Currently, surgery to remove breast cancer is one of the main treatments for this malignant neoplasm. All over the world, this is the most common. In the general population, it is second only to lung cancer.
Breast cancer surgery removes a colony of atypical (abnormal) 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. Complete removal of the tumor is carried out within the healthy tissue. The best cosmetic effect is achieved whenever possible.
- Radical. Complete or partial removal of the breast is performed.
Operations preserving the integrity of the organ
Lumpectomy is performed relatively quickly compared to other methods. A small arcuate incision is made a few centimeters long. 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 with a small area of the surrounding healthy tissue. As a result, it is possible to preserve the mammary gland. This is very important, especially for young women. The disadvantages include possible postoperative deformity and changes in the volume of the gland. Recurrence of malignant neoplasm is possible.
Sectoral breast resection is one of the most common breast-conserving operations. Sometimes it is called the Blokhin operation. It is performed more often under general anesthesia. Apply local anesthesia with Novocaine or Lidocaine. The operation is performed for small tumors that affect 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 breast is removed. Simultaneously with the excision of the tumor and glandular tissue, the pectoralis minor muscle and lymph nodes (subclavian, subscapularis) are often removed.
Cryomammotomy is one of the newest methods of treatment for patients diagnosed with breast cancer.
First, a small incision is made. Then a special probe is brought directly to the tumor cells. The temperature of the probe tip 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 with a small tumor and.
Radical operations
Halstead mastectomy is performed under general anesthesia. After providing surgical access by incision of the skin and subcutaneous fat, the glandular tissue is removed. Then the pectoralis major and minor muscles are removed on the same side. It is imperative to remove the subscapularis 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 above technique. This is the removal of the entire breast. 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.
Paty's mastectomy is a modified version of the classic mastectomy. Complete removal of the glandular tissue of the mammary gland, pectoralis minor muscle is performed. A distinctive feature of the operation is that the pectoralis major muscle and adipose tissue are preserved.
Modified Madden mastectomy differs from previous options in that after removal of the breast itself, the underlying pectoral muscles are retained. Thoracic fascia, axillary, intermuscular and subscapularis tissues are removed. At the same time, the risk of further development of metastases in the lymph nodes located in the tissue is leveled.
Breast amputation is an operation to remove the gland itself while completely preserving the underlying tissues.
The main indications for the removal of the mammary gland
The tumor should be well visualized on images taken with a computed tomography or X-ray machine. Particular attention is paid to patients in whom a tumor is found in several places at the same time, for example, in different lobes of 1 gland. In this case, 1 of the radical operations is considered priority.
If a tumor reoccurs after a lumpectomy, a radical mastectomy is recommended. Radical intervention is recommended for women who have contraindications for concomitant lumpectomy chemotherapy.
In patients with very small breasts, organ-preserving surgeries are inappropriate.
This is due to the fact that after removal of the tumor focus, a 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 option, is combined with radiation therapy. This is necessary when a large number of lymph nodes are affected by metastases, with a large tumor size (more than 5 cm in diameter). In the presence of multiple cancerous foci in the glandular tissue in the postoperative period, a course of radiation therapy is performed.
Cancer cells are sometimes found at the edges of the excised tissue by a special examination in the laboratory of the removed material. This is an indication for postoperative radiation therapy.
How is the operation going
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 preliminarily placed on the operating table. The arm on the side of the lesion is removed from the body perpendicularly and placed on a support.
Initially, an incision is made around the entire circumference of the gland in the form 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, move certain muscles to the side. This removes lymph nodes that have cancer, such as in the armpit or under the collarbone.
Each removed lymph node must be sent for examination. After removing the planned volume of tissue, drainage is required, which will allow the resulting fluid to flow out in the early postoperative period.
The drain is most often a small rubber tube. At the final stage of the operation, it is necessary to stop bleeding in the surgical wound, if any. Then the surgeon sutures the wound.
Sometimes during the operation it is necessary to remove large areas of the skin along with the glandular tissue. This in some cases complicates the process of stitching the edges of the wound at the final stage of the operation. The surgeon uses special laxative incisions to ensure normal wound healing. They are made shallow in the skin on the sides of the surgical wound.
At present, techniques have been developed for performing 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. This is due to the intersection of the sensory nerves located in the skin with the surgeon's scalpel. This symptom is associated with both minimally invasive and radical mastectomy.
Sensitivity is almost always restored over time. Another unpleasant consequence of the operation can be excessive sensitivity or tingling in the area of intervention. It is also associated with irritation of the nerve endings during surgery. Unpleasant sensations pass after a while.
The choice of a specific type of operation is carried out by a mammologist surgeon after a 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 oncological hospital or in a specialized department is mandatory. The patient, taking into account the preoperative preparation, the operation itself and the postoperative period, is in the hospital for about 2-3 weeks.
If, in addition to the main operation to remove breast cancer, plastic reconstructive surgery is performed, then the length of stay in the hospital increases. When performing minimally invasive procedures (for example, lumpectomy), the length of hospital stay can be shortened at the discretion of the attending physician. In the future, outpatient supervision is necessary.
Manipulation of the mammary gland, especially its complete removal, is very stressful for a woman. It is necessary to conduct a thorough examination, establish an accurate diagnosis and, if possible, perform the most sparing option. Numerous methods of breast replacement after mastectomy are available today.
The operation of massectomy (removal of the mammary gland) for a considerable number of women is not a bad dream, but a reality. This intervention saves lives, but it takes away the feeling of being fulfilled.
It is very important for a woman to be examined on time. With the advent of mammography (Rh-graphy of the mammary glands), it is much easier to detect breast cancer at an early stage. After all, a mammograph is the device that “sees” and shows oncological foci ranging in size from 2-5 mm. It is not possible for a doctor to find such tiny tumors by palpation (hands).
After operation…
A woman can count on plastic reconstruction (restoration) of her breasts. It is carried out in the Oncology Department of Reconstructive Surgery of the V.I. NN Aleksandrova, in the department of plastic and reconstructive microsurgery of the Minsk Regional Clinical Hospital. Also, this direction is being developed by the oncological department N1 of the Minsk city clinical oncological dispensary and a number of regional oncological dispensaries.
There are several options for reconstruction:
- endoprosthetics - implantation of a silicone prosthesis;
- breast reconstruction at the expense of the patient's own tissues;
- combined methods.
Where can I find support?
How to find strength, regain confidence after mastectomy? Here are the tips of a counseling psychologist Elena Nikolaevna Ermakova:
It's no secret that society dictates tough conditions: a woman is a person when she is healthy, young, beautiful. What about women who have undergone such a psychologically difficult operation as mastectomy?
Change the dominant and discard stereotypes: now the most valuable thing is your life. She is 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 no matter how you look ...
In addition, now it is important to find other women who have undergone the same operation in order to feel support, to feel: you are not alone! Consolations of healthy people are significant, but even more weighty is the friendly word of those who have experienced and know firsthand about your disease and its consequences.
Of course, during this period, the support of a husband or friend is necessary ... When the relationship of two people was originally built on love and mutual affection, then, as a rule, an illness or other serious condition only unites them.
In this regard, advice to men: do not pretend that "nothing like this" happened to your wife. Some husbands do this with the best of 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 me talk. Set your wife up to be positive, talk about your feelings, because now more than ever, comfort and attention are important to her.
Sometimes it seems to a man in such a situation: some actions on his part are enough - after all, he did not quit, did not leave. What else does?! But for a woman in such a state, 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 of breast cancer treatment. There are many options for performing an operation to remove breast cancer, and one of the tasks of a professional surgeon is to explain to the patient the options for the operation and, together with her, choose the most optimal option. The possibilities of plastic surgery make it possible not only to remove cancer, but also to achieve a good aesthetic and functional result.
Some patients with breast oncology are shown organ-preserving surgery, others - mastectomy (complete removal of the breast). Also, recovery operations are performed by various techniques. How do you choose the right surgical technique?
- Each case of breast cancer is different. This means that if one technique works for a patient, it is not at all necessary that it works for some other patient. For each woman, we plan the operation individually, depending on the characteristics of the education, the size of the breast, the woman's wishes, her age, life situation and the presence of other diseases. I explain to each patient her risks and advantages when choosing a particular type of surgery, says Jari Viinikainen, a surgeon specializing in breast cancer treatment for breast cancer at Docrates Cancer Clinic.
Increasingly, women with breast cancer undergo organ-sparing surgery
Many women think it is safer to have a complete breast removal, or even both breasts. This is due to uncertainty and fears that over time, the disease will manifest itself again. However, complete breast removal does not guarantee the best good treatment results. Partial resection of the so-called organ-saving surgery today is safer, even safer, and this technique is used much more often it is carried out much more often. During surgery, the surgeon removes the tumor while preserving healthy breast tissue.
- When performing an organ-preserving operation, a woman is prescribed postoperative radiation therapy. Such a complex treatment gives good results, and sometimes even better results of better quality, than when performing a mastectomy alone. Therefore, there is often no need to completely remove the breast, says Dr. Viinikainen.
Various techniques for performing breast reconstruction
Women who are still advised to have complete breast removal should not be upset. The possibilities of modern surgery make it possible to restore the mammary gland, to carry out reconstruction, and even during the main operation to remove the 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 of the cancerous tumor, and only then receive adjuvant therapy (drug treatment and radiation therapy), after which the surgeon performs an operation to restore the breast.
To achieve the best results in plastic surgery, various breast modeling techniques are used when performing organ-preserving surgery. If the breast is removed completely, the new breast can be built 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 type of woman's figure and her wishes. Here, the size of the breast and the presence of adipose tissue in the patient, for example, in the lower abdomen, matter. If the shape or size of the operated breast differs from the second breast, the second breast can be reduced or reshaped.
Organ-preserving surgery allows you to preserve the breast and self-confidence
Organ-preserving surgery can be important for a woman to maintain her self-confidence. ... As a result, a breast that has undergone partial resection retains its functionality and naturalness better than a breast that has been completely removed and repaired with plastic surgery. Breast reconstruction is usually not required after breast conserving surgery.
- Breast cancer is a serious disease, therefore, often at the initial stages of treatment, the question of the appearance of the breast fades into the background. However, the functionality and aesthetic appearance of the breasts are becoming important for most women, and many patients evaluate the overall result and express their 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 a person from the outside will not guess that a woman has undergone an operation to remove a breast cancer, says surgeon Jari Viinikainen.
Various Breast Reconstruction Techniques
Patchwork reconstruction... During such an operation, reconstruction is carried out by grafting the patient's adipose tissue and skin from one place to another.
With technicians reconstruction DIEP, TRAM & SIEA fatty tissue from the patient's abdomen is used to build the breast. It is with the transplantation of fatty tissue in 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 and remain sensitive.
In the case of applying the techniques TMG, LAP, I-GAP & S-GAP reconstructions is a skin flap used to build the breast? the inner 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. Typically, in thin women with small breasts, adipose tissue is taken from the inner thighs.
With technology LD reconstruction a flap of the latissimus dorsi muscle, adipose tissue and skin of the upper back is used. If the obtained tissue is not enough, an implant or adipose tissue transplant can be used in the reconstruction.
Reconstruction with implants- a technique in which silicone implants are placed under the pectoral muscle. Reconstruction with implants is especially suitable for women with small breasts, if there is not enough natural adipose tissue for transplantation.
Adipose tissue transplant Is a procedure during which fat cells are pumped out and transferred to the breast area using a cannula. Most often, adipose tissue transplant is used when it is necessary to increase the volume of the breast, when correcting minor irregularities, asymmetries and when building the breast.
Terminology(translated from Finnish)
· 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 breast. Mastectomy may be necessary in cases where the tumor is large in relation to the mammary gland or there are multiple metastases in the mammary gland. Because young women are at high risk for cancer recurrence, mastectomies are more often performed in young women.
· Breast reconstruction- Surgical breast reconstruction after surgery. Breast reconstruction can be performed using a variety of surgical techniques. The choice of the operation technique is influenced by the size of the breast, the type of the patient's figure and the wishes of the patient. New breasts can be formed from subcutaneous fat and skin from the abdomen, back, thighs, and muscle tissue.
· Oncoplastic surgery- Reconstruction of the breast at the same time as breast-conserving surgery to remove breast cancer. In case of asymmetry, it is possible to correct the second breast at the same time.
Docrates Clinic has a whole team of breast cancer treatment specialists working with patients, including a Russian-speaking nurse. For treatment questions and additional information, you can contact Victoria Zafataeva +358505001899
Sources: Plastic surgeon Jari Viinikainen and Finnish Breast Cancer Society Rintasyöpäyhdistys Europadonna.
Since ancient times, the female breast has been considered the main symbol of femininity and fertility. She is an object of female pride and an object of increased attention from men. At all times, artists admired women's breasts, poets sang it. Today, unfortunately, mammologists and oncologists most often talk about breasts: according to statistics, it is the most common cancer in the world. And very often the only way to save a patient's life is an operation to remove a breast, or a mastectomy.
When are breasts removed?
Most of the operations to remove the mammary glands are performed to treat and prevent cancer, both in women and in men. Mastectomy is used to remove accessory mammary glands as well as accessory breast lobes.
How is the breast removal operation going?
Surgery to remove a breast tumor is performed under general anesthesia. Surgical intervention lasts from 1.5 to 4 hours, depending on the type of surgery. There are several types of mastectomy, the choice of which depends on the stage of the disease:
- lumpectomy - remove the tumor and a small amount of surrounding tissue;
- 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 mammary gland and some lymph nodes are removed.
Immediately after the removal of the breast, it is possible to carry out its reconstruction or postpone it for a later date.
Postoperative period after breast removal
After the operation to remove the breast, the patient remains in the hospital for 2-3 days, this is the most painful period. In addition, the patient may develop complications after removing the mammary glands:
- bleeding;
- wound infection;
- lymphedema (swelling of the hand);
- accumulation of fluid (seroma) at the incision site;
- pain and numbness of the skin;
- improper scarring.
When you are discharged home, doctors advise avoiding physical activity for the first 6 weeks, not lifting weights (more than 2 kg), but not leaving your hand motionless. 1-2 weeks after the operation, you will need to consult a doctor 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 severe. Therefore, doctors recommend returning to normal life as soon as possible. The support of relatives, as well as those who have already undergone mastectomy, is of great importance in recovery. In addition, it is important to have a regular sex life - this will help the woman not to feel defective.
One month after the operation, you can wear a prosthesis, and after another two months - think about breast reconstruction surgery.
The indications accepted in clinical mammology for the removal of the mammary gland are mainly associated with malignant neoplasms. Most doctors insist on having a mastectomy if:
- the woman has tumors in more than one quadrant of the breast;
- already received radiation therapy for the affected breast;
- the tumor is more than 5 cm in diameter and did not shrink after neoadjuvant chemotherapy;
- the biopsy showed that the initial segmental tumor resection did not remove all cancerous tissue;
- the patient has connective tissue diseases such as systemic lupus erythematosus or scleroderma, which cause very severe side effects of radiation therapy;
- the swelling is accompanied by inflammation;
- the woman is pregnant, but radiation therapy is not possible due to the risk of damaging the fetus.
This method is recognized as the main method for preventing recurrence of breast cancer, especially when the 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 breast cancer affected by cancer reduces the risk of tumor recurrence in the same breast, but does not exclude the likelihood of cancer in the other breast.
Preparing to remove the breast
The operation is prescribed when the patient is diagnosed, that is, a mammography was performed and a biopsy of the tumor tissue was performed. Therefore, preparation for a mastectomy comes down to a general blood test, repeated chest and chest fluoroscopy, and an electrocardiogram (ECG).
When referring a woman to an operation, the doctor must make sure that a few days before the scheduled operation (and preferably a couple of weeks before it), the patient has not taken blood thinning drugs (aspirin, warfarin, phenylin, etc.). Also, the surgeon and the anesthesiologist should be informed about the patient's use of any drugs based on medicinal plants or herbal decoctions. So, stinging nettle, water pepper herb, yarrow, ginkgo biloba leaves can increase the risk of bleeding and, therefore, they should not be used at least two weeks before any surgical intervention.
A dose of antibiotics may be given to prevent inflammation. 8-10 hours before the operation, the patient should stop eating.
Breast removal surgery
Such a surgical intervention as the removal of 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 the involvement of the surrounding tissues and regional lymph nodes in the pathological process ...
Removal of breast cancer, especially large tumors at a later stage of the disease or when tumors may occupy a significant area within the breast contours, can be performed with simple or general mastectomy. That is, the surgeon removes all of the breast tissue and the ellipse of the skin (including the nipple skin), but does not remove the muscle tissue under the breast. With this type of operation, a biopsy of the nearest (control or sentinel) lymph node is required. The postoperative scar is usually transverse.
A skin-sparing approach to removing the mammary gland (subcutaneous mastectomy) is practiced, in which the tumor, all breast tissue, nipple and areola are removed, but almost 90% of the breast skin is retained, the incision and, accordingly, the scars are less. However, if the breast is large, then an incision is made downward, and then the scars after removal of the breast will be larger.
Resection of the gland is also performed while preserving the nipple and areola, but this is possible only when the tumor is located at a considerable distance from the nipple zone. In this case, an incision is made on the outside of the breast or along the edge of the areola and all tissue is removed through it. In modern clinics, this method includes either the simultaneous reconstruction of the gland, or the placement of a special expander tissue expander in place of its removed structures for subsequent breast reconstruction.
With radical resection of a common malignant neoplasm, it is necessary to remove not only all the structural parts of the gland, but also the underlying muscles of the chest, tissue from the armpits, axillary lymph nodes, and often deeper 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 it is about when it is necessary to carry out a mastectomy according to Halstead, Paty or Madden.
When an anomaly such as an accessory mammary gland forms in the armpit, the accessory mammary gland is removed. Usually, glandular and adipose tissues predominate in the structure of the excess organ; they are cut out, the muscle tissue is sutured, and a suture is applied on top, which is removed after about a week. With a significant size of the accessory gland, fat can be removed by pumping it out.
It should be noted that the cost of a mastectomy operation depends on the stage of the disease, the size and location of the tumor and, of course, on the status of the medical institution and the prices of the pharmacological agents used.
Removal of two breasts
The above surgical methods are used to remove two mammary glands, double or bilateral mastectomy. The need for such an operation may be due to the presence of a tumor in one breast and the woman's fear of the risk of developing cancer in the other, contralateral breast. Most often, such fears persecute women who have a tendency towards oncopathologies in the gynecological sphere in their family.
As you remember, the topic of Angelina Jolie and the removal of mammary glands was discussed for a long time, 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 of the genetic analysis for BRCA confirmed a high (up to 87%) risk of malignant neoplasms in the actress's breasts. After resection of both breasts, Jolie was reported to have a 5% chance of developing cancer.
Even with a complete double mastectomy, not all breast tissue that may be at risk of becoming cancerous in the future can be removed, according to the National Cancer Institute. In addition, during such an operation, the surgeon cannot remove the tissue of the chest wall and supraclavicular region, but the presence of cells of the breast stroma is possible in them.
Sectoral removal of the breast
Gland-preserving and less invasive surgical methods include sectoral removal of the breast (segmental resection or lumpectomy), when the tumor itself and part of the surrounding normal tissues (without atypical cells) are resected. In this case, the removal of regional axillary lymph nodes can be performed through a separate incision. This technique is applicable in stage I-II oncology, and after surgery, 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 a large hormone-dependent benign cystic or fibrous formation. However, only phylloid fibroadenoma of any size threatening with malignancy and significant fibrocystic neoplasias prone to degeneration are subject to mandatory resection. Although fibrosis of breast tissue reappears in almost 15 cases out of 100.
In other cases, enucleation (exfoliation) or laser therapy is performed, and the removal of a breast cyst can be performed without excision: by sclerosing its cavity by aspiration.
Removal of mammary glands in men
In the case of breast cancer, the 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 could be breast carcinoma. Naturally, the final decision on the need for surgical intervention is made only after a comprehensive examination - with mammography and biopsy.
Also, abnormally enlarged glandular tissues are removed in case of gynecomastia in men over 18 years of age with the ineffectiveness of testosterone hormone therapy.
In adolescence - against the background of hormonal imbalance of the puberty period, mastectomy is not performed, since this pathology can spontaneously regress over time. In addition, mastectomy before puberty is complete may cause gynecomastia to recur.
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 removing the mammary gland
A natural consequence is pain after removal of the mammary gland, for the removal of which pain relievers 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 such main complications after removal of the mammary gland as:
- postoperative bleeding and bruising;
- temperature associated with suppuration of a postoperative wound or necrosis of poorly blood-supplied tissues at the incision site;
- lesion of the skin of the chest with beta-hemolytic streptococcus, due to which erysipelas develops;
- as a result of scarring of dissected tissues, scars are formed, often this process causes discomfort and is painful;
- the development of more prolonged neuropathic pain syndrome, which is manifested by stabbing pain, numbness and tingling in the chest wall, armpit, or in the arm;
- depressive mood, a sense of their own inferiority.
Almost always, after a month and a half, a violation of the natural outflow of interstitial fluid appears and lymphostasis develops. This violation is especially pronounced due to the cessation of normal lymph flow when the axillary lymph nodes are removed. Lymphostasis leads to the fact that not only swelling of the hand appears from the side of the removed organ, but also numbness of the skin on the inner surface of the hand is felt. Also noted is frozen shoulder syndrome - a short-term or longer-term restriction of the range of motion of the arm in the shoulder joint. This syndrome can appear within several months after surgery, and its cause lies in damage to the nerve endings located in the area of surgical intervention.
Recovery after breast removal
Already 1.5 days after the operation, you can get up and walk, but it is not recommended to force the restoration of motor activity: it should go gradually, since the sutures are removed about 1-2 weeks from the day of the operation.
In most patients, recovery after breast removal lasts 4-6 weeks, but it may take longer (this largely depends on the complexity of the operation and overall health).
The list of things that cannot be done after a mastectomy includes prohibitions on:
- showering (and washing in the bath) before removing the stitches;
- physical activity, lifting weights and vigorous movements;
- exposure to heat and UV radiation;
- any injection into the arm from the side of the removed breast;
- swimming in ponds and a pool (at least two months);
- sexual contacts (within 1-1.5 months).
In connection with lymphostasis, mammological surgeons give their patients the following recommendations after removal of the mammary gland:
- observe personal hygiene and cleanliness of hands;
- avoid injuries to the hands that damage the integrity of the skin, and in the case of the smallest scratch, use antiseptics;
- do not sleep on the side of the operated gland;
- wear a special elastic bandage (providing gentle compression to improve lymph drainage and reduce edema);
- do massage regularly: in the form of upward stroking of the hand in the direction from the fingers to the shoulder joint.
After removing the stitches, 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 a hand behind the head (at first, you can help with the other hand);
- in a standing position, bend your elbows in front of the chest and raise your elbows to the sides as high as possible;
- in a standing or sitting position, placing your hands behind your back.
Meals should include enough calories, but be light, that is, it is not recommended to eat fatty and spicy foods, as well as sweets. It is useful to eat more often, but in smaller portions; the diet should include ordinary foods (cereals, meat, fish, dairy products, vegetables and fruits). Animal fats should be replaced with vegetable fats, and salt and sugar intake should be reduced.
Treatment after removal of the breast
Cancer patients are treated after removal of the mammary gland - adjuvant therapy. At any stage of cancer after complete or partial removal of the breast, in order to destroy the remaining atypical cells and avoid relapse, chemotherapy is prescribed (with Cyclophosphamide, Fluorouracil, Mafosfamide, Doxorubicin, Xeloda, etc.) and a course of radiation therapy.
If the tumor is a hormone-dependent neoplasm, hormonal drugs are used. Tableted anti-estrogenic agent Tamoxifen (other trade names: Zitazonium, Nolvadex, Tamoplex, Cytofen, Zemid, etc.) is taken 1-2 times a day, 20-40 mg.
Toremifene (Fareston) is prescribed for women after menopause; the standard daily dosage is 60 mg, but the doctor can increase it 4 times (up to 240 mg).
The drug Letrozole (Femara, Letrosan) also inhibits the synthesis of estrogen in the body; it is prescribed only to patients aged once a day on a tablet (2.5 mg). Anastrozole tablets (synonyms - Arimidex, Anastera, Selana, Egistrazole, Mammozol, etc.) are not prescribed for premenopausal women, the drug should be taken 1 mg once a day.
The anti-cancer effect of drugs for targeted therapy is achieved by acting precisely on the molecules of cancer cells that support the development of the tumor. Thus, the drugs of this group are able to stabilize the pathological process and prevent the recurrence of the disease. The targeted drugs Bevacizumab (Avastin), Trastuzumab (Herceptin) are administered intravenously every two or three weeks; Lapatinib (Tyverb) tablets (by mouth 1000-1250 mg per day).
Life after breast removal
The main thing to remember is that life continues after the removal of the mammary gland, although for all women who have undergone such an operation, this is a slightly different life ...
First, a woman gets a disability after a mastectomy. Specifically: according to the “Instructions for the establishment of disability groups” approved by the order of the Ministry of Health of Ukraine (No. 561 dated September 5, 2011), a woman underwent unilateral mastectomy as a result of a malignant neoplasm. re-examination).
Secondly, it concerns the reconstruction of the 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 breast pads, as well as a removable denture - textile or silicone.
Today, the so-called exoprostheses for women who have lost their breasts are produced by many companies in a large assortment: these are fabric prostheses for the first time, and silicone ones for permanent use, of various sizes and modifications.
There is also a large selection of orthopedic underwear, as you need a bra to fix 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 swimwear is also on sale.
Plastic surgeons themselves claim that plastic surgery after mastectomy is a complicated and rather expensive operation. It can be a 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, a woman has 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 removal of the mammary gland.
Loading ...