mastectomy is performed if:

malignant breast tumor;
purulent lesions of the mammary gland (purulent, necrotic, phlegmonous mastitis, breast abscess);
nodular, fibrocystic mastopathy;
breast sarcomas.

Sometimes mastectomy is performed for preventive purposes. Such a radical decision is made when it is necessary to prevent breast cancer, as well as when the patient is at risk due to genetic predisposition.

In men, the operation is performed for gynecomastia - enlargement of the mammary glands. In this case, the breasts resemble those of a woman. It can occur if the body has:

hormonal disorders;
genetic predisposition.

Sometimes doctors cannot identify the causes of gynecomastia.

Male type pathology can affect both adults and newborns. But in the latter case, it can disappear on its own during adolescence.

Gynecomastia can occur in 3 stages. At the stage of development of the disease, it can be cured non-surgically. The intermediate (building of glandular tissue) and fibrous (enlargement of glandular and adipose tissue) stages require surgery.

Types of surgical interventions

In medicine, it is customary to distinguish several types of operations involving the removal of the mammary gland.

In some cases, a prophylactic mastectomy is performed to eliminate the risk of cancer cells damaging the healthy gland.

Unilateral or bilateral mastectomy?

When choosing a method of surgical intervention, most women have recently insisted on having a bilateral mastectomy. This is due to the fact that the affected cells can transfer to a healthy breast. However, this option is not suitable for all patients.

According to doctors, a prophylactic mastectomy does not guarantee the absence of the likelihood of cancerous tumors forming in the second breast. This state of affairs occurs if the patient does not have a genetic predisposition to cancer.

Bilateral mastectomy is a traumatic type of surgery. During postoperative treatment with chemotherapy or radiation therapy, tissues recover much more slowly.

If men have bilateral gynecomastia, then a double mastectomy is performed.

Preparing for surgery

When breast formations occur in men and women, an examination of the body is carried out, which includes:

blood analysis;
computed tomography;
radiography.

During the last procedure, the doctor evaluates the location of the tumor, as well as the extent of the spread of the cancer. It is also necessary to determine whether damage has occurred to the lymph nodes, liver, lungs, bones and other organs.

The doctor must be aware of the patient's medications. Before surgery, it is necessary to exclude aspirin, ibuprofen, naproxen, vitamin E and other medications that interfere with blood clotting.

Carrying out the operation

In women, the operation is performed under general anesthesia. Its duration is approximately 2-3 hours. It may take longer if lymph nodes are removed or during reconstructive surgery.

The surgeon makes a 13 to 20 cm long incision in the chest. It starts from the inside of the chest in the sternum area and extends to the armpit. After removing the breast tissue, it is sutured using absorbable sutures or staples. Every 2 weeks, the staples are removed by the doctor during your appointment.

Plastic drainage tubes are placed in the chest to remove excess fluid. This process speeds up healing and reduces swelling.

In a subcutaneous mastectomy, the entire breast is removed. In this case, the nipple and areola remain in place.

A complete or simple mastectomy involves cutting the gland tissue, freeing it from the skin and muscles, and then subsequently removing it along with the nipple and areola.

To assess the risk of cancer cells spreading, a biopsy of the lymph nodes located in the armpit is performed. Sometimes, in order to prevent this process, a prophylactic mastectomy is performed.

A modified radical mastectomy involves removing the breast and some lymph nodes. During radical surgery, not only the lymph nodes are eliminated, but also the chest muscles.

In men, a mastectomy is performed within 1–1.5 hours. The surgeon determines the tactics of the operation. If there is excess glandular tissue, then liposuction is necessary. Excess is removed during penetration into the nipple-areolar area. After the operation, the stitches located along the edge of the pigmented area are practically invisible.

Postoperative observation of women and men lasts from 1.5 to 2 days in order to prevent the development of complications.

Rehabilitation process

After the operation, discharge occurs on the third day. Before leaving home, a woman should familiarize herself with the recommendations for handling the drainage system that was installed in the chest.

The patient may experience pain. To eliminate them, you need to take painkillers prescribed by your doctor. Usually the pain disappears within 4-5 days.

After a mastectomy, it is forbidden to make sudden movements, raise your arms above your head, or carry heavy objects.

The rehabilitation process takes about 4 weeks. During this period, the patient visits a medical facility for dressings, as well as aspiration of serous fluid (after removal of the drainage tubes).

In severe forms of the disease, the following is prescribed:

chemotherapy;
hormonal or radiation therapy;
combination of treatment procedures.

If no complications arise, after a few months many women experience complete recovery of the body.

After a mastectomy, men are advised to wear a compression bandage on the chest. It speeds up the recovery of the body and improves the results of the intervention. If there is a risk of inflammation, the doctor will prescribe antibiotics.

In the case of men, it is planned to refuse saunas and steam baths for a month, as well as sports. If the patient follows the recommendations, recovery will not take much time.

Complications after surgery

Some patients experience a number of complications after breast removal. These include the appearance of:

phantom pain;
bleeding;
impaired lymphatic drainage, which causes swelling of the hands;
stiffness of movement during the action of the shoulder joint;
pain in the neck;
sluggish healing process;
depression.

In the male case, with complications, a slow healing process of scars is observed, as well as painful sensations. However, their rehabilitation process is much easier.

If tumors appear in the female breast, an emergency consultation with a doctor and treatment, including a mastectomy, are necessary. For the stronger sex, this operation is especially exciting and important, since the disease causes a lot of inconvenience and complexities.

In situations where the tumor is large, or a woman has aggressive breast cancer, a mastectomy is necessary, an operation in which the entire mammary gland is removed. Complete removal of breasts with small tumors is an option for women who want to avoid radiation therapy and minimize the chance of recurrence. Unlike partial resection (sectoral resection, lumpectomy, quadrantectomy), breast irradiation, as a rule, cannot be avoided.

Read in this article

Who is suitable for mastectomy surgery?

previously received radiation therapy to the chest area;
there are multiple tumors in the mammary gland, located in different quadrants (1/4 of the breast);
extensive damage to breast tissue DCIS (ductal carcinoma in situ);
large tumor compared to breast volume;
There are clear criteria for familial breast cancer or certain genetic mutations in the BRCA1 and BRCA2 genes.

Mastectomy Options

In the last decade there have been significant changes in approaches to surgical treatment of breast cancer:

The proportion of operations involving complete removal of the mammary gland has decreased significantly. With the advent of the so-called organ-preserving treatment, lumpectomy, sectoral resection, and quadrantectomy, in which part of the mammary gland is excised, have become more common.
The previously widely used radical mastectomy, in which the entire mammary gland, as well as all nearby lymph nodes and chest muscles, was removed, was replaced by a modified, less traumatic operation (the pectoral muscles are not removed).
Many large oncology clinics have begun to perform mastectomies, in which breast tissue is removed, leaving large areas of the skin, nipple and areola intact, allowing reconstructive surgery to be performed with good cosmetic results.

There are the following options for mastectomies (total removal of the breast), which are currently considered the gold standard for surgical treatment of breast cancer.

A simple total mastectomy is the removal of the entire breast, nipple and areola. The axillary lymph nodes are not removed, and breast reconstruction is usually performed on time or after two weeks. The length of hospitalization varies: for some women it is an outpatient procedure, while for others it may require a stay in a hospital bed for several days.
Modified radical mastectomy. In this operation, the breast, nipple and areola are removed, and axillary lymph node dissection (excision of the axillary lymph nodes) is performed. Breast reconstruction (reconstructive surgery) is usually performed after three weeks.
Subcutaneous mastectomy. When the breast, nipple and areola are removed, the skin of the breast is left untouched. This option of mastectomy allows you to achieve a good cosmetic result and perform reconstruction of the gland during surgery. It also allows you to easily install a tissue expander during surgery if reconstruction is delayed for any reason.
Nipple-sparing mastectomy is a new technique for removing the mammary gland, used in women who have a small tumor located not near the areola, but in the depths of the gland tissue. During this operation, the surgeon excises the skin along the outside of the breast, as well as around the edge of the areola. He then separates the gland tissue from the inside of the areola, thereby preserving the nipple. This technique involves simultaneous breast reconstruction and also allows for the placement of a tissue expander as the first stage of reconstruction.
Nipple and areola sparing mastectomy. Using this technique, the surgeon separates the breast tissue from her skin through an incision, usually made on the outside, thereby preserving the nipple and areola. This allows for immediate breast reconstruction, or, if this fails, to install a tissue expander (perform the first stage of breast reconstruction surgery).
Scarless mastectomy is a fairly new surgical technique that has been developed and performed in large cancer centers. The main objective of this operation is, regardless of how the breast tissue is separated from the skin, to do this through small surgical incisions, thereby avoiding the formation of noticeable scars. It is not uncommon for tissue removal to be performed through openings that are smaller than 2 inches.
Preventive/prophylactic mastectomy - removal of one or both breasts. Its goal is to reduce the risk of developing breast cancer. Women who have mutations in genes such as BRCA1 and BRCA2 or have close relatives diagnosed with breast cancer (family history of cancer) are candidates for this surgery. They are also sometimes advised to have their ovaries removed. Genetic counseling can confirm or rule out any suspicions about the heritability of this cancer.

Since there is no evidence that prophylactic mastectomies require lymph node dissection (removal of the axillary lymph nodes), it is not performed during such operations. To ensure that “everything is in order” at the site of the removed mammary gland, after these interventions the patient must undergo regular examinations for 90 days.

All mastectomy options listed above, with the exception of the modified one, allow for simultaneous reconstructive surgery (both operations, breast removal and reconstruction, are performed simultaneously).

Possible complications of breast removal surgery

Like any surgical intervention, mastectomy has its own unique complications. Here are some of them:

Temporary tissue swelling.
Pain in the area of the postoperative wound.
Hardening in the area of the scar that forms at the site of the incision.
Infection of a postoperative wound.
Bleeding.
Swelling of the arm on the side of the operation if lymph node dissection (removal of axillary lymph nodes) was performed. This may be preceded by earlier signs of this complication, such as a feeling of numbness in the hand, soreness of the skin to any touch, and redness.
Symptoms of phantom pain, which are manifested by itching, tingling, pulsation in the area of the removed breast. These sensations can be managed with medication, exercise, or massage. Phantom pain is not a sign of the presence of cancer cells in the area where the breast was removed and does not mean that the cancer is likely to return.
Seroma is a fairly common complication after mastectomy, the result of the accumulation of tissue fluid in the cavity formed after the operation (clear fluid trapped in the wound). The surgeon treats large seromas (all kinds of manipulations that help remove fluid) on an outpatient basis.
"Ugly" scar. Although scarring cannot be avoided, it is usually not noticeable unless the mastectomy is performed by highly trained professionals. Quite often, especially in the first year after surgery, many patients experience discomfort under the arm if lymph node dissection has been performed.
Depression and feelings of loss of gender identity.

There are also other complications, the occurrence of which largely depends on the general health of the patient. Therefore, you should definitely discuss all possible risks of the procedure with your surgeon before surgery.

The woman's condition after surgery

After the operation is completed, the patient is sent to the recovery room for observation. The type of mastectomy and type of anesthesia largely determine how long your stay in this room will last. After the patient's blood pressure, pulse, and breathing have stabilized and she has regained consciousness, she is transferred to a regular ward.

After a mastectomy, patients usually stay in the hospital from 1 to 3 days, sometimes longer, depending on the type of surgery and whether there was breast reconstruction.

In most cases, the soreness may last several days, although many patients experience no pain after surgery. It is recommended to take pain medication to relieve symptoms as recommended by your doctor. Aspirin and some other painkillers can cause bleeding. Therefore, before taking any medication, you should consult your doctor.

Recovery at home

From the moment a woman finds herself at home after being discharged from the hospital, she needs to ensure that the post-operative area is dry and clean. To do this, the doctor will give certain instructions, and he can also give recommendations on how to change it yourself.

If breast removal was performed with lymph node dissection, the surgeon may recommend exercises to help develop the arm on the surgical side. Pain after lymph node dissection in the axillary region often forces a woman to hold her arm in a forced position, which leads to shoulder stiffness. That is why it is necessary to start exercises to prevent this pathology as early as possible. Like any physical activity, these exercises can cause injury, so you should consult your surgeon before attempting them. They are useful to perform even if lymph node dissection has not been performed.

Women usually return to their normal routine within 4 weeks after a mastectomy. Recovery time may be longer if breast reconstruction is performed at the same time, which can take several months.

Therefore, the recovery period largely depends on the individual case. The timing of your rehabilitation should be discussed in advance with the surgeon.

You should also tell your doctor if the following symptoms occur:

a sharp increase in body temperature, accompanied by chills;
there is fluid leakage from the wound (blood, etc.), there is redness and swelling;
increase in pain intensity;
sudden numbness and tingling in the hand from the side of the operation.

Depending on your specific situation, your surgeon may provide additional postoperative instructions.

Many patients have concerns about the appearance of their breasts after a mastectomy. Fortunately, recent versions of this operation allow breast reconstruction to be performed in most women. An alternative solution to restoring breast shape after surgery is to wear a prosthesis or a special bra.

Mastectomy Options

Radical mastectomy

This term is already more than 100 years old; translated from ancient Greek it means: mastos - breast, ek tome - remove. That is, a mastectomy is the removal of the mammary gland. Radix - in Latin this is 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 surgery corresponds to the name “radical mastectomy” (W.S. Halsted “The treatment of wounds with especial reference to the value of the blood clot in the management of dead spaces.” John Hopkins Hospital Rep., 1890-1891. 2:255. W.S. Halsted 1894, The results of operations for the cure of cancer of the breast performed at the Johns Hopkins Hospital from June 1889 to January 1894. Johns Hopkins Hospital Reports, 1894-95, 4:297.). 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 level 2 lymph nodes into the pectoralis major muscle; or when performing palliative operations. Accompanied by deformation of the anterior chest wall due to tissue deficiency in the subclavian region.

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 lymph nodes of 3 levels are removed (Patey D.H., Dyson W.H. The prognosis of carcinoma of the breast in relation to the type of operation performed. Br.J.Cancer , 1948, 2, 7-13). 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.

Madden modified radical mastectomy

(Madden J.L. Modified radical mastectomy. Surg. Gynecol. Obstet., 1965, 121, 1221-1230). 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.

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 (Auchincloss H. Significance of location and number of axillary metastases in carcinoma of the breast. Ann. Surg., 1963, 158, 37-46).

Radical mastectomy with pectoral muscle sparing

This involves removing the mammary gland and lymph nodes of levels 1-3. Both pectoral muscles are preserved. (V.P. Letyagin, 1981). 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%, it is greater 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.

Mastectomy– removal of only the mammary gland (the oldest operation, its authorship has become confused over the centuries), there are situations in which removal of the axillary lymph nodes can be avoided.

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

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:

transverse recto-abdominal muscle *, TRAM) flap;
thoracodorsal flap (flap based on the latissimus dorsi muscle) in combination with an implant;
a two-stage method in which in the first stage an expander (a silicone reservoir that can be gradually inflated by injecting 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 advantages: the TRAM flap consists only of the woman’s own tissue, it tolerates radiation therapy well.

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

The fundamental features of our technology are:

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, 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.

With the active growth of a malignant tumor in the breast, severe purulent damage to the gland, detection of sarcoma or nodular mastopathy, which often degenerates into cancer, the patient is prescribed a mastectomy. What it is? Resection of the affected breast and nearby lymph nodes is carried out if there is a high risk of metastasis and tumor growth.

Is it necessary to remove the mammary glands? How is the rehabilitation period going? How to eliminate a cosmetic defect? What is a preventative mastectomy? The answers are in the article.

general information

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

Important details:

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

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

Lifestyle

Helpful Tips:

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

Possible complications

The use of modern methods of resection of affected mammary glands in combination with comprehensive rehabilitation reduces the likelihood of an inflammatory process and the spread of metastases. Strict adherence to the recommendations given by the mammologist reduces the strength of negative feelings after a mastectomy.

After surgery, some patients experience complications:

the hand swells when the outflow of lymphatic fluid is disrupted;
phantom pain in the surgical area;
bleeding and poor wound healing;
skin necrosis, contractures;
decreased mobility of the shoulder joint;
erysipelas of tissue with further degeneration into more severe forms: abscess, sepsis;
depressive states, especially in the absence of desire or opportunity for breast surgery;
curvature of the spine, causing pain in the cervical area and poor posture.

An important factor that reduces the risk of complications is cooperation with a qualified breast oncologist and surgeon. Mastectomy is a complex operation. Inaccuracies during the removal of the gland, the choice of an inappropriate method of surgical treatment without taking into account the individual characteristics of the patient can lead to dangerous complications. You need to find a high-level clinic and an experienced doctor. Most medical institutions that use the latest equipment and an effective set of measures during the rehabilitation period offer women reconstructive plastic surgery to eliminate cosmetic defects.

Breast reconstruction

To reduce psychological discomfort and eliminate the defect after a complete mastectomy, the mammologist suggests that the patient restore the shape and size of the breast after surgery. With a highly qualified plastic surgeon, the difference between natural glands and reconstructed organs disappears.

Two methods are used:

use of authentic (the patient’s own) tissues. The doctor removes flaps of skin, fatty tissue and muscle from the buttocks, thighs, and abdomen. The technique is used less frequently than the second method of breast reconstruction;
installation of implants- modern technique with high results. The doctor inserts the silicone implant into a special “pocket” to imitate the natural shape of the mammary glands.

Which method is more effective and safe? Doctors are sure: method No. 1 is using one’s own tissues, but not every plastic surgeon will undertake such a complex operation. Installing implants is a simpler and less traumatic method. For this reason, artificial fillers are more often used.

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

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

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

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 Halsted-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 interfere with the mobility of the 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, the muscle tissue is intersected, which allows for 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.

A circumferential 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 cleared of remaining fiber.
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 in the modern world is damage to the pectoralis major muscle by a tumor process.

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 of plastic surgery to be permanent and the postoperative period to be easy and without complications, it is necessary to comply with some requirements:

exclusion of any physical activity for 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.