Mastectomy complications. Mastectomy - what is it? Surgery to remove the mammary gland. Possible complications after mastectomy

When doctors raise the question of the need for a mastectomy operation for a woman, many mammologist patients panic and try to delay the question and delay the operation as long as possible.

Meanwhile, in the dilemma of whether or not to have a mastectomy, the time of decision-making determines both the positive prognosis of the cure and the quality further rehabilitation and recovery.

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

The concept of mastectomy.

Mastectomy is the surgical removal of the mammary gland and part of its surrounding tissue. There are several types of mastectomy surgery, when, along with the tumor-affected mammary gland, nearby muscle tissue, fat deposits and The lymph nodes.

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

Types and methods of mastectomy.

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

2. Halstead method, or complete radical mastectomy. A Halstead mastectomy involves the most complete removal of the mammary gland, which is why it is called radical. This mastectomy method removes all axillary lymph nodes, as well as the pectoralis major and minor muscles, and all fatty tissue. Only the thoracic nerve is left. Nowadays, mastectomy according to the Halstead method is used only in severe late stages of cancer, in which deep penetration of metastases into the adjacent muscles is diagnosed. This type of mastectomy is highly invasive and entails forced extensive removal of the woman's body surface.

3. Madden’s method, when the mammary gland itself is removed, and the nearby one muscle glands and axillary lymph nodes remain. Although often, during a mastectomy using the Madden method, the lymph nodes located directly in the mammary gland are removed along with it. Typically, a Maden mastectomy is a surgical procedure indicated for women who have ductal carcinoma. This method is also used to perform preventive operations when there is a high probability of cancer due to genetic characteristics, such as the detection of a mutated BRCA1 gene.

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

Prophylactic mastectomy.

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

Apparently, for them, the well-founded fear of getting cancer prevailed in their choice to do or not to have a mastectomy, because statistics are inexorable and with a 90 percent probability predict the development of a cancerous tumor if the BRCA1 gene is present in the body. To understand whether or not to do this operation, and even more so for preventive purposes, you need to determine the possible complications after a mastectomy and the indications for its use.

Indications for mastectomy.

In the question of whether or not to have a mastectomy, the answer is usually clear - do it. Because a cancerous tumor has a tendency to progressive development and metastasis, which in most cases leads to fatal outcome. In some cases, treatment with radiation and chemotherapy with careful monitoring of its results is possible to stop cancer. More often, such therapy is carried out as a preparatory or final stage for mastectomy. The number of positive outcomes after mastectomy is steadily growing, and provides the most guaranteed result. Therefore, mastectomy is the preferred method to combat breast cancer.

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

Complications during mastectomy.

Complications after mastectomy are divided at the psychophysical level.
1. Complications immediately after surgery are associated with the wound healing process.
- Heavy bleeding from the wound. Usually occurs in the first postoperative period of mastectomy. Bleeding is stopped with coagulant medications. If the wound does not heal for a long time, repeated excision may be required.
- The healing of the wound left by mastectomy in the axillary region depends on general condition health of the patient and the presence or absence of her chronic diseases. A disease like diabetes greatly increases total term healing.
- The healing process can be complicated by suppuration of the postoperative wound; antibiotics are used to combat this complication.
- At the last stage of the mastectomy operation, a drainage tube is inserted into the wound to ensure the outflow of residual blood, tissue and lymphatic fluid, in common parlance, ichor. Complications include profuse lymphorrhea.
- Lymphostasis and lymphedema are swelling of the arm after a mastectomy.

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

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

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

Except stated reasons complications, there may be other psycho-sexual reasons that an experienced psychologist can identify and remove, so getting rid of such complications in mandatory includes consultations with a psychotherapist.

Treatment after mastectomy.

Treatment of the patient immediately after a mastectomy mainly comes down to regular high-quality dressings and aspiration of fluid formed in the wound. Postoperative period cannot be treated without antibiotic treatment. In the future, when secondary complications such as swelling of the arm occur, treatment involves the addition of therapeutic exercises, swimming, wearing compression sleeves and bandages. Sometimes, when wearing exoprostheses, there is a need to treat skin irritations, but this does not relate directly to the mastectomy operation itself.

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Women are susceptible various diseases breasts Sometimes conservative treatment impossible, so we have to resort to surgery. Mastectomy - breast surgery that removes tissue - can be preceded by serious illnesses. Sometimes surgical intervention is also carried out in 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 tumor breasts;
• purulent lesions of the mammary gland (purulent, necrotic, phlegmonous mastitis, breast abscess);
• nodular, fibrocystic mastopathy;
• breast sarcomas.

Sometimes mastectomy is performed for preventive purposes. This radical solution taken when it is necessary to prevent breast cancer, as well as when the patient is at risk for breast cancer 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.

Pathology male type 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 surgical intervention most women in Lately insist on performing 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, prophylactic mastectomy does not guarantee the absence of the likelihood of formation cancerous tumors 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 admission medicines. 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 incision in the chest. It starts from inside 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 liquid. 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 spread cancer cells 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. At 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 recommendations for handling drainage system, which was installed in the chest.

The patient may be bothered painful sensations. 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 and aspiration. serous fluid(after removing 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 appear, after a few months many women experience full recovery body.

After mastectomy in men, wearing 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.

In the event of the appearance of neoplasms in female breast An emergency consultation with a doctor and treatment, including mastectomy, are required. For the stronger sex, this operation is especially exciting and important, since the disease causes a lot of inconvenience and complexities.

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 fix 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 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 for early stage Oncopathology allows you to get by with organ-preserving surgery. In advanced cases of cancer, active process 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: than before the tumor stops the negative impact on the body, the more favorable the prognosis of therapy.

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

Lifestyle

Helpful 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, baking, White bread, 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 - important elements recovery, 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;
• lungs are useful physical exercise. Be sure to develop your hands, perform special exercises, selected by a rehabilitation doctor. Muscles should not be overloaded, but lack of movement in rehabilitation period leads to stagnation, swelling, poor lymph movement. Perform all exercises strictly with the permission of the mammologist, within the time frame specified by the doctor.

Possible complications

Application modern methods resection of the affected mammary glands in combination with comprehensive rehabilitation reduces the likelihood inflammatory process and 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 healing wounds;
• 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 gland removal, choice of inappropriate method surgical treatment excluding individual characteristics patients can lead to dangerous complications. Need to find a clinic high level 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 uses your own tissues, but not everyone plastic surgeon will undertake such 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.

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

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 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.

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.

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 of 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. Cellulose armpit is not subject to removal. 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.