Suture inflammation after mastectomy. Breast removal postoperative period. Prevention of complications after breast removal

Mastectomy - effective method eliminate a cancerous tumor by removing the mammary glands of the breast. The operation is performed surgically, which involves suturing incisions in the chest area or armpit. The suture is reapplied after a mastectomy if the suturing site pulls, swells, does not heal, or comes apart.

Patients should be aware of all the nuances, so a plastic surgeon and specialist in the field aesthetic medicine talks in detail about the reasons for re-suturing.

Why does the suture pull after a mastectomy?

Pain and pulling sensations V postoperative period are considered natural reaction body for surgical intervention, but sometimes it is a reason to consult a doctor.

This is due to the following reasons:

Increased sensitivity of the skin due to damage to nerve fibers;
The appearance of discomfort due to contact of the wound with clothing;
Overstrain of internal muscles, stretching of soft tissues;
Inflammatory processes or rejection of threads by the body.

How does a wet stitch appear after a mastectomy?

Fluid may ooze from the incision after suturing. of various nature- ichor, blood, pus.

Causes:

Infection and development of wound inflammation;
Injury to soft tissues and microvessels;
Hematomas or death of internal cells;
Allergic reaction for operating instruments;
The appearance of edema when excision of skin and capillaries.

When does a stitch not heal after a mastectomy?

The speedy healing of wounds depends on the progress of the operation, the location of the tumor and the degree of its development, the professionalism of the surgeon and compliance with his instructions.

What to do to make the scar heal:

Wear compression underwear, change the dressing regularly.
Use only medications prescribed by a specialist.
Avoid overheating, hypothermia, swimming, sunbathing, overload.
Treat wounds antiseptics and sterile materials.

What to do if the stitch breaks after a mastectomy?

Dehiscence of sutured skin can occur due to infections, injuries and bruises, the use of tight or weak sutures, as well as physical activity and pressure on the scar. Most often, doctors prescribe repeated suturing, which avoids previous mistakes and speeds up the recovery process.

Warn possible risks you can by contacting an experienced surgeon. The success of plastic surgery is confirmed by thousands of patients. You can sign up for free consultation see a doctor by calling us at the number on the website.

We spoke with a doctor, candidate medical sciences, Associate Professor Oksana Antonovna Shabanova and asked to answer several important issues about the rehabilitation period and return to full life women who have undergone breast removal surgery.

Oksana Antonovna, what set of rehabilitation measures is indicated in the postoperative period? What are the contraindications and restrictions?

First, let's discuss what major changes occur in a woman's body:

Shoulder stiffness and poor posture

One of the complications radical treatment Breast cancer is stiffness of the shoulder joint as a result of the scarring process in this area. Clinical manifestations stiffness is pain when trying to abduct and raise the arm. Shoulder stiffness and poor posture are most successfully eliminated by performing therapeutic exercises, a special set of exercises in water, using compression-elastic bandages and a posture corrector.

Lymphedema, lymphostasis

To increase the effectiveness of the operation, during a mastectomy, not only the tumor is removed, but also The lymph nodes, vessels, and also, if necessary, part of the pectoralis major and minor muscles, cartilage tissue. As a result of the operation, the outflow of lymph becomes difficult, it accumulates in the area of surgical intervention and upper limb, can be released from a postoperative wound in the form of lymphorrhea, and later manifest itself as lymphostasis of the arm.

One of the serious complications of radical antitumor treatment of breast cancer is the development of lymphedema (secondary lymphedema) of the upper limb on the side of the operation. Moreover, immediately after radical mastectomy, the latent period can range from 1-2 weeks to several years. In patients with late edema, in most cases a disorder is detected venous outflow in the axillary-subclavian segment of the vein, which is explained by the development of cicatricial changes.

Contraindications for the treatment of lymphedema:- Patients with relapse/metastasis should not undergo lymphedema relieving therapy to avoid further tumor spread;

Patients with a history of cardiovascular disease, as well as those taking anticoagulants, should undergo ultrasound and Doppler examination before starting treatment to exclude deep vein thrombosis. During treatment, they must submit everything in a timely manner. necessary tests(prothrombin time, etc.;

If pain occurs, treatment should be stopped until the causes are clarified and the pain stops;

Erysipelas is also a contraindication to the use of compression therapy;

Hydrokinesitherapy (swimming pool)

After surgery to remove the mammary gland, attending physicians and physiotherapists recommend starting swimming as soon as possible. For therapeutic exercises, all types of swimming are recommended, but primarily breaststroke. Regular long swimming sessions in a gentle mode lead to physical strengthening body and improve posture.

Physiotherapy

After surgery, women often experience problems with the spine, pain in the lower back, shoulders and muscles. Therefore, it is recommended to do gymnastics. You need to exercise regularly during the day for 10-15 minutes in a well-ventilated area and in comfortable clothes.

Rehabilitation after a mastectomy can be done quickly and effectively using modern means. Properly selected not only allows a woman to feel confident, but is also a therapeutic and prophylactic agent that promotes rapid post-operative adaptation. Such a prosthesis compensates for weight imbalance, preventing secondary body deformations (poor posture, curvature of the spine, drooping shoulders, etc.).

Contraindications to exoprosthetics are:

Progression of the underlying disease; Relapse in;

postoperative scar Complications after complex treatment : divergence of the edges of a postoperative wound as a result of repeated courses of polychemotherapy or radiation therapy

In addition to a correctly selected exoprosthesis, it is of great importance, the main function of which is reliable fixation of the exoprosthesis. Special bras are designed for use together with exoprostheses and provide the necessary safety and comfort when wearing these prostheses. The straps are specially designed: they are padded, widened in the shoulder area, do not cut into the skin, reduce pressure on the shoulders, preventing lymphedema. should fit tightly so that the prosthesis does not change position when moving and bending. The main thing in choosing a bra is functionality, without excluding attractiveness.

Postmastectomy depression

Loss of the mammary gland is not only a physical disability, but also a severe mental trauma that affects women’s adaptation in everyday life and society. Women who have undergone a mastectomy tend to exaggerate the cosmetic consequences of the operation, negatively evaluate their appearance, and focus on the change, in their opinion, in the attitude of others towards them.

Approximately 25% of women after mastectomy experience severe depression (difficulty coming to terms with their appearance, loss of breasts; fear of relapse), even thoughts of suicide. The impossibility of coming to terms with what happened and returning to normal life requires the help of an experienced psychotherapist. At the same time, quick and effective cosmetic correction of a postmastectomy defect (and selection) can reduce the level of asthenic-anxious-depressive state, which contributes to the successful adaptation of women in everyday life and society.

Of the psychocorrective methods of rehabilitation, it is worth highlighting those that prevent the processes of self-isolation and immersion in illness. From this point of view, any types of psychotherapy should be carried out in natural conditions of group communication, which allows one to remove the inferiority complex and believe in recovery. At the stage of active rehabilitation, it is necessary to create conditions for attracting women to specialized recreational swimming groups. Of particular importance in overcoming depression are the natural and climatic factors of sanatorium-resort treatment. Finding themselves in the new environment of a sanatorium-resort institution, patients stop recording their somatic sensations and quickly recover from a severe stressful situation. As a rule, after a correct (based on faith in recovery) implementation of a set of rehabilitation measures, post-mastectomy depression can be overcome.

How long after surgery can I choose and wear a silicone exoprosthesis?

The mammary gland is intended for early rehabilitation period(a few days after surgery) made of soft cotton or microfiber. There are many primary compensation bras with a prosthetic pocket made from cotton and microfiber to suit different tastes. Fashionable design, functionality and optimal reliability will help solve the problem for the first time after mastectomy.

Silicone breast exoprostheses are best suited for permanent wear; they ideally provide a feeling of naturalness and reliability. Exoprostheses have almost all the characteristics that are characteristic of a healthy mammary gland: color, consistency, shape, surface, elasticity. New generation exoprostheses have a soft inner surface that provides minimal touch and friction with your own tissues, especially in the area of the postoperative scar. External silicone prostheses completely imitate the nipple-areolar area of the gland. The shape of prostheses can be round, teardrop-shaped, symmetrical, asymmetrical, sectoral.

For two months after surgery, temporary lightweight prostheses are used that do not interfere with the healing of sutures. Postoperative prostheses are lightweight, do not interfere with the healing of sutures, and do not injure the skin of the breast - intended for temporary (2 months) use.

Then various exoprostheses are prescribed according to indications:

For continuous daytime wear, use 1 month after surgery;

Special prosthetics for gymnastics and swimming;

A silicone prosthesis can and should be worn 6-8 weeks after surgery. If the seam has completely healed - permanently. If a woman is undergoing radiation therapy or the postoperative scar has not yet fully formed - 2-3 hours a day. This will avoid the development of complications such as scoliosis.

Today, there are symmetrical (can be used on both the right and left side) and asymmetrical (left and right) breast exoprostheses. The shape of symmetrical exoprostheses can be different: teardrop-shaped, oval, etc. The shape of asymmetrical prostheses must fully correspond to the shape of a healthy mammary gland.

Choosing the right one is not only cosmetic product, helping women hide postoperative tissue deficiency, but is also used as a therapeutic and prophylactic agent that promotes rapid adaptation of injured tissues. In combination with special underwear or a swimsuit, the exoprosthesis literally becomes part of the woman herself.

What characteristics of a prosthesis are important to look for when choosing a manufacturer?

Exoprostheses must be made from environmentally friendly modern materials, which have passed strict dermatological and physiological control (have various quality certificates, for example, international - TUV).

A good prosthesis is one that you will not think about for a single minute during the day.

How many hours a day can exoprostheses be worn?

Women's breasts are unique and differ not only in the volume of the cup, but also in its shape. To achieve perfect selection and fit, most manufacturers offer three various shapes exoprosthesis cups – for mature, medium and full breasts.

Women with small underbust volume tend to have full breasts, while women with large underbust volume tend to have mature breasts.

How to choose the correct size of an exoprosthesis: First, you need to measure your breast volume and determine the appropriate cup.

Outdated orthopedic views about the need to eliminate weight imbalance after mastectomy by primitively selecting an exoprosthesis with the same weight are now recognized as one of the reasons for the development of postmastectomy syndrome due to increased load on the vessels of the shoulder.

The process of selecting an exoprosthesis consists of three steps:

1. Completeness

One thing to consider is whether the fullness of the remaining breast is: (1) mature, (2) medium full, or (3) full?

By looking at the remaining mammary gland, you can determine which of the following shapes is more suitable (if both mammary glands are removed, then what size and shape would the woman choose: (c) symmetrical, (a) asymmetrical (e) Extra volume, (y) universal.

Generally speaking, symmetrical breast shapes are better after a standard mastectomy, while asymmetrical breast shapes are more suitable if lymph nodes have been removed and a large number of armpit tissue.

3.Bra size

To determine the size and shape of the breasts, it is necessary to measure the volume under the breasts and the distance from the middle of the chest through the very high point the remaining breast, to the middle of the back, to determine the appropriate bra size. The fit of the bra is critical to achieving a natural breast shape and is very important.

In what cases is wearing a massage exoprosthesis indicated?

One of the most fashionable and popular breast prostheses of this American brand, which completely hides any breast asymmetry that has arisen after the removal of part of the breast tissue during a mastectomy operation. These massage breast prostheses from the USA belong to the Pink Line ABC line and are the ideal breast shape for women who want to feel more confident and easy in any environment, both statically and during sudden and intense movements.

The front layer of the ABC Massage Form exoprosthesis is made of lightweight silicone, and the back layer is made of standard silicone. Silicone gel channels on the back layer provide optimal air circulation and a “massage” effect on the chest wall, resulting in reduced sweat throughout the day. The massage form of the prosthesis itself is asymmetrical and fills the deficiency of breast tissue, creating maximum safety from displacement and comfort. This massage breast prosthesis is best worn with a bra that provides support and fixation to the breasts. The effect of constant massage created by the ABS massage exoprosthesis is especially necessary for women with lymphedema and lymphostasis of the arm formed after a mastectomy.

Oksana Antonovna, what recommendations can you give for psycho-emotional assistance to women after radical mastectomy? How can those close to her help a woman go through the postoperative recovery period more comfortably?

One of the severe consequences after radical mastectomy is postmastectomy depression. Loss of the mammary gland is not only a physical disability, but also a severe mental trauma that affects a woman’s behavior in everyday life and society. Women who have undergone a mastectomy tend to exaggerate the cosmetic consequences of the operation, negatively evaluate their appearance, and focus on the change, in their opinion, in the attitude of others towards them.

Approximately 25% of women after mastectomy experience severe depression (difficulty coming to terms with their appearance, loss of breasts; fear of relapse), even thoughts of suicide. The impossibility of coming to terms with what happened and returning to normal life requires, in some cases, the help of an experienced psychotherapist. At the same time, quick and effective cosmetic correction of a postmastectomy defect (exoprosthetics and selection of specialized underwear) can reduce the level of depression, which contributes to the successful adaptation of women in the family and society.

Of the psychocorrective methods of rehabilitation, we should highlight those that prevent the processes of self-isolation and immersion in illness. From this perspective, any type of psychotherapy should be carried out in natural conditions of group communication, which allows one to remove the inferiority complex and believe in recovery. At the stage of active rehabilitation, it is necessary to create conditions for attracting women to specialized groups for recreational swimming, yoga therapy, etc. A special place in overcoming depression belongs to natural and climatic factors when spa treatment. Finding themselves in the new environment of a sanatorium-resort institution, patients quickly recover from a severe stressful situation.

As a rule, after correct (based on faith in recovery) implementation of a set of rehabilitation measures, postmastectomy depression can be overcome.

“Health Pantry” thanks Candidate of Medical Sciences, Associate Professor Oksana Antonovna Shabasova for the interview.

Content

Breast cancer is a terrible pathology that is widespread in the modern world. Advances in medicine with this diagnosis help save patients’ lives. Mastectomy – surgical method solving the problem. What indications do the operations have, what is the difference between the techniques used, how does it happen? post-operative recovery– information, useful for women any age.

What is a mastectomy

A tumor found in the breast becomes a physiological and psychological problem for women. To resolve it, mastectomy is used - an operation to remove the mammary gland, which has options for execution. Surgeons, trying to preserve a woman’s breasts, choose the least traumatic method in all respects. Doctors' tasks:

eliminate a dangerous disease;
create conditions for subsequent breast reconstruction;
improve a woman's quality of life.

During surgery, depending on the type of technique, the mammary gland, pectoralis major and minor muscles, and fatty tissue containing lymph nodes are removed. A cancerous tumor is dangerous due to the rapid growth of metastases. Surgical intervention has features depending on the stage of development of the pathology and the woman’s age. Indications for breast removal are:

cancer risk more than 51%;
sarcoma;
purulent inflammation;
genetic predisposition to cancer;
gynecomastia.

There are restrictions for removing mammary glands. Contraindications for performance:

cerebrovascular accident;
liver, kidney failure;
decompensated diabetes mellitus;
swelling in the gland, spreading to the chest;
severe form of cardiovascular failure;
multiple metastases to the lymph nodes with swelling of the arms;
tumor growth in the chest tissue.

Types of mastectomy

The earlier a woman is diagnosed with breast cancer, the less traumatic surgery will be. Subsequent measures for breast reconstruction also depend on this. Several techniques for performing mastectomy have been developed. In addition to removing the mammary gland, they mean:

The most minimally traumatic method with the possibility of subsequent breast reconstruction is subcutaneous mastectomy. The affected glandular tissue is scraped out through a small incision. Modified types of radical intervention are used together with the elimination mammary gland:

Indications

Before performing a mastectomy, doctors evaluate the woman’s condition, the degree of tumor development, and the structure of the cancer. This is taken into account when choosing the method of surgical intervention. Everyone has their own testimony:

Methodology	Indications for testing	Performance	Chemotherapy
Subcutaneous	The neoplasm is close to the nipple, size up to 20 mm	Access to the tumor through a small incision	Not required
According to Pirogov	Stage 1.2 cancer, tissue damage	Removing part of the chest and muscles	Not required
According to Madden	Second stage of cancer with lymphostasis	Removal of breasts and lymph nodes	Required

Oncologists choose a modification of mastectomy in accordance with the indications for the procedure and the severity of the process:

Methodology	Indications for testing	Performance	Chemotherapy
Bilateral (bilateral mastectomy)	Multiple tumors stage 3-4 affecting both mammary glands, genetic mutations	deletion	Performed before surgery
	Tumor size no more than 4 cm, presence of pain, burning sensation	The mammary gland is removed with subcutaneous tissue and chest muscle	Not assigned
Radical	Stage 3 cancer with pain	Elimination of all chest muscles	Not assigned

The choice of surgical intervention is a crucial moment for oncologist surgeons. The need for chemotherapy is determined by the doctor. Commonly used types of mastectomy:

A tumor in the last stage with metastases is treated with surgical operation carried out using the following methods:

Preparation for surgery

Before proceeding with a mastectomy, the doctor performs initial examination women, collecting anamnesis. An examination is ordered, and based on the results, the method of performing the operation is selected. Preoperative measures include:

general, biochemical analysis blood;
breast mammography;
urine test;
tissue biopsy;
computed tomography;
blood clotting test;
research on tumor markers;
prescribing a light diet;
admission restriction medicines, promoting blood thinning;
prohibition on drinking and eating on the operating day.

Carrying out the operation

When choosing a surgical procedure, it is taken into account whether one breast is removed according to plan (unilateral mastectomy) or whether both are removed. The operation is performed under general anesthesia. Duration ranges from one to three hours, depending on:

the patient's condition;
stages of cancer;
tumor localization;
presence of metastases.

Exists general algorithm actions when removing mammary glands in women:

anesthesia is administered;
Marking of the rifling is applied with a special marker;
skin is incised;
the subcutaneous tissue and mammary gland are separated from it;
tissue is removed, including lymph nodes if necessary;
in accordance with the surgical technique, fatty tissue and pectoral muscles are excised;
vascular links and nerve endings can be traced;
drainage is installed to drain fluid;
Stitches are placed and removed after 12 days.

According to Halstead

This type of mastectomy is considered a classic option, used for stages 1-3 of cancer. The method bears the names of the doctors who developed it - Halsted-Mayer. For the patient, this is the most traumatic method of intervention, which is used in the case of extensive metastasis of the lymph nodes and chest muscles. During the operation, the following is simultaneously removed:

mammary gland;
pectoralis major and minor muscles;
subcutaneous fatty tissue - subscapular, axillary, subclavian;
lymph nodes;
nipple;
skin.

Holder-Meyer mastectomy is used when other methods are powerless. Contraindications for surgery must be taken into account. The technique causes a serious complication - limited mobility of the shoulder joint due to muscle removal and nerve damage. As a result of the removal of a large amount of tissue, problems arise during plastic breast reconstruction:

restoring the symmetry of the glands;
correction of volume, shape;
reconstruction of the nipple-areolar complex.

Radical mastectomy according to Madden

The type of surgical intervention developed by Madden is considered more gentle and less traumatic. Mastectomy is used to treat women with nodular forms of cancer. During the event:

the mammary gland, axillary, subscapular, subclavian lymph nodes with subcutaneous tissue are removed;
all muscle groups are preserved;
there is no heavy bleeding;
vascular and nerve endings are preserved.

As a result of the Madden mastectomy, due to the reduction in the volume of surgical intervention and the reduction in trauma, complications rarely occur. After operation:

is happening fast healing wounds;
the mobility of the shoulder joint is not impaired or restoration is carried out using special gymnastics and massage;
Plastic reconstruction of the mammary glands is successful;
there is a possibility of recovery in a short time.

Breast amputation

When choosing a method of performing an operation, oncologists take into account the stage of the disease, the degree of cancer activity, the rate of tumor growth, and hormonal state. female body. Amputation of the mammary gland is a simple mastectomy. It does not apply to radical interventions. It is planned to remove the mammary gland and fascia of the pectoralis major muscle, nipple and areola. Indications for this are:

stage 4 cancer;
disintegrating malignant neoplasms;
pathologies of 2-3 degrees when it is impossible to perform radical surgical intervention.

This type of operation is used for preventive purposes if there is genetic predisposition to the development of breast cancer. Large size of the tumor is also an indication. Features of surgical intervention:

A biopsy of nearby lymph nodes is required;
if the cancer tumor is up to two centimeters in size, the areola and nipple are not removed;
subsequent radiation and chemical therapy is prescribed.

By Patey

During the operation using this doctor’s method, the pectoralis major muscle is not removed. Peyti's method helps preserve the functions and cosmetic appearance of the remaining tissues. During surgery:

the mammary gland and fascia of the pectoralis major muscle are removed;
the small one is excised, providing access to the axillary lymph nodes;
they are removed;
subcutaneous tissue and skin around the malignant tumor are excised;
drainage is installed;
stitches are placed.

Patey's technique - modified radical mastectomy - is considered low-traumatic, finds wide application in oncology. After the operation, a minimal number of complications are observed. The disadvantages include:

the appearance of scars in the area of the subclavian vein;
difficulties in breast formation using artificial implants;
slight but quickly recoverable limitation of mobility of the shoulder joint.

Postoperative period

In order for a woman to quickly regain her shape after surgery, it is necessary to carry out rehabilitation measures prescribed by the doctor. This will help relieve pain syndromes, increase the mobility of the shoulder joint, restore lymph flow, and eliminate complications. In the postoperative period it is necessary:

refuse to visit the solarium, bathhouse;
avoid lifting heavy objects;
use an elastic bandage;
wear special soft clothing;
drink more fluids;
avoid injury;
be regularly examined by a doctor.

The postoperative condition requires careful attention to health. It is recommended for a woman:

limit working hours;
reduce movement;
perform a special complex of exercise therapy;
visit the swimming pool;
use a bandage;
eliminate exposure to heat;
wear specialized underwear - bra, swimsuit;
do gymnastics;
do not inject into the arm on the removal side;
conduct a course of psychological recovery;
See a doctor if you feel worse.

During rehabilitation after a mastectomy you will need:

normalize nutrition - use a low-calorie diet;
carry out physiotherapy;
perform massage, hydromassage;
use exercise machines to restore mobility of the shoulder joint;
limit prolonged stay in an inclined position;
use compression sleeves during air travel;
use therapeutic wrap;
take the drug Tamoxifen to prevent relapses;
perform reconstructive plastic surgery measures.

Complications

Having a mastectomy can have serious consequences. Complications appear after surgery and in the subsequent, long-term period. After the operation, it is possible that problems may arise:

suppuration of a postoperative wound;
bleeding;
breathing problems;
appearance in lower limbs blood clots;
lymphorrhea - prolonged leakage of lymph as a result of injury to the lymph nodes;
allergies to medications;
marginal tissue necrosis;
damage to the nerve endings of the muscles of the back, arms, chest;
organ infection abdominal cavity.

During the recovery period after a mastectomy, long-term complications may appear:

pain, stiffness in the hands;
shoulder joint mobility problems;
lymphostasis – swelling of the hands caused by impaired outflow of lymphatic fluid;
rough postoperative sutures;
proliferation of connective tissue;
disorder of the outflow of venous blood due to blockage of the lumen of the axillary and subclavian vein during surgery.

The most serious problems for women are post-operative psychosexual problems. Removal of the breast causes:

depression;
feeling of one's own inferiority, inadequacy;
difficulties in communicating with the opposite sex;
limiting social contacts;
fear of relapse of the disease;
fictional and real difficulties of sexual life;
difficulty making new acquaintances;
problems in family relationships.

Breast reconstruction

Women undergo plastic surgery to restore their breasts due to psychological discomfort. In addition, problems arise at the physical level associated with an imbalance of loads on the spine. After mastectomy the following are observed:

change in posture;
drooping shoulder on one side;
rachiocampsis;
disruption of the lungs and heart.

Reconstruction is often performed in conjunction with a mastectomy, or six months after surgery. As a result of measures at the site of removal of the mammary gland, restoration is carried out:

volume of subcutaneous fatty tissue, skin;
excised tissue located nearby, chest muscles;
nipple-areolar complex;
in addition to the operated breast, a second breast to adjust the size and shape.

There are several reconstruction techniques that differ in implementation and results. One of the popular methods is the use of endoprostheses. Features of plastic surgery:

performed after subcutaneous mastectomy;
An expander, a special device, is inserted through the incision;
the skin is stretched, a cavity is formed for subsequent installation of the implant;
advantages - low trauma;
Disadvantages - unnatural breasts to the touch and appearance, risks of tissue necrosis, restrictions on implant installation.

To create a breast that is natural in appearance and feel, a transplant of one’s own tissue is used, which is taken from the back and anterior abdominal wall. This technique, the TRAM flap method, is characterized by:

complexity of the operation;
high morbidity;
the need for long-term anesthesia;
the possibility of tissue rejection;
long recovery period;
no problems associated with implant displacement.

Another reconstructive method is the use of vacuum devices. When using them:

a domed bowl is placed on the chest;
a vacuum is created under it;
skin stretches;
its excess is formed;
a site is formed for the subsequent installation of a silicone implant and fat tissue transplantation;
The disadvantage of this method is that it requires wearing the device for a long time, the appearance of stretch marks is possible, and it is difficult to stretch the implant to a large size.

A combined breast reconstruction technique is often used. Breast plastic surgery includes a combination of methods:

replenishment of tissue deficiency by transplanting flaps of the patient’s own muscles, subcutaneous tissue, and skin;
correction of shape, size, symmetry, restoration of volume, elimination of depressions is carried out using silicone implants.

Price

Mastectomy in Moscow is performed in specialized clinics, oncology centers. Surgery involves only breast removal or simultaneous plastic reconstruction. The cost depends on the stage of cancer, the characteristics of the implementation process, the qualifications of specialists, and the status of the clinic. Transaction price in rubles:

Video

Recurrence in the area of the operated breast

A recurrence of a malignant tumor may occur in the same area of the breast where the cancer was. The term "recurrence" means that the cancer is not new, meaning it is not a new disease. However, sometimes cancer can recur in another area other than the site primary tumor. In this case, they talk about cancer metastasis. The appearance of a new breast tumor is not so common, but this is preferable to a recurrence. If the doctor finds a tumor in your other breast or in another area of the breast, then this is not a relapse, but the appearance of a new tumor. This is especially true if a new tumor appears 5 years after surgery.

Recurrence of cancer can occur in the following areas: in the breast area, in the chest wall area, in the lymph node area, in the bone area, in the lung area, in the liver area, in the brain area.

It is worth saying that malignant tumors from other areas of the body very rarely metastasize to the mammary gland or chest wall. If you have a tumor in the lymph nodes, lungs, bones, liver or brain, then this is most likely a relapse of breast cancer, and not an independent cancer of one or another organ. In other words, if you had breast cancer and now a tumor is detected in the bones, liver or lungs, then this is a transition (metastasis) of breast cancer to these organs. That is, if you do a biopsy of the metastasis site and examine it under a microscope, breast cancer will be detected. This is very important to understand, since breast cancer is much more treatable than tumors that originally arose in the bone tissue, or, for example, in the liver.

Metastatic breast cancer to other parts of the body is invasive cancer. However, recurrent breast cancer that occurs in the breast after surgery and/or radiation therapy can be either invasive or non-invasive. If cancer has arisen in the opposite mammary gland, in most cases this is not a relapse, but a new tumor.

Recurrence of breast cancer, depending on its spread, can be:

Local relapse: in the area of the operated mammary gland.
Regional metastases: relapse occurs in nearby lymph nodes.
Metastatic cancer: Breast cancer occurs in other areas or organs, such as the liver, bones, brain, or distant lymph nodes.

Local recurrence of breast cancer

In two-thirds of cases when cancer recurs in the same breast, cancer is usually found in the same place or immediately next to that place. The remaining third of cancer recurrences are new tumors. Also, if the tumor arose in another area of the breast where there was cancer, or in the opposite mammary gland, then in this case we are talking about a new disease, and not about a relapse. About a third of local breast cancer recurrences are detected using mammography alone. The other third of relapses are detected by a routine physical examination (feeling the breast by a doctor or during self-examination) and, finally, the remaining third of relapses are detected by combining mammography with a physical examination. Almost 80% of women with local recurrence of breast cancer have no further signs of cancer elsewhere.

Local cancer recurrence after lumpectomy and radiation

If you had a lumpectomy for breast cancer (removal of part of the breast along with the tumor) and subsequently had a course of radiation therapy (or without it), you are at risk of developing a local recurrence. Such a relapse is manifested by the appearance of a new tumor in the thickness of the mammary gland, which becomes larger or an area of densification of the gland tissue. However, you should not immediately panic if you find a lump in the area of the “former” breast cancer. It is quite possible that this is one of the following conditions: adipose tissue that is destroyed as a result of the treatment, scar tissue that has enveloped a small suture node in the thickness of the gland (the so-called ligature granuloma), scar tissue that has developed after the removal of breast tissue.

Redness and swelling in the breast area can also be symptoms of cancer recurrence, but usually the cause is different. The fact is that the entire breast area may look red and swollen for several months after surgery and radiation therapy. Over time, the redness goes away and the skin acquires its normal color, but this usually takes a certain time.

If after several months or even years a new area of redness appears in the breast area, especially if it is accompanied by irritability and pain, elevated temperature, then most likely these are symptoms of inflammation of the gland - mastitis. Antibiotics are used to treat this disease. If antibiotics do not lead to positive result within one to two weeks, and the mammary gland remains the same swollen and reddened, then the doctor will recommend a biopsy. Sometimes non-cancerous diseases, such as psoriasis (a skin disease), can lead to such changes in the skin of the breast.

However, redness and swelling of the breast skin can also be signs of cancer recurrence. This causes the skin to thicken and may look like an orange peel. If the doctor suspects a recurrence of the tumor, a mammogram is usually prescribed. The following signs of local cancer recurrence may be detected on a mammogram: increased size and increased heterogeneity at the site where the tumor was removed, a new tumor or tissue heterogeneity, new accumulations of microcalcifications in the breast tissue.

If similar results are obtained during mammography, it is usually carried out additional methods studies: ultrasound, MRI or PET. If the results of these research methods allow you to suspect a relapse, then the next stage is a biopsy.

Local cancer recurrence after mastectomy

If a woman has undergone a mastectomy for cancer (removal of the entire mammary gland with adjacent lymph nodes), local recurrence of cancer can be: in the area of the skin of the breast, in the area of soft tissue remaining on chest wall, in the area of the reconstructed breast.

In very rare cases, a new tumor may develop after a mastectomy. This cancer arises from the remaining normal breast cells. These cells may remain either under the skin of the breast or in front of the muscles that lie behind the breast. An experienced pathologist can usually determine whether a tumor is a recurrence or a new cancer by comparing the cells obtained in a biopsy with the primary cancer samples. New cancer breast cancer is more treatable than relapse.

Fat necrosis

If a woman has undergone reconstructive surgery to restore the shape of her breasts after a mastectomy, she will usually notice some swelling or swelling - this is called fat necrosis. This is caused by scar tissue or deposits of dead fat cells. Don't be afraid - these swellings have nothing to do with cancer. Such “tumors” are usually less common if reconstruction was done with implants only. These swellings are usually detected several months after reconstructive surgery, when the general postoperative swelling mammary gland. Over time, these tumors may decrease in size. If there are several of these “tumors” together, they can merge into one large one. You should definitely consult a doctor if these swellings begin to increase in size, although most likely this does not indicate anything serious.

If new tumors have appeared in the thickness of the skin or under the skin, you should be suspicious if the tumor is heterogeneous, dense to the touch, pink or red, painless.

If your own tissue was used during reconstructive surgery (TRAM, GAP or DIEP flap techniques), then mammography is performed to clarify changes in the mammary gland. Unfortunately, if silicone implants were used during reconstruction, then mammography is useless in this case, since the implant obscures the entire view of the tissue. In this case, a physical examination by a doctor is very important, as well as methods such as ultrasound and MRI. If the doctor doubts the presence of a relapse, then sometimes even a PET scan can be used.

Different types of rash

Sometimes a rash may appear on the skin that is not related to cancerous tumors. For example, psoriasis. However, sometimes a red velvety rash may appear on the skin against a background of swelling. It could be a relapse inflammatory cancer mammary gland. If the rash is accompanied by non-healing ulcers, then most likely this indicates a relapse of cancer. After radiation treatment for breast cancer, it is common to experience redness, swelling, and sores in the area of the breast. These manifestations progress slowly, their peak occurs in the first or second weeks after the end of irradiation, after which they gradually disappear over several months. However, if such changes occur within a few weeks after the end of treatment, then this is more of a manifestation of inflammation. In this case, antibiotics are prescribed.

Recurrence of breast cancer in the lymph nodes - regional metastases

In 40% of cases, breast cancer recurrence occurs in the lymph nodes. Typically, during surgery for breast cancer, the surgeon may also remove the lymph nodes in the armpit. However, metastases can also occur in other groups of lymph nodes: in some of the remaining axillary lymph nodes, supraclavicular lymph nodes, subclavian lymph nodes, lymph nodes inside the chest (intrathoracic lymph nodes), very rarely in the axillary lymph nodes of the opposite side.

If you yourself or your doctor find swelling in the indicated areas round shape, it may be a regional metastasis. Sometimes enlarged lymph nodes are detected during mammography. Typically, regional metastases rarely affect only the lymph nodes in the axillary region. This occurs in less than 5% of cases. Most often, such metastases appear both in the lymph nodes and in the breast tissue or in the chest wall.

If enlarged lymph nodes are detected, a biopsy and histological examination are usually performed.

Treatment of regional metastases

If regional metastases are detected in the nearest lymph nodes, treatment consists of: local therapy, and systemic. In this case, a full course of systemic therapy is carried out, which includes: chemotherapy, targeted therapy (Herceptin), hormonal treatment (anti-estrogen drugs), anti-angiogenesis therapy.

Treatment options for recurrent breast cancer

Currently, oncology has various modern effective methods treatment of recurrent breast cancer and its metastases. These methods include both local treatment and systemic treatment.

Local treatments include surgery and radiation therapy.
Systemic treatment includes chemotherapy, hormonal therapy, as well as modern trends in treatment oncological diseases- molecular targeted therapy (target - target, goal). One of the well-known drugs for such targeted therapy is Herceptin.

What kind of local and systemic treatment will be carried out for you depends on the same factors that were taken into account at the time the primary tumor was identified. In the case where cancer was detected for the first time with metastases, treatment depends on where exactly the metastasis was found.

A thorough diagnosis is very important in choosing the right treatment. Even if you took various pictures during diagnosis, it is quite possible that you will need more such studies - mammography, MRI, CT, PET, scintigraphy, ultrasound and others. If the cancer recurs in the area where the lumpectomy was performed, but there are no other signs of tumor in other areas, then a good outcome of treatment is quite possible, that is, if the cancer recurred in the form of a small tumor in the mammary gland, then most likely Only local treatment (surgery + radiation therapy) will be required. Local treatment is effective in 8 out of 10 women with recurrence localized to the breast.

If the primary treatment for breast cancer consisted of a lumpectomy followed by a course of radiation therapy, then the standard treatment for recurrence in this case is complete removal breast – mastectomy. A repeat lumpectomy instead of a mastectomy followed by radiation therapy can only be used if you have not had radiation therapy before and you have a low risk of tumor metastasis. This is possible in the following situations: cancer recurrence is localized only at the site of the previous tumor, the size of the recurrent tumor is no more than 4 cm and it can be easily removed, the cancer recurrence is non-invasive (DCIS - ductal carcinoma in situ), a long period of time between the end primary treatment and the development of cancer relapse, the course of the cancer is not aggressive and the nearest lymph nodes are not affected.

As an alternative to a mastectomy, if you have had a lumpectomy and radiation therapy, you can try treatments that are clinical trials, in particular – partial irradiation of the breast (MammoSite).

If, when a relapse is detected, the tumor is assessed as more aggressive, then systemic therapy is added to local treatment. Its goal is to destroy everything cancer cells, which may be located outside the mammary gland, but are not detected during the study.

Recurrence of cancer in the chest wall

If a tumor recurrence occurs in the place where the mastectomy was performed (that is, complete removal of the mammary gland with the underlying pectoral muscles and axillary lymph nodes), then this is a recurrence in the chest wall area. After all, in this place After a mastectomy, there is no breast tissue left, just the chest wall. Usually surgery to remove the tumor is performed first. But in the following cases, surgery is rarely performed: several tumors that are widely scattered throughout the body, the presence of a red rash, which is the transition of cancer to the skin.

If recurrence occurs in the area where reconstructive surgery was performed, sometimes the implant or flap is removed.

The next stage of treatment after surgery is a course of radiation therapy, if you have not had it before. However, if you have previously undergone such treatment, then in this case it is possible to use a short course of radiation.

However, the likelihood of developing side effects from radiation is much higher: difficult-to-heal skin rashes, an increased risk of rib fractures due to the effects of radiation on bone tissue, and the development of a scarring process in the muscles, which leads to their hardening.

To reduce the impact of side effects after repeated exposure to radiation, the doctor makes some changes in treatment. To do this: the amount of radiation in each radiation dose is reduced, the frequency of irradiation is reduced, and the area of irradiation is reduced. For example, a course of radiation therapy can be carried out in small doses twice a day. If you have not received radiation therapy in the past, side effects will be less pronounced. It is quite possible that they will look ordinary sunburn, which manifests itself as redness, irritation, itching and slight flaking of the skin. To reduce these effects, your doctor may prescribe various ointments or creams (for example, 1% hydrocortisone ointment, aloe cream, etc.).

If after irradiation you have pain in your chest, painkillers or anti-inflammatory drugs are prescribed. In some cases, if you have breast implants, exposure to radiation can cause rough scar tissue to form around them. This can cause pain and also changes in the shape of the implant.

In case of relapse in the chest wall area, systemic treatment may be recommended: chemotherapy, hormone therapy and targeted therapy. In about half of women whose breast cancer recurs in the chest wall, the tumor cells gradually spread outside the chest. Systemic therapy drugs are aimed at destroying these cells.

Chemotherapy is not performed if the patient has ALL of the following conditions: the patient is postmenopausal, the patient has only one tumor in the chest wall that can be removed, the interval between the last treatment for breast cancer and the development of relapse is more than 10 years.

The type of treatment given depends in part on what kind of treatment was given before. Sometimes recurrence of a tumor in the chest wall can occur during hormonal therapy. In this case, it is usually recommended to change the hormone therapy drug to another.

Mastectomy is a method of treating breast cancer by surgical removal the whole breast or part thereof. Scars are the result of this procedure.

The incision and surgical approach depend on the volume of breast that needs to be removed, as well as the woman's desire to undergo breast reconstruction after a mastectomy.

Selected surgical approaches, such as nipple-sparing surgery, can improve appearance scars.
The surgeon's actions during the mastectomy depend on the size and depth of the tumor.
A woman's desire for breast reconstruction also determines the type of surgery.

How is a mastectomy performed?

The appearance of mastectomy scars depends on the type of surgery that was performed.

Often, the appearance of the scars left after a mastectomy depends on the incision and the technique the surgeon uses.

At the beginning of the operation, the surgeon will make an incision in the skin of the chest to open inner part breasts

Once the surgeon has removed the breast tissue, as well as the muscle and, if necessary, lymph nodes, he will immediately sew up the skin where the incision was made.

When the tissue damage heals, scars will appear on the skin of the chest. Despite the various surgical approaches described in the current material, most mastectomy scars form a horizontal line across the chest, and sometimes these scars have a crescent-shaped appearance. Quite often, the type of incision the surgeon makes and the resulting scars depend on where the cancer first affected the mammary glands.

Over the decades, the techniques used by surgeons during breast surgery have undergone significant changes. There are currently a large number various procedures, which become more accessible to women every year. Of course, before surgery, the patient should ask her surgeon what surgical method he intends to use and what results can be expected.

What types of mastectomies result in scars?

To the scars to varying degrees severity results from any type of mastectomy. However, there are a number of approaches that a surgeon can use.

Partial mastectomy or lumpectomy

A partial mastectomy involves some area of breast tissue. Sometimes the surgeon also removes the layer of tissue that covers the chest muscles.

A lumpectomy usually leaves a straight scar on the skin of the chest. Sometimes the surgeon may be able to make an incision in the crease of the breast or around the nipple to try to hide the scar.

A partial mastectomy usually leaves most of the breast intact, so breast reconstruction is usually not required. Women who have had a lumpectomy often need follow-up radiation therapy.

Skin sparing mastectomy

This surgical method is usually performed if a woman intends to undergo breast reconstruction immediately after undergoing the main procedure. A skin-sparing mastectomy involves removing the breast, areola, nipple, and lymph node or nodes. But at the same time, the surgeon leaves the breast skin.

Preserving most of the breast skin allows for immediate reconstruction using either implants or the woman's own tissue. Skin-sparing mastectomy usually leaves a visible, medium to large scar on the front of the breast. However, the surgeon can hide this scar by making an incision in a less obvious location.

Nipple sparing mastectomy

Women who undergo prophylactic or precautionary mastectomy, as well as those patients who have early stage breast cancer patients may be candidates for nipple-sparing mastectomy (nipple-sparing mastectomy). This procedure also involves preserving the skin of the breast and areola.

This surgical approach is usually offered to women with small breasts and leaves a scar on the side of the breast. However, the surgeon can also make an incision in the breast crease, that is, on the bra line, and thus make the scar invisible.

Simple mastectomy

This type of surgical approach involves removing the breast, areola and nipple, and sometimes lymph nodes and some area of breast skin, the area of which depends on the woman's plans for reconstruction. The chest wall and lymph nodes located distant from the operated breast, for example, in the axillary region, are preserved.

Usually the surgeon makes an incision oval shape, which runs around the nipple across the entire width of the chest. This incision leaves behind a significant and visible scar.

Modified radical mastectomy

This method involves the surgeon removing all of the breast tissue, as well as lymphatic vessels in the chest and armpit area. The chest wall usually remains intact. A modified radical mastectomy leaves a large, visible scar on the chest.

What additional treatment is required after a mastectomy?

The main goal of a mastectomy or any other cancer surgery is to remove the minimum amount of tissue necessary to treat the cancer.

The surgeon and oncologist will discuss everything possible options help the woman and make the best decision for her. After the operation, the woman will most likely need drainage tubes along with several weeks of rehabilitation.

Certain types of breast surgery, such as a lumpectomy, do not always require the patient to stay in the hospital overnight, but mastectomies do.

The length of the procedure is determined by the type of mastectomy the woman has, as well as the type of reconstruction.

Recovery from a mastectomy takes several weeks. In addition, chemotherapy may be required after surgery

A woman needs to take care possible signs the appearance of infection, such as local fever, redness or discharge at the incision site, and fever, which may indicate the presence of a systemic infection in the body.

How is breast reconstruction performed after a mastectomy?

Reconstruction is a surgical procedure performed after a mastectomy to improve the appearance of one or both breasts. It can be performed either at the same time as a mastectomy, or after a certain period of time.

To perform the reconstruction, the surgeon may take tissue from another area of the woman's body, use implants, or use a combination method.

Tissue expansion and implants

If a woman decides to reconstruct her breasts with implants, the doctor will need to place a device called a tissue expander under the chest muscles or under the skin of the breast.

This procedure can also be performed either at the time of the mastectomy (immediate reconstruction) or later (delayed reconstruction). The woman will need to visit the doctor several times to fill the implant with a saline solution for expansion.

Once the chest skin has stretched and healed from surgery, the surgeon can prepare permanent implants. This time usually occurs approximately 2-6 months after the mastectomy.

However, some women receive permanent implants directly during a mastectomy.

Reconstruction using autologous tissue

Another popular method of breast reconstruction is reconstruction using autologous or own tissue. During this procedure, the doctor takes tissue from the woman's abdomen, back, or buttocks and uses it for reconstruction along with the area of breast skin that was saved during the mastectomy.

This type of procedure is more complex because the surgeon sometimes has to restore blood circulation to the breast tissue.

This type of reconstruction can also be performed either directly during the mastectomy or after some time.

What if a woman does not want breast reconstruction?

Although breast reconstruction after mastectomy is very popular, some women refuse this procedure

According to BreastCancer.org, About 44% of women undergoing mastectomy do not express a desire for further reconstruction.

Women prefer to refuse reconstruction for a number of reasons various reasons. This series includes:

health problems that may make future surgery unsafe or unwise;
the desire to quickly restore normal daily activity;
fear of using tissue from other parts of your body or implants during reconstruction;
high cost of reconstruction.

Sometimes women who do not want to have their breasts reconstructed decide to use prosthetics (artificial breasts), which can be placed in a bra. These women also have access to a sticky pear-shaped device that is attached to the body.

Many women do not use either reconstruction or prostheses and refuse to explain their decision.

How to improve the condition of sutures after mastectomy without reconstruction?

If a woman decides not to undergo reconstruction, she should talk to her doctor about surgical methods, with the help of which you can maximize the condition of the sutures remaining on the skin after a mastectomy.

For example, the surgeon may take steps to make the sutures flatter against the surface of the skin, resulting in a smoother chest wall. Otherwise, a woman may be left with rough scars on her chest, which creates a lumpy appearance of this area of the body.

Even though it does not cause any physical discomfort, women do not like the look of such scars.

Sometimes the surgeon may make what is called a Y-cut, that is, make two small incisions as additions to the main one. This technique can slightly reduce the protrusion of the skin.

Tattoos after mastectomy

In February 2017, the Journal of the American Medical Association published an article, “The Healing Role of Tattoos After Mastectomy.” The story revealed details of the work of a tattoo artist who often has to apply designs over mastectomy scars.

This new approach for women who decide not to undergo breast reconstruction.

Some women who have undergone breast reconstruction go to tattoo parlors to get nipple tattoos. These tattoos give the nipples an additional three-dimensional effect. There are masters who specialize in working in this direction.

Conclusion

The decision regarding breast reconstruction, concealing mastectomy scars, or not even wearing prosthetics rests solely with the woman. However, you should talk to your surgeon about all your options.

If a woman feels that the doctor does not respect her wishes regarding reconstruction or refusal, she can consult with another specialist.

Sometimes wives express a desire to delay making a decision regarding reconstruction until after they have undergone a mastectomy.