Currently, surgery to remove breast cancer is one of the main treatments for this malignant neoplasm. This is the most common all over the world. In the general population it is second only to lung cancer.
Surgeries for breast cancer remove a colony of atypical (irregular) cells from the body. This saves the body from the development of tumor metastases, increases the duration and quality of life.
Depending on the amount of healthy tissue removed along with the tumor, operations are divided into:
- Organ-preserving. Implemented complete removal tumors within healthy tissue. Whenever possible, the best cosmetic effect is achieved.
- Radical. Complete or partial removal of the mammary gland is performed.
Operations preserving the integrity of the organ
Lumpectomy is relatively quick compared to other methods. A small arc-shaped incision a few centimeters long is made. An electric scalpel is often used for this. This allows you to reduce blood loss during treatment and achieve a better cosmetic effect in the future.
Then the tumor itself is removed along with a small area of healthy tissue surrounding it. As a result, it is possible to preserve the mammary gland. This is very important, especially for young women. Disadvantages include possible postoperative deformation and changes in the volume of the gland. Recurrence of malignant neoplasm is possible.
Sectoral resection of the mammary gland is one of the most common organ-preserving operations. Sometimes it is called the Blokhin operation. Performed more often under general anesthesia. Apply local anesthesia Novocaine or Lidocaine. The operation is performed for small tumors affecting a small part of the gland. Approximately 1/8 to 1/6 of its volume is removed.
Subtotal resection with lymphadenectomy. During this operation, 1/3 or even half of the mammary gland is removed. Simultaneously with excision of tumor and glandular tissue, the pectoralis minor muscle and The lymph nodes(subclavian, subscapular).
Cryomammotomy is one of the the latest methods treatment of patients diagnosed with breast cancer.
First a small incision is made. Then a special probe is applied directly to the tumor cells. The probe tip temperature is around -100-120°C. The tumor quickly freezes and turns into an ice ball frozen to the cryoprobe. This design is easily removed through a small incision through the chest.
This procedure is performed in rare cases when small size tumors and
Radical operations
Halstead mastectomy is performed under general anesthesia. After securing surgical access By cutting the skin and subcutaneous fat, glandular tissue is removed. The pectoralis major and minor muscles on the same side are then removed. It is necessary to remove the subscapular tissue, in which small metastatic foci are often found.
The axillary tissue behind the pectoral muscles is removed at all 3 levels.
Urban mastectomy is similar to the technique described above. This is complete removal of the mammary gland. In addition to this, the lymph nodes located on the sides of the sternum are removed. The sternum is a flat bone located in the center of the chest at the front.
Patey's mastectomy is a modified version of the classic mastectomy. Complete removal of the glandular tissue of the mammary gland and pectoralis minor muscle is performed. Distinctive feature The operation is that the pectoralis major muscle and fatty tissue are preserved.
Modified Madden mastectomy differs from previous options in that after removal of the mammary gland itself, the underlying pectoral muscles. The pectoral fascia, axillary, intermuscular and subscapular tissue are removed. At the same time, the danger is leveled further development metastases in lymph nodes located in the tissue.
Breast amputation is an operation to remove the gland itself while completely preserving the underlying tissue.
Main indications for breast removal
The tumor should be clearly visualized on photographs taken using computed tomograph or an X-ray machine. Special attention is given to patients in whom the tumor is found in several places at the same time, for example, in different lobes of 1 gland. In this case, 1 of radical operations is considered a priority.
If the tumor recurs after a lumpectomy, a radical mastectomy is recommended. Radical intervention is recommended for women who have contraindications to chemotherapy concomitant with lumpectomy.
In patients with very small breasts, breast-conserving surgery is not advisable.
This is due to the fact that after removal of the tumor focus, significant deformation of the mammary gland often occurs with a change in its volume. For many women this is unacceptable from a cosmetic point of view.
In some cases, mastectomy, regardless of the option, is combined with radiation therapy. This is necessary when affected by metastases large quantity lymph nodes, with a large tumor size (more than 5 cm in diameter). In the presence of multiple cancerous foci in the glandular tissue, a course of radiation therapy is carried out in the postoperative period.
By special examination in the laboratory of the removed material, cancer cells are sometimes discovered along the edges of the excised tissue. This is an indication for postoperative radiation therapy.
How is the operation performed?
Surgery to remove breast cancer lasts on average 1.5-2 hours. The operation, with the exception of minimally invasive ones, is performed under general anesthesia. The patient is first placed on the operating table. The arm on the affected side is taken away from the body perpendicularly and placed on a stand.
Initially, an incision is made along the entire circumference of the gland in the shape of a semi-oval. The doctor then separates the skin from the subcutaneous fat. Often, dissection and subsequent removal of the pectoral muscles are performed. Then, if necessary, certain muscles are moved to the side. This makes it possible to remove cancerous lymph nodes, which are located, for example, in the armpit or under the collarbone.
Each lymph node removed mandatory sent for research. After removing the planned volume of tissue, drainage must be installed, which will allow the resulting fluid to flow out in the early postoperative period.
Drainage most often takes the form of a small rubber tube. At the final stage of the operation, it is necessary to stop the bleeding in surgical wound, if any. The surgeon then sutures the surgical wound.
Sometimes during surgery it is necessary to remove large areas of skin along with glandular tissue. This in some cases complicates the process of suturing the edges of the wound at the final stage of the operation. The surgeon uses special releasing incisions to ensure normal wound healing. They are made shallowly in the skin on the sides of the surgical wound.
Currently, techniques have been developed to perform operations with maximum preservation of the skin.
Regardless of which type of surgery was used, patients often complain of loss of sensation in and around the wound area. This is due to the intersection of the sensory nerves located in the skin with the surgeon's scalpel. This symptom associated with both minimally invasive and radical mastectomy.
Over time, sensitivity is almost always restored. To others unpleasant consequence During surgery, there may be excessive sensitivity or tingling in the area of intervention. This is also due to irritation of nerve endings during surgery. Unpleasant sensations pass after some time.
The choice of a specific type of operation is made by a mammologist surgeon after thorough examination. It is necessary to establish the exact location of the tumor, its size and using laboratory methods finally confirm the diagnosis. How to determine the presence of a tumor and determine its type.
With radical methods, hospitalization in an oncology hospital or in a specialized department is mandatory. The patient, taking into account preoperative preparation, the operation itself and the postoperative period, remains in the hospital for about 2-3 weeks.
If plastic reconstructive surgery is performed in addition to the main operation to remove breast cancer, the length of stay in the hospital increases. When performing minimally invasive interventions (for example, lumpectomy), the length of hospital stay can be shortened at the discretion of the attending physician. In the future, outpatient monitoring is necessary.
Manipulation of the mammary gland, especially its complete removal, is severe stress for woman. It is necessary to conduct a thorough examination to establish accurate diagnosis and, if possible, implementing the most gentle option. Today, numerous methods of breast replacement after mastectomy are available.
The operation of masectomy (removal of the breast) for a considerable number of women is not bad dream, but reality. Such intervention saves lives, but deprives the feeling of fullness.
It is very important for a woman to undergo examination on time. With the advent of mammography (Rh-graphy of the mammary glands), breast cancer can be detected in initial stage much easier. After all, a mammograph is a device that “sees” and shows cancer lesions ranging in size from 2-5 mm. It is not possible for a doctor to find such tiny tumors by palpation (with his hands).
After operation…
A woman can count on plastic reconstruction (restoration) of the breast. It is carried out in the Oncology Department of Reconstructive Surgery of the Research Institute of Oncology and Medical Radiology named after. N.N. Aleksandrova, in the department of plastic and reconstructive microsurgery of the Minsk regional clinical hospital. This area is also being developed by the oncosurgical department N1 of the Minsk City Clinical Oncology Dispensary and a number of regional oncology dispensaries.
There are several reconstruction options:
- endoprosthetics - implantation of a silicone prosthesis;
- breast reconstruction using the patient’s own tissue;
- combined methods.
Where can I find support?
How to find strength and regain confidence after a mastectomy? Here are the advice of a psychologist-consultant Elena Nikolaevna Ermakova:
It is no secret that society dictates strict conditions: a woman is a person when she is healthy, young, and beautiful. What should women do who have suffered such psychological major surgery like a mastectomy?
Change your dominant and discard stereotypes: now the most valuable thing is your life. She is the most important! And no matter what happens, your parents and children continue to love you.
Those people who are most afraid of losing you, who need you regardless of what you look like...
In addition, it is now important to find other women who have undergone the same operation in order to feel support, to feel: you are not alone! Consolations healthy people are significant, but even more significant is the friendly word of those who have experienced and know first-hand about your illness and its consequences.
Of course, during this period the support of a husband or friend is necessary... When the relationship of two people was initially built on love and mutual affection, then, as a rule, illness or other serious condition only unites them.
In this regard, advice to men: do not pretend that “nothing like that” happened to your wife. Some husbands behave this way with the best intentions. But such a reaction sometimes deeply hurts a woman. Therefore, it is better to talk about what worries your half, only very delicately.
Listen to all complaints, fears, concerns. Just listen and let them talk. Set your wife up for the positive, talk about your feelings, because now more than ever, comfort and attention are important to her.
Sometimes a man in such a situation thinks that some action on his part is enough - after all, he didn’t quit, didn’t leave. What else does?! But for a woman in this condition this is not enough. The most important thing now is to provide the wife with maximum psychological comfort. Therefore, show more care, warmth, support not only with deeds, but also with words in full “volume”.
Surgery is an important part in the treatment of breast cancer. There are many options for breast cancer surgery, and one of the professional surgeon's jobs is to explain to the patient possible options operations and, together with it, choose the most best option. Possibilities plastic surgery They allow not only to remove cancer, but also to achieve a good aesthetic and functional result.
Some patients with breast cancer are indicated for breast-conserving surgery, and some are recommended for mastectomy (complete removal of the breast). Also recovery operations performed using various techniques. How to choose the right technology surgical treatment?
– Each case of breast cancer is individual. This means that if one surgical technique suits a patient, it is not at all necessary that it will suit some other patient. For each woman, we plan the operation individually, depending on the characteristics of education, the size of the mammary gland, the woman’s wishes, her age, life situation and the presence of other diseases. I explain to each patient the risks when choosing a particular type of operation and the advantages, says Jari Viinikainen, a surgeon specializing in the treatment of breast cancer at the Docrates Oncology Clinic.
Increasingly, women with breast cancer are undergoing breast-sparing surgery
Many women think it is safer to have a complete breast removal or even both breasts removed. This is due to uncertainty and fears that over time the disease will appear again. However, complete breast removal does not guarantee better treatment results. Partial resection of the so-called Today, organ-saving surgery is safer, even safer, and this technique is used much more often and is carried out much more often. During surgery, the surgeon removes the tumor while preserving healthy breast tissue.
– When performing organ-conserving surgery, a woman is prescribed postoperative radiation therapy. This complex treatment gives good results, and sometimes even better results, than with mastectomy alone. Therefore, complete removal of the breast is often not necessary, says Dr. Viinikainen.
Various options for breast reconstruction techniques
Women who are still advised to undergo complete breast removal should not be upset. Possibilities modern surgery allow you to restore the mammary gland, carry out reconstruction, and already during the main operation to remove cancer. This means that, at best, the surgeon can remove the tumor and reconstruct the breast in one go. But, nevertheless, in certain cases, in order to achieve good results, it is safer to first carry out surgical removal cancerous tumor, and only then receive adjuvant therapy ( drug treatment and radiation therapy), after which the surgeon performs breast reconstruction surgery.
To achieve better results in plastic surgery when performing organ-preserving surgery, various techniques breast modeling. If the mammary gland is completely removed, a new breast can be constructed from the patient’s own tissue, using implants, or using implants and the patient’s tissue. The surgical technique is chosen by the surgeon together with the patient, depending on the woman’s body type and her wishes. What matters here is the size of the breast and the presence of fatty tissue in the patient, for example, in the lower abdomen. If the operated breast is different in shape or size from the second breast, then the second breast can be reduced or its shape changed.
Breast-conserving surgery allows you to preserve your breasts and self-confidence
Breast-conserving surgery may be important for a woman to maintain her self-confidence. . IN end result a mammary gland that has undergone partial resection retains functionality and naturalness better than a breast that has been completely removed and restored through plastic surgery. As a rule, breast reconstruction is not required after breast-conserving surgery.
– Breast cancer – serious illness, therefore, often in the initial stages of treatment, the issue of breast appearance fades into the background. However, the functionality and aesthetic appearance of the breasts are becoming important for most women, and many patients appreciate overall result and express gratitude after undergoing surgical treatment. Both factors further affect the patient’s quality of life. It is certainly pleasant when nothing visually reminds of the disease and nothing needs to be hidden, and an outsider will not guess that the woman underwent surgery to remove a breast cancer tumor, says surgeon Jari Viinikainen.
Various breast reconstruction methods
Flap reconstruction. During such an operation, reconstruction is carried out by transplanting the patient's fatty tissue and skin from one place to another.
With techniques reconstruction DIEP, TRAM & SIEA Fat tissue from the patient's abdomen is used to build breasts. It is when transplanting fatty tissue from the lower abdomen that the best result is obtained, because From this area the surgeon receives the necessary amount of material to build the breast. In addition, thanks to this surgical technique, the breasts retain their natural appearance. appearance and maintains sensitivity.
In case of using techniques reconstructions TMG, LAP, I-GAP & S-GAP Is a flap of skin used to build breasts? inside thighs, buttocks or lower back. This technique can be used when there is not enough fatty tissue in the lower abdomen to modulate the breasts. Usually skinny women with small breasts, fat tissue is taken from the inner thighs.
With technology LD reconstruction A latissimus dorsi muscle flap, adipose tissue and skin from the upper back are used. If the resulting tissue is insufficient, an implant or fat grafting may be used in the reconstruction.
Reconstruction with implants- a technique in which silicone implants is installed under the pectoral muscle. Reconstruction with implants is especially suitable for women with small breasts if there is not enough natural fat tissue for grafting.
Fat grafting is a procedure during which fat cells are pumped out and moved to the chest area using a cannula. Most often, fat tissue transfer is used when it is necessary to increase breast volume, when correcting small irregularities, asymmetry and when building breasts.
Terminology(translated from Finnish language)
· Partial resection (sectoral resection)– surgery to remove breast cancer while preserving the breast. To achieve the best treatment results, radiation therapy is almost always performed after sectoral resection.
· Mastectomy– complete removal of the mammary gland. Mastectomy may be necessary in cases where the tumor big size in relation to the mammary gland or in the mammary gland there are multiple metastases. Because young women have a higher risk of cancer returning, younger women are more likely to have mastectomies.
· Breast reconstruction– surgical reconstruction of the breast after surgery. Breast reconstruction can be performed using different surgical techniques. The choice of surgical technique is influenced by the size of the breast, the patient’s body type, and the patient’s wishes. New breasts can be formed from subcutaneous fat and skin from the abdomen, back, thighs and muscle tissue.
· Onko Plastic surgery – breast reconstruction simultaneously with breast-conserving surgery to remove breast cancer. In case of asymmetry, it is possible to correct the second breast at the same time.
At the Docrates clinic, a whole team of breast cancer treatment specialists, including a Russian-speaking nurse, works with patients. For questions regarding treatment and additional information You can contact Victoria Zafataeva +358505001899
Sources: plastic surgeon Jari Viinikainen and Finnish breast cancer society Rintasyöpäyhdistys Europadonna.
Since ancient times, female breasts have been considered the main symbol of femininity and fertility. She is a subject of female pride and an object increased attention on the part of men. At all times, artists have admired women's breasts and poets have sung them. Today, unfortunately, mammologists and oncologists most often talk about breasts: according to statistics, they are the most common cancer in the world. And very often the only way to save the patient’s life is breast removal surgery, or mastectomy.
In what cases are breasts removed?
Most breast removal surgeries are performed for treatment and prevention. oncological diseases, both in women and men. Mastectomy is used to remove accessory mammary glands, as well as accessory lobes of the mammary gland.
How is breast removal surgery performed?
Surgery to remove a breast tumor is performed under general anesthesia. The surgical intervention lasts from 1.5 to 4 hours, depending on the type of operation. There are several types of mastectomy, the choice of which depends on the stage of the disease:
- lumpectomy - the tumor and a small amount of surrounding tissue are removed;
- conventional mastectomy - the mammary gland is completely removed;
- radical mastectomy - not only the breast is removed, but also the lymph nodes associated with it, as well as the pectoral muscles;
- modified radical mastectomy - only the breast and some lymph nodes are removed.
Immediately after breast removal, it is possible to reconstruct it or postpone it to a later date.
Postoperative period after breast removal
After breast removal surgery, the patient remains in the hospital for 2-3 days, this is the most painful period. In addition, the patient may develop complications after removal of the mammary glands:
- bleeding;
- wound infection;
- lymphedema (swelling of the arm);
- accumulation of fluid (seroma) at the incision site;
- pain and numbness of the skin;
- improper scarring.
When discharged home, doctors advise avoiding physical activity for the first 6 weeks, not lifting heavy objects (more than 2 kg), but not leaving the arm motionless. You will need to see your doctor 1-2 weeks after surgery and discuss the results with him. You may need breast treatment after removal - a course of radiation or chemotherapy.
Life after breast removal
Breast removal is a serious psychological trauma for a woman: pain after breast removal can be accompanied by severe pain. Therefore, doctors recommend returning to work as soon as possible. normal life. Great importance The support of relatives, as well as those who have already undergone a mastectomy, plays a role in recovery. In addition, it is important to maintain regular sex life– this will help a woman not to feel inferior.
Already a month after the operation you can wear a prosthesis, and after another two months you can think about breast reconstruction surgery.
Indications for breast removal accepted in clinical mammology are mainly associated with malignant neoplasms. Most doctors insist on performing a mastectomy if:
- the woman has tumors in more than one quadrant of the breast;
- radiation therapy has already been carried out on the affected breast;
- the tumor is more than 5 cm in diameter and has not shrunk after neoadjuvant chemotherapy;
- a biopsy showed that the initial segmental resection of the tumor did not remove all cancerous tissue;
- the patient has such diseases connective tissue, How systemic lupus or scleroderma, which causes very severe side effects radiation therapy;
- the tumor is accompanied by inflammation;
- the woman is pregnant, but radiation therapy is not possible due to the risk of damage to the fetus.
This method is recognized as the main way to prevent breast cancer recurrence, especially if a BRCA gene mutation has been identified. At the same time, the world's leading experts in the field of mammology note that complete removal of a cancer-affected breast reduces the risk of tumor recurrence in the same breast, but does not exclude the possibility of cancer appearing in another breast.
Preparing for breast removal
The operation is prescribed when the patient is diagnosed, that is, a mammogram was performed and a biopsy of tumor tissue was performed. Therefore, preparation for a mastectomy comes down to general analysis blood, repeated fluoroscopy of the chest and chest, and an electrocardiogram (ECG).
When referring a woman for surgery, the doctor must make sure that a few days before the scheduled operation (or preferably a couple of weeks before it), the patient did not take medications that thin the blood (aspirin, warfarin, phenylin, etc.). Also, the surgeon and anesthesiologist should be informed about the patient’s use of any drugs based on medicinal plants or herbal decoctions. Thus, stinging nettle, water pepper herb, yarrow, ginkgo biloba leaves may increase the risk of bleeding and, therefore, should not be used at least two weeks before any surgical intervention.
A dose of antibiotics may be administered to prevent inflammation. 8-10 hours before the operation, the patient should stop eating.
Breast removal surgery
Such a surgical intervention as removal of the mammary glands in women has various modifications that are designed to solve specific problems taking into account the diagnosis of a particular patient, the clinical picture and stage of the identified disease, the degree of damage to the gland itself, as well as involvement in pathological process surrounding tissues and regional lymph nodes.
Removal of breast cancer, primarily large tumors for more late stages disease or when tumors may occupy a significant area within the contours of the breast, a simple or general mastectomy may be performed. That is, the surgeon removes all of the breast tissue and an ellipse of skin (including nipple skin), but does not remove the muscle tissue underneath the breast. With this type of operation, a biopsy of the nearest (control or sentinel) lymph node is necessarily performed. The postoperative scar is usually transverse.
A skin-friendly approach to breast removal (subcutaneous mastectomy) is practiced, in which the tumor, all breast tissue, nipple and areola are removed, but almost 90% of the breast skin is preserved, the incision and, therefore, scarring are smaller. However, if the breast is large, then the incision is made downward, and then the scars after breast removal will be larger.
Resection of the gland is also performed while preserving the nipple and areola, but this is only possible when the tumor is located at a considerable distance from the nipple area. In this case, the incision is made on outside breast or along the edge of the areola and all tissue is removed through it. In modern clinics, this method includes either simultaneous reconstruction of the gland, or placement of a special tissue expander in place of its removed structures for subsequent breast reconstruction.
During radical resection of a common malignant neoplasm, it is necessary to remove not only all structural parts of the gland, but also the underlying muscles of the chest, tissue from the armpit area, axillary lymph nodes, and often deeper-lying tissues. If the mammary gland is removed along with the internal mammary lymph node, then an extended radical mastectomy is performed.
All these operations have a clear methodology, and specialists know what they are talking about when it is necessary to perform a Halstead, Patey or Madden mastectomy.
When forming in the area armpit If an anomaly such as an accessory mammary gland occurs, the accessory mammary gland is removed. Typically, the structure of the extra organ is dominated by glandular and adipose tissue; they are cut out, the muscle tissue is sewn together, and a suture is placed on top, which is removed after about a week. If the accessory gland is large in size, fat can be removed by pumping it out.
It should be noted that the cost of mastectomy surgery depends on the stage of the disease, the size and location of the tumor and, of course, on the status medical institution and prices for the pharmacological agents used.
Removal of two mammary glands
The above surgical methods also include removal of two mammary glands, double or bilateral mastectomy. The need for such surgery may be caused by the presence of a tumor in one breast and the woman's concern about the risk of developing cancer in the other, contralateral breast. Most often, such fears haunt women who have a family history of gynecological cancer pathologies.
As you remember, for a long time The topic of Angelina Jolie and the removal of mammary glands was discussed, since the contralateral mastectomy operation performed by the actress in 2013 was preventive, that is, anticipating the development of breast cancer. In addition to the fact that her mother and grandmother (Marcheline and Lois Bertrand) died of ovarian and breast cancer, the results genetic analysis BRCA tests confirmed a high (up to 87%) risk of malignant tumors in the actress’s breast. It was reported that after resection of both breasts, Jolie's risk of developing cancer decreased to 5%.
Even with a complete double mastectomy, not all breast tissue that may be at risk of becoming cancerous in the future may be removed, according to the National Cancer Institute. In addition, during such an operation the surgeon cannot remove tissue from the chest wall and supraclavicular region, but breast stromal cells may be present in them.
Sectoral removal of the mammary gland
Towards iron preserving and less invasive surgical methods refers to sectoral removal of the mammary gland (segmental resection or lumpectomy), when the tumor itself and part of the surrounding normal tissue (without atypical cells) are resected. In this case, the removal of regional axillary lymph nodes can be performed through a separate incision. This technique applicable for oncology I-II stages, and after surgical intervention 5-6 weeks of radiation therapy should be carried out.
By resection from the mammary gland, it is possible to remove the focus of chronic purulent mastopathy, as well as large hormone-dependent benign education cystic or fibrous. However, only phyllodes fibroadenoma of any size that threatens malignancy and significant fibrocystic neoplasia that is prone to degeneration are subject to mandatory resection. Although fibrosis of breast tissue appears again in almost 15 cases out of 100.
In other cases, enucleation (husking) or laser therapy is performed, and removal of a mammary gland cyst can be done without excision: by sclerosing its cavity by aspiration.
Removal of mammary glands in men
In case of cancer mammary glands removal of the mammary glands in men is performed. Regardless of age, a mastectomy is considered a medical necessity when there is concern that a man's breast enlargement may be breast carcinoma. Naturally, the final decision on the need for surgical intervention is made only after a comprehensive examination - including mammography and biopsy.
Pathologically enlarged areas are also removed glandular tissues for gynecomastia in men over 18 years of age when testosterone hormone therapy is ineffective.
IN adolescence- on the background hormonal imbalance puberty mastectomy is not performed, since this pathology can spontaneously regress over time. In addition, mastectomy before puberty is completed may cause recurrence of gynecomastia.
For elementary obesity in adult men, which is often manifested by excessive deposition of adipose tissue in the mammary glands, liposuction can be used.
Consequences of breast removal
A natural consequence is pain after breast removal, for the relief of which painkillers are taken (primarily NSAIDs). Also, this operation is characterized by the release and accumulation of significant volumes of serous fluid in the wound cavity and under the skin. To remove it, the wound must be drained for at least seven days. In addition, a fairly tight bandage with an elastic bandage is applied around the chest, and it must be worn for at least a month.
Experts note the following main complications after breast removal:
- postoperative bleeding and hematomas;
- associated with suppuration postoperative wound or necrosis of tissues poorly supplied with blood at the incision site; temperature;
- defeat skin breast beta-hemolytic streptococcus, which causes erysipelas;
- due to scarring of the dissected tissues, scars are formed, often this process causes discomfort and is painful;
- development of longer-term neuropathic pain syndrome, which appears stabbing pain, numbness and tingling in the chest wall, armpit or arm;
- Depressive mood, feeling of self-worth.
Almost always, after a month or a month and a half, a violation of the natural outflow of interstitial fluid appears and lymphostasis develops. This disorder is especially pronounced due to the cessation of normal lymph flow when axillary lymph nodes are removed. Lymphostasis leads to the fact that not only swelling of the arm appears on the side of the removed organ, but also numbness of the skin is felt on inner surface hands. Frozen shoulder syndrome is also noted - short-term or longer-term limitation of the range of motion of the arm in shoulder joint. This syndrome can appear within several months after surgery, and its cause lies in damage to the nerve endings located in the surgical area.
Recovery after breast removal
Already 1.5 days after the operation you can get up and walk, but speed up recovery motor activity not recommended: it should proceed gradually, since the sutures are removed approximately 1-2 weeks from the day of the operation.
For most patients, recovery after breast removal lasts for 4-6 weeks, but may take longer (this largely depends on the complexity of the operation and general condition health).
The list of what is prohibited after a mastectomy includes prohibitions on:
- taking a shower (and bathing) before removing stitches;
- physical exercise, lifting weights and vigorous movements;
- exposure to heat and UV radiation;
- any injections into the arm on the side of the removed breast;
- swimming in ponds and pools (at least two months);
- sexual contacts (within 1-1.5 months).
In connection with lymphostasis, breast surgeons give their patients the following recommendations after breast removal:
- maintain personal hygiene and clean hands;
- avoid hand injuries that damage the integrity of the skin, and in case of the slightest scratch, use antiseptics;
- do not sleep on the side of the operated gland;
- wear a special elastic bandage (providing gentle compression to improve lymphatic drainage and reduce swelling);
- massage regularly: in the form of upward stroking of the hand in the direction from the fingers to the shoulder joint.
After removing the sutures, it is necessary to purposefully develop the arm. Gymnastics consists of the following exercises:
- in a standing or sitting position, raising straight arms to the sides and up;
- in the same position, placing your hand behind your head (at first you can help with your other hand);
- in a standing position, bend your elbows in front of you chest and raise your elbows to the sides as high as possible;
- in a standing or sitting position, placing your hand behind your back.
The diet should include enough calories, but it should be light, that is, fatty and spicy foods are not recommended, as are sweets. It is useful to eat more often, but in smaller portions; you should include regular foods in your diet (cereals, meat, fish, dairy products, vegetables and fruits). Animal fats should be replaced with vegetable fats, and the consumption of salt and sugar should be reduced.
Treatment after breast removal
Cancer patients are treated after removal of the mammary gland - adjuvant therapy. For any stages of cancer after complete or partial removal mammary gland to destroy the remaining atypical cells and to avoid relapse, chemotherapy is prescribed (with the drugs Cyclophosphamide, Fluorouracil, Mafosfamide, Doxorubicin, Xeloda, etc.) and a course of radiation therapy.
If the tumor is a hormone-dependent neoplasm, apply hormonal drugs. The tableted anti-estrogenic drug Tamoxifen (other trade names: Zitazonium, Nolvadex, Tamoplex, Cytofen, Zemid, etc.) is taken 1-2 times a day, 20-40 mg.
Toremifene (Fareston) is prescribed to women after menopause; standard daily dosage is 60 mg, but the doctor can increase it 4 times (up to 240 mg).
The drug Letrozole (Femara, Letrosan) also suppresses estrogen synthesis in the body; it is prescribed only to older patients once a day, one tablet (2.5 mg). Anastrozole tablets (synonyms - Arimidex, Anastera, Selana, Egistrazole, Mammozol, etc.) are not prescribed to premenopausal women; the drug should be taken 1 mg once a day.
Anti-cancer effect medicines for targeted therapy is achieved by precisely targeting molecules cancer cells, ensuring tumor development. Thus, drugs of this group are able to stabilize the pathological process and prevent relapse of the disease. Targeted drugs Bevacizumab (Avastin), Trastuzumab (Herceptin) are used intravenously every two or three weeks; Lapatinib (Tayverb) tablets (orally 1000-1250 mg per day).
Life after breast removal
The main thing to remember is that life continues after breast removal, although for all women who have undergone such an operation, this is a slightly different life...
First, a woman becomes disabled after a mastectomy. Specifically: according to the “Instructions on the establishment of disability groups” approved by the order of the Ministry of Health of Ukraine (No. 561 dated September 5, 2011), suffered by a woman due to a malignant neoplasm, unilateral mastectomy is an indisputable basis for establishing disability group III - for life (that is, without the need for periodic re-examination).
Secondly, this concerns the reconstruction of a lost gland (plastic surgery) or the creation of the appearance of its presence. The second option, of course, is much cheaper and may be temporary.
You can choose or order chest pads, as well as removable denture– textile or silicone.
Today, so-called exoprostheses for women who have lost breasts are produced by many companies in a large assortment: these are fabric prostheses for the first time, and silicone prostheses for permanent use, in various sizes and modifications.
There is also a large selection of orthopedic underwear, as you will need a bra to secure the breast prosthesis. These are quite elegant and at the same time functional and comfortable bras with “pockets” into which the prosthesis is inserted and wide straps. Special swimsuits are also sold.
Sami plastic surgeons claim that plastic surgery after mastectomy is a complex and quite expensive operation. This can be plastic surgery to install a silicone implant or mammoplasty using own tissues taken from other parts of the body (skin, subcutaneous tissue, muscles). But in any case, the woman gets a mammary gland that is very similar to a natural organ, which, of course, has a positive effect on the general emotional and psychological state of patients who have undergone mammary gland removal.
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