Removal of the mammary glands. Is complete breast removal necessary for breast cancer? How it all began

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Two years ago, Angelina Jolie shocked the whole world: in order not to get cancer, like her mother, she did a preventive double mastectomy - she removed both breasts. The surgeons, of course, restored the ideal figure of the actress with the help of plastic surgery. The desire to have breast plastic surgery is the first thought that comes to mind after the operation. But can plastic surgery bring life back? Olga, 46, says no. “When I was in the hospital with bandages on my already flat chest, I had no shadow of doubts - of course, plastic. How is it, at forty years old and without a breast? But I underwent plastic surgery to restore the breast even harder than removing it. A prosthesis cannot replace an amputated arm. Implants will not replace breasts: a part of me, my body ... After all, I was breastfeeding my children! The operation will not return the old days, will not help "forget everything." Artificial roundness can deceive others, but not yourself. "

According to the Curie Institute in France, of the 12,000 patients undergoing mastectomy every year, only 20% agree to the subsequent operation. But why so few women decide to take this step, if the idea of ​​plastics first comes to mind? Psychoanalyst Françoise Brullmann is confident that, upon learning about the upcoming mastectomy, women cling to the possibility of future plastic surgery to restore their breasts, hoping that it will be their salvation. Psychotherapist Carole Louvel, herself a breast cancer survivor, agrees with her. “There is nothing to blame women for. It is difficult, impossible, to come to terms with the lack of breasts. But the majority then refuse plastic surgery, because they believe that they have already suffered enough due to the disease, their bodies are already crippled and is it time to leave them alone? .. And some want to tell the world: “Yes, now I am like that, without breasts cut and sewn up. Accept me for who I am. " And this is a very powerful message. "

57-year-old Daria decided not to restore her breasts after surgery (both breasts were removed). “I adore beautiful lingerie, in my closet there was always a large selection of lace and silk sets ... Therefore, at first I was sure that I would do breast augmentation. At first, I wore special bra tabs, but one day I asked - why am I doing this? Why? Is it really just for the sake of not being looked at as a sick person? And I realized that I do not want to depend on other people's views. This is my story, these are my scars. It happened to me, and there is no point in hiding it. I threw away the tabs and began to wear light dresses and thin T-shirts ... This is not easy: I want to warn all women - you will have to learn to endure the views of others. You will be looked at as a disabled person, with surprise, pain, shock. You will have to learn to speak - yes, I am different, but I am a woman, as before. "

There is a direct link between the word "femininity" and the diagnosis of breast cancer. “The disease brings a woman back to the past. Questions about growing up, sexuality come involuntarily ... What were the views of those around you: lustful, admiring, mocking? " - Françoise Brühlmann argues. 52-year-old Oksana burst into tears when her husband examined and stroked her scar for a long time. “It was only then that I realized that I had not ceased to be a woman. My nature has been injured, mutilated, abused, and because of the removal of the breast, and because of chemotherapy. But it seemed to be waiting for the moment to be reborn. Accepting me for who I am (what I have become), my husband seemed to be telling me that I can be desired - and for this I do not need breasts ... This attitude is much more important than plastic surgery. " Angelina Jolie once admitted that without the support of her husband she would not have been able to survive a three-month cycle of operations: “Brad was present at each one. Even in the most difficult moments, he managed to make me laugh. "
“In order to decide whether or not to have breast augmentation, a woman needs support from her partner,” confirms Carole Louvel. - How a woman feels about her loss depends in part on how her lover feels about it. Of course, true femininity is not limited to breasts or lack thereof. "

40-year-old Svetlana resolutely refused lipofilling of 1 breast. “I didn’t even want to think that they would cut something off from one side and put it on the other! Operations again, suffer and endure again? No, I can’t and don’t want any more. I want to make years of fear and illness a thing of the past. I want to enjoy life. And I also want my transformation to be beautiful, in spite of all those who are sure that life is over. " Now Svetlana is thinking about creating beautiful lingerie for women like her.

And 42-year-old Valeria is looking for a good tattoo artist to turn her scar into a garland of delicate flowers. “This scar is a sign of the suffering I have endured. I want to learn how to live with it, I have no need to wash it. You cannot erase a part of life, but you can force yourself to smile and enjoy even after the worst experiences. "

Having breast augmentation means getting back to life before the diagnosis. But those who have undergone mastectomy argue that this is not possible. And today thousands of women do not strive for this: their life goes on, no matter what.

1 The lipofilling technique allows the breast to be reconstructed by injecting fat taken from another area of ​​the body.

And the most significant reason for this tragic fact is the late diagnosis of recurrent breast cancer and the rapid progression of the disease after radical treatment.

Recurrence of breast cancer is the resumption of the tumor process in a period of 6 months or more after the antitumor treatment. In most cases, it occurs 3-5 years after completion of treatment, but in many cases the disease recurs within 1 year.

According to medical oncological statistics, even before the start of primary treatment, about 60% of breast cancer patients have either diagnosable or preclinical (non-diagnostic, “dormant”) micrometastases. In the future, relapses of cancer affect up to 85% of patients, most of whom suffer from metastases in the bones of the skeleton.

The recurrence of the disease is most susceptible to young women under 35 years of age.

Mortality in case of recurrence of breast cancer within 5 years ranges from 50 to 100%, many patients die within 1 year.

In modern oncology, a woman who has lived without cancer recurrence for 5 years after breast surgery is considered to have passed the five-year disease-free survival (DFS) milestone and is in remission.

The degree of cure of the disease is determined only after 10 years have passed without cancer recurrence after the antitumor treatment. But even this period for breast cancer is not an objective indicator - there are known cases of the resumption of the cancer process 20 and even 25 years after the allegedly successful treatment.

Unfortunately, the recognition of the diagnosis and treatment of breast cancer is accompanied by great suffering for the woman. After the diagnosis is made, severe psychological stress develops, and most women experience a state of duality. On the one hand, it is necessary to go through difficult treatment, undergo a mutilation operation (breast removal), but stay alive, despite the consequences for work and family life; on the other hand, it is impossible to come to terms with the operation to remove the mammary gland, which turns you into a "freak". Sometimes this leads to the disintegration of the family, if the husband or loved one is not so strong in spirit and gives up in front of a difficult life situation exactly when the woman especially needs their love and support.

After mastectomy and other methods of treatment, already at home, a woman with a "sore" arm and a suture at the site of an operation to remove a mammary gland, weak, deprived of the ability to perform many household chores, overtakes a second psychological shock, depriving, as it seems to her, of any hope of return to the old life. Oncologists call this situation a psychological collapse, since breast removal "knocks out" most women from their usual social and social environment and leads to serious changes in their psyche and lifestyle. Such a crisis situation requires a change in life position, a woman's reconsideration of her attitude to the world around her, the words and actions of relatives and friends.

Helping a woman after a mastectomy to cope with these difficulties is the main task of the attending doctors, friends, family, colleagues, since it is during this period that the further way of life of this woman in the family and society is formed. Oncologists believe that the microclimate in the family depends on the patient's attitude to her disease: the less a woman dramatizes the situation of breast removal, the more chances she has to receive support from her family. First, you should analyze your previous life and try to identify the factors that contributed to the appearance of her breast cancer and, if possible, eliminate them.

After mastectomy, anatomical and physiological disorders occur in the body, which can lead to partial disability. The question arises: how to live on, live long, have a happy family, work actively?

So, what needs to be done after a mastectomy so that there is no recurrence of breast cancer, in order to increase the body's defenses, feel good, work at full strength and enjoy life?

• not to waste invaluable time in oncological diseases, relying only on passive medical supervision, as well as the use of any supposedly anti-cancer dietary supplements, phyto-assemblies and other "miraculous" means, but it is MANDATORY to undergo specialized treatment under the "Radical" program of the "ONCONET" complex antitumor system. Take care of yourself and your loved ones! Save your life and health! Then it may be too late! ;
• change the daily routine;
• change the diet;
• lose weight and stabilize it;
• engage in physiotherapy exercises;
• learn to remove physical and psycho-emotional overload;
• monitor your appearance;
• do what you love;
• regularly undergo a medical examination.

To restore physical strength, strengthen the nervous system, it is necessary:

• sleep for 7-8 hours with an open window or window;
• before going to bed, take a warm shower, directing jets of water primarily to sore spots;
• put the sore hand in bed on a pillow so that the hand is on a dais (this normalizes the circulation of lymph and its outflow);
• sleep on your back or on the side opposite to the operated side, so that your weight during sleep does not squeeze the blood vessels of the arm from the side of the breast removal site;
• if you experience painful sensations of a shooting nature in the area of ​​surgery to remove the breast, arm, supra-shoulder region, you should consult a doctor (this may be a symptom of bronchoplexitis - inflammation of the brachial plexus);
• do not lift or carry heavy objects, if possible, do not overextend the arm from the side of breast cancer removal. With an increase in the load, the muscles require more oxygen, which increases the blood flow to the arm, which is already overloaded with venous blood and lymph, while the outflow from it is difficult;
• it is recommended to limit the load on the arm from the side of the operation - up to 1 kg for one year, up to 2 kg for four years and up to 3-4 kg during the whole life. It is better to carry the bag on the shoulder of a healthy hand;
• avoid any work involving a prolonged reclining position with hands down. Such restrictions are needed to prevent stagnation of lymph in the lymphatic vessels of the arm;
• after physical work, be sure to do gymnastics, self-massage of the hand (stroking from the fingers of the hand to the armpit), give it an elevated position at an angle of 10 ° -15 °;
• when working in a summer cottage, washing, washing dishes, especially with the use of strong detergents, it is recommended to use protective gloves;
• sew with a thimble;
• avoid mosquito bites, bees, using a repellent for protection;
• it is not recommended to do injections, donate blood for analysis, measure blood pressure on the arm from the side of the operation to remove the mammary gland;
• the hand should not be squeezed from the side of breast cancer removal: exclude tight cuffs on the blouse and nightgown, make sure that the armholes of the clothes are not too narrow, the bra straps should not cut into the shoulder. Rings, bracelets and watches should be held loosely on the arm, without girth;
• avoid burns while cooking, avoid sunburn. In summer, wear a hat, long-sleeved clothing (to protect from sunlight);
• do not use hot water when washing dishes, taking a bath. After a mastectomy, a sauna, a steam room is contraindicated, and it is recommended to replace washing in the bathroom with a shower;
• protect the hand from the side of the breast removal from cuts, burns, abrasions, cracks, scratches caused by animals and plants. These precautions are important in preventing erysipelas. Erysipelas leads to the appearance and increase of swelling of the hand;
• if a hand is injured from the side of breast cancer removal, it is necessary to rinse the wound with running water and treat it twice with an antiseptic solution (iodine, 0.01% chlorhexidine digluconate, 70-degree alcohol solution). If the hand at the site of injury turns red, pain appears, body temperature rises, swelling of the hand increases, you should consult a doctor;
• after work, you need to take off your bra with a prosthesis, give your body a rest, put on loose cotton clothes;
• protect the area of ​​operation to remove the mammary gland with the second, healthy hand in transport, in the market, in crowded places.

During the recovery period (7-8 days after mastectomy), it is recommended to carry out a complex of therapeutic exercises to restore the maximum range of motion in the hand from the side of breast removal, maintain correct posture, coordinate movements, complete breathing, and normalize the general condition. Exercise is best done twice a day - in the morning and in the middle of the day. Exercises in the pool are very effective for the restoration of motor function of the arm from the side of breast removal. They can be started 2-3 months after breast removal surgery.

Indications and performance of surgery to remove the mammary gland

Removal of the breast is called a mastectomy, and the removal of the breast can be complete or partial. According to indications, the pectoral muscle and lymph nodes in the armpit can be removed. The main indication for this surgical intervention is breast cancer (BC). Breast amputation can be a solution to the problem of oncology or a way to somewhat prolong life in case of a disease. Breast cancer is currently the leader among all forms of oncology in women, and if breast removal is proposed, you must agree without hesitation.

Breast cancer development factors

The contributing factors are:

• heredity;
• hormonal imbalance;
• microtrauma of the breast;
• degeneration of fibroadenoma (benign process), existing cysts;
• stagnation of milk with hepatitis B.

Prevention as such does not exist, there are many factors, it is impossible to single out one main one separately. All that remains is a regular examination by a mammologist.

Prevention as such does not exist, there are many factors, it is impossible to single out one main one separately

The mammary gland can be amputated for the following indications:

• tumor size exceeds 1 quadrant;
• the radiation or chemotherapy performed were unsuccessful;
• the tumor is larger than 5 cm;
• after the resection of the breast, the affected area was not completely removed, therefore, a complete amputation is required;
• contraindications to radiation therapy;
• extensive phlegmon of the mammary gland;
• mastopathy with multiple lesions of the gland with cysts or nodes.

Removing the breast on one side reduces the risk of cancer, but does not guarantee that it will not appear on the other.

Removal of mammary glands (video)

Analyzes and preparation for surgery

• blood and urine tests;
• Ultrasound of the gland;
• a blood test to determine coagulability;
• biopsy;
• mammography.

With the upcoming operation, you should:

• stop taking anticoagulants 2 weeks before her;
• preventively, on the evening before the operation, the woman is injected with antibiotics;
• 12 hours before surgery, the patient should not eat;
• cleanse the intestines with an enema.

Types of operations

The following types of surgical intervention can be distinguished:

1. General Breast Removal Surgery - A complete amputation is performed including the nipple and areola. The pectoral muscles are left. If the tumor does not exceed 2 cm in size, then the nipple and areola are not removed.
2. Subcutaneous - in this case, the tumor should be near the areola no further than 2 cm; the gland with the lymph nodes is removed, but the nipple and areola remain. The incision is made around the areola. After that, radiation therapy is required.
3. Partial (lumpectomy) - remove only the damaged area and part of the healthy tissue around it. In stage 1 and 2 cancer, lymph nodes are also removed, long-term results are good.
4. Halstead radical mastectomy - it is performed with extensive lesions: the gland is removed, both pectoral muscles and axillary lymph nodes, fatty tissue from the armpit, under the collarbone and scapula. The operation is radical, but more traumatic. Today, this method is rarely used, only in the late stages of cancer, when the tumor grows into the pectoralis major muscle, infiltrates it and causes edema. The incision is closed with the remaining skin. The scar after the operation is cm. There are many complications after such an operation.
5. Radical improved - breast amputation is performed: everything is removed, even small blood vessels of the lymph nodes, but the incision is made in the form of an incision around the areola. Through it, the tissue of the gland is removed. The scar remains transverse.
6. Radical enlarged - removal of the pectoralis minor muscle and resection of the chest wall where the tumor has grown is added to the removed gland, pectoralis major muscle, lymph nodes.
7. Quadranthectomy - it is performed if the tumor occupies the quadrant of the mammary gland. A separate incision is then made through which the axillary lymph nodes are removed.
8. Paty's Modified Radical Mastectomy - 2 semi-oval incisions are performed around the gland, from the parasternal to the midaxillary line (axillary lines). The gland with the fascia of the pectoralis major muscle is removed from this incision, the muscle itself is not touched; the pectoralis minor muscle is removed or pulled to the side to open access to the lymph nodes in the armpit; and then the iron and nodes are removed in a single block. A drain is inserted and the wound is sutured. The pectoralis major muscle is preserved, so the operation is less traumatic, the functions and cosmetic appearance of the remaining muscles are better preserved. Currently, this model of surgery is most often performed, which has become the gold standard in the surgical treatment of breast cancer.
9. Urban extended radical mastectomy - the technique is similar to Halstead, but here the parasternal lymph nodes are additionally removed. For this, 2-3 costal cartilage is removed along the peristernal line. This method has no advantages over the Halstead method. It is also rarely used, only if there are metastases to the specified lymph nodes.

All operations are performed under general anesthesia. Depending on the amount of removal, the procedure can take from 1 to 3 hours or more. The operation does not guarantee a complete cure. It all depends on the type and size of the tumor, its stage, etc. Often, after operations, to consolidate the results, according to indications, chemotherapy or radiation therapy can be prescribed. Removal of mammary glands in women can be carried out bilaterally, according to indications, when both are removed at once.

Lymph node metastases in any operation reduce the 5-year postoperative survival rate, so they are tried to be removed.

When mutating genes are detected, women are under dynamic supervision of doctors to detect the early stage of cancer.

Prophylactic mastectomy

The hereditary nature of breast cancer implies a mutation in the BRCA1 and BRCA2 genes. This discovery led to the emergence of preventive breast removal. In the United States, an example was set in 2013 by Angelina Jolie, who removed her mammary glands bilaterally, when it became clear that she had an 80% risk of breast cancer due to heredity. In Russia, preventive disposal is not practiced. When mutating genes are detected, women are under dynamic supervision of doctors to detect early stages of cancer. Preventive removal of the mammary glands is possible only when there is a risk of developing cancer with a possible complication.

Breast surgery (video)

Postoperative period

After 1.5 days, it is allowed to walk, but in the first days there is a pronounced pain syndrome. Patients should not make sudden movements, raise their hands up. You cannot force physical activity.

After removal of the drainage tubes, fluid may accumulate at the site of the operation, and usually it will dissolve on its own. In other cases, the doctor removes the fluid during the bandaging by puncture. A tight bandage is applied around the chest, which must be worn for a month. The bandage forces the skin to tightly adhere to the area of ​​operation against the muscles so that lymph does not collect here. But it happens that the lymph is still collected, in such cases, a puncture is periodically carried out by the surgeon at the place of residence. In obese women, lymph collects longer. The stitches are removed 2 weeks after the operation. If there are no complications, the woman returns to her rhythm of life in 1.5-2 months. Sexual life can be resumed at the same time.

Consequences of a mastectomy

In the first days after the operation, there is a feeling of discomfort in the neck and back, numbness of the arms, shoulders, chest and armpits; at the site of the operation, the skin is stretched and coarse. Arms and shoulders may weaken temporarily. In rare cases, these sensations remain irreversible. In connection with these phenomena, a few days after the operation, they begin to do special therapeutic exercises.

Removal of the lymph nodes under the armpits often leads to the fact that the outflow of lymph slows down and edema develops - lymphedema. Sometimes this is irreversible. This complication can appear immediately or after several months.

The hand on the operated side must be protected from injury at all times. Many women are interested in reshaping their breasts. Such reconstructions can be performed during surgery or 9-12 months after surgery using a silicone implant or using your own tissue from another part of the body: skin, fat and muscles can be taken from the abdomen, buttocks or back. Options and expected results are discussed with the plastic surgeon. The reconstructed breast, even if it visually resembles a healthy one, will still differ in sensitivity and touch.

Removal of mammary glands in men

The operation of mastectomy can also be performed on men. They may also develop breast cancer (carcinoma), although this is extremely rare. They may also have gynecomastia, which is treated with hormones. If there is no effect, the breast is also removed. With obesity, the breast is not removed, only liposuction is performed.

Complications after mastectomy

In the form of complications, the following can be observed:

1. Hematomas and postoperative bleeding.
2. Suppuration of the wound.
3. Erysipelas is the most common and dangerous complication of lymphedema. In this case, a bacterial infection of the skin and subcutaneous tissue develops, which in turn causes thrombophlebitis, abscesses. Erysipelas can be treated well with timely treatment.
4. Painful scars and scars.
5. Neuropathic pain syndrome in the form of tingling, numbness and stitching pains in the chest wall, armpit, arm.
6. Lymphostasis may develop after 4-6 weeks.
7. Frozen shoulder syndrome - movement of the arm in the shoulder joint is limited and painful. This can develop several months after surgery and is due to damage to the nerve endings during surgery.

Contraindications after surgery

It is strictly forbidden to shower and wash before removing the stitches. It is necessary to exclude physical activity, you cannot sunbathe and overheat (forever), swimming in the pool is prohibited for 2 months. You cannot sleep on your side from the side of the operation; you need to regularly massage your hand - stroking from fingers to shoulders. After removing the stitches, you need to start doing gymnastics: raising your arms to the sides and up; placing a hand on the affected side behind the head; bend your elbows and raise your elbows.

Is it possible not to remove the lymph nodes? This is ruled out because the risk of cancer coming back increases.

Do I need to visit an oncologist after surgery? A visit to a doctor is required every 3 months. If there are no complications, then later visits with a regularity of once every six months. A visit to a doctor is especially important for women with venous insufficiency because they often develop lymphedema.

A visit to a doctor becomes urgent if:

• pallor and blueness of the hand appeared;
• the hand became swollen, tight and taut, cold;
• pain appeared and it became difficult to move the arm.

For swelling of the hand, treatment is prescribed:

• benzopyrones and niacin to relieve swelling, inflammation and improve blood circulation;
• olive and jojoba oils are used to nourish and moisturize the skin of the hand;
• to normalize the outflow of lymph, you must wear a special elastic sleeve (sold at the pharmacy);
• protect your hand from injury: you can't even measure blood pressure on it, give injections, droppers, take tests, allow mosquito bites, bruises;
• exclude any physical work.

As soon as the lymph stops accumulating, you can go in for sports, do your usual work at home. Young women can give birth, but after consulting a doctor.

After surgery, the elderly are advised to purchase special underwear with a removable prosthesis to balance the load on the spine. A woman after a mastectomy is given a lifetime disability group 3. After the operation, adjuvant or prophylactic therapy is always prescribed, which complements the radiation method and the operation. This is done to prevent micrometastases caused by breast cancer. This includes hormones, chemotherapy, targeted therapy with special drugs for a targeted targeted effect only on cancer cells. Thus, mastectomy is today the only way to help women solve their problems or prolong their lives.

What are the types of breast reconstruction after mastectomy?

Breast reconstruction is a big deal. During the reconstruction process, the tissues of the back and the anterior abdominal wall, the second mammary gland, if its shape needs to be corrected, may be affected.

Usually, the following is subject to restoration:

• the volume of skin and subcutaneous fat in the area of ​​the removed mammary gland;
• the volume of tissues around the reconstructed breast in the event that during the operation of mastectomy adjacent tissues and the pectoralis major muscle were removed;
• nipple-areola complex;
• the shape and size of the second breast can be adjusted to improve the appearance of the bust and eliminate asymmetry.

Of all the known plastic surgery techniques, almost any can be used:

• use of spanders and breast endoprostheses;
• moving the skin, subcutaneous fatty tissue and muscles to the area of ​​the restored breast;
• lipomodeling;
• laser polishing of scars;
• areola area tattoo;
• in some cases, it is possible to use vacuum devices to stretch the skin in the area where the breast is reconstructed after mastectomy.

As you can see, to carry out breast reconstruction from a plastic surgeon, a large number of skills are required, therefore, such work does not need to be entrusted to unverified people.

What is it for

Lack of a mammary gland is not only a psychological problem. Although in most cases it is psychological discomfort that motivates most patients who decide for plastic surgery.

In addition to the problems associated with the unaesthetic appearance of the bust after mastectomy, there may be:

• imbalance of the load on the thoracic spine on both sides: where the mammary gland is preserved, the load will be greater;
• secondary changes in the osteoarticular system associated with an imbalance in the load on the spine, which are expressed by impaired posture, drooping shoulders, curvature of the spine;
• consequences of curvature of the spine: disruption of the functioning of the organs of the chest - heart and lungs.

Therefore, after a mastectomy is not only a way to regain self-confidence, but also an excellent preventive measure against a number of chronic diseases of the cardiovascular and respiratory systems.

Video: Life After Mastectomy

What determines the volume of plastic surgery during breast reconstruction

Not all plastic surgeon patients have breast reconstruction operations the same. The volume depends on a number of criteria.

• The volume of tissue removed during surgery for cancer.

Depending on the degree of cancer development, different amounts of tissue may be removed.

The simplest situation is the removal of local formations while preserving a healthy part of the mammary gland. In this case, retracted scars and areas of retraction are formed at the sites of removal of nodes and tumors.

All breast tissue can be removed while preserving the skin and subcutaneous tissue covering the mammary gland. A relatively easy option for subsequent reconstruction. Currently, this type of surgery for cancer is rare. In most cases, it is used to prevent breast cancer in individuals with a genetic predisposition to developing the disease.

This operation was performed by Angelina Jolie, whose mother at one time died of cancer. Endoprostheses are installed in place of the removed glandular tissue. Complete breast removal is the most common way to remove breast cancer in women.

In cases where there is a risk of spreading metastases, the entire mammary gland, the pectoralis major muscle, the subcutaneous fatty tissue of half of the breast are removed in order to remove the lymphatic vessels and lymph nodes to which the lymph flows from the diseased breast. This option is the most difficult for the subsequent restoration of the bust and requires the special skill of a plastic surgeon.

The patient should be able to undergo the next surgery and anesthesia without complications. Here it should be borne in mind that contraindications for plastic surgery will be much more stringent than for surgery performed for health reasons (for cancer, for example). And the fact that in the past did not interfere with the surgical treatment of cancer, can become a serious contraindication for reconstructive surgery on the mammary glands.

• The appearance of the second breast and the client's wishes regarding the future size and shape of the bust.

It only seems at first that there is no life after a mastectomy. Over time, while thinking and discussing with a plastic surgeon the details of the upcoming breast reconstructive surgery, there is often a desire to "put in order" the healthy mammary gland, if its prolapse is outlined, there is a desire to reduce or increase the size of the bust.

One of the reasons why many agree to this is the reluctance to subsequently undergo another anesthesia when it will be necessary to perform a surgical breast lifting, reduction or enlargement.

Do you want no traces of surgery left on your mammary gland after plastic surgery? Learn more about seamless breast augmentation.

Read all about women's breasts, postpartum recovery and breastfeeding at this link.

How removal can be done

Until recently, it was believed that the optimal is to first remove the mammary gland, and to carry out reconstructive surgery only a year after the mastectomy.

Some surgeons are still convinced that this is the best way to prevent the development of metastases and cancer recurrence. But not all patients psychologically simply wait so long. For some, a physical defect becomes so significant that even the fact of getting rid of cancer is no longer happy.

Family relationships are deteriorating. According to a number of reports by European authors of opinion polls and studies, 70% of marriages fall apart in the first two years after mastectomy. As a result, there is no illness, but the quality of life leaves much to be desired.

Therefore, in most cases, now the reconstruction is performed simultaneously with the removal of the mammary gland, if there are no serious health problems and contraindications to extended surgery.

How soft tissue is restored in the area of ​​the removed breast

There are several options for restoring the volume of tissues in the area of ​​mastectomy.

An expander can be used

The expander is a special device that is installed in the area of ​​breast reconstruction for a period of 3 to 6 months. It stretches the skin and forms a cavity sufficient for the subsequent placement of the implant. Resistance bands are on the list of products offered by most breast implant companies. The algorithm for two-stage use and breast implant is shown in the video.

Video: Breast reconstruction (expander + implant)

It is placed under the skin and filled with liquid over a period of time. Liquid is injected with a syringe. The procedure is performed on an outpatient basis.

Benefits of using an expander:

• much less trauma of the operation in comparison with the transplantation of the musculocutaneous flap;
• the final skin volume required for breast reconstruction is achieved twice as fast as using a vacuum system.

Disadvantages of using an expander:

• The need for frequent visits to the doctor for injections;
• Unnaturalness of the chest externally and to the touch;
• There is a risk of tissue necrosis (necrosis) over the expander if the skin is stretched too quickly;
• The implant is located directly under the skin, therefore there is a risk of rapid development of ptosis, there are restrictions on the use of a number of implants in terms of the density of the gel, so that the final result is as close to natural as possible.

A vacuum device can be used to form excess skin in the area where breast reconstruction is planned. For such cases, the Brava system has been developed. You need to wear it for a long time. Every day, to get the desired result, you need to use it for hours.

The essence of the method is that a special cup shaped like a dome is put on the area of ​​the mammary glands. A vacuum is created under the bowl, thanks to which the skin is constantly taut and gradually stretched.

The advantages of the method are that:

• performed simultaneously with liposuction;
• the method allows you to use implants and transplanted own fat to restore the volume of the mammary gland;
• if adipose tissue transplantation is used, then there is no scarring.

The disadvantages of this method are that:

• you need to wear a special device on your chest for many months;
• it is difficult to achieve significant stretching of the breast to a large implant size;
• there is a risk of stretch marks and vascular network.

The entire technique consists of three stages:

Stage 1 - preparatory. It consists in wearing the vacuum system for a specified period of time every day of the hour. The system can be worn both day and night.

Stage 2 - adipose tissue transplantation. Fat is taken from the places where it is usually excess by liposuction. Adipose tissue is transferred to the breast area by injection.

Stage 3 - final. The Brava system must be worn for another 3-4 weeks in order to increase the survival rate of the displaced adipose tissue.

Musculocutaneous flap transplant

The flap can be transplanted from the back (latissimus dorsi) or from the anterior abdominal wall (rectus abdominis).

• mammary gland natural in shape and touch;
• there are no problems associated with the use of implants, such as displacement of the implant, the need for replacement.

• long-term anesthesia (4-5 hours);
• very high trauma of the operation;
• long period of rehabilitation;
• there is a risk of necrosis of the transplanted musculocutaneous flap and its subsequent rejection;
• significant postoperative scars.

Combined technique

For breast reconstruction, a skin flap from the buttocks, abdomen or back and an implant are used.

Restoration of soft tissues around the removed breast.

If an extended operation is performed to remove not only the mammary gland, but also the adjacent soft tissues of the breast, then during the reconstruction it is necessary to restore their missing volume from the side of the surgical intervention.

Usually, the restoration is performed by means of fatty tissue transplantation, which is taken from the places where its surplus is.

Methods for restoring the nipple-areola complex

Breast reconstruction will be considered incomplete without nipple and areola reconstruction, as it is important for a woman to look good both in clothes and without them.

There are three main ways to recreate the nipple and areola:

• the areola is recreated from the tissue of the areola from the healthy side;
• the skin of the labia minora is transplanted, if it is pigmented;
• the nipple is formed from the tissues of the breast being repaired, and the areola is pigmented with the help of tattooing.

Correction of the second breast

In order to eliminate asymmetry, improve the shape of a healthy breast, a large number of methods are used:

• mastopexy;
• mastopexy with breast augmentation with an endoprosthesis;
• mastopexy with breast reduction.

Less commonly used methods such as breast lift with threads, the use of fillers.

What plastic surgery is performed on the nipples and areolas? Read about all types of plastic surgery for inverted nipples in the article - nipple correction.

Breast ptosis is a gradual prolapse of the mammary glands and loss of their volume. See photos here.

Contraindications

• the presence of infectious diseases;
• the presence of a tumor process of any stage and localization;
• serious diseases of internal organs, in which their function is impaired;
• diabetes;
• violation of blood clotting;
• age under 18;
• less than a year from the end of lactation;
• the general serious condition of the patient;
• obesity;
• doubts about the necessity and feasibility of reconstructive surgery on the part of the patient.

Preparing for surgery

• consultation with a surgeon;
• laboratory and instrumental examinations to identify possible contraindications to surgery;
• it is forbidden to take alcohol two weeks before the operation, as this can lead to problems with anesthesia and withdrawal from it;
• it is recommended to stop smoking at least two months before the operation, especially if transplantation of musculocutaneous flaps is planned, in order to prevent problems with delayed healing and necrosis.

Complications

• bleeding;
• swelling;
• necrosis of the skin flap or skin over the expander;
• scars;
• delayed healing;
• infection;
• complications associated with wearing implants (capsular contracture, rotation and displacement of the implant, and others).

Rehabilitation

The time it takes for the body to fully recover from the operation depends on the extent of the operation itself. If we talk about the Brava method, then this is the least traumatic method that requires a hospital stay for a maximum of three days during liposuction and adipose tissue transplantation.

Full recovery of working capacity occurs 2-3 weeks after the operation and does not require any restrictions, except for the ban on thermal procedures. The use of expander and endoprostheses essentially involves two operations. During the first, an expander is installed, during the second, it is removed and replaced with an implant.

After each of the operations, there is a need to limit the load, take painkillers, observe the ban on thermal procedures and sunbathing. It is recommended to wear a compression garment after implant placement.

The rehabilitation period is about 4 weeks. If we are talking about the formation of the mammary gland by moving the musculocutaneous flap, then the rehabilitation period is often difficult and long.

• the period of stay in the clinic is about days;
• the sutures are removed on day 14;
• intense pains are possible, which gradually subside by the end of the rehabilitation period;
• a ban on lifting weights and intense physical activity for a period of at least 6 months;
• wearing a bandage or compression underwear for at least six months after the operation;
• avoiding sexual activity for 3-6 weeks after breast reconstruction.

The recovery period in this case can be from 6 weeks.

What is false gynecomastia, symptoms, and how you can get rid of it, in this article. What methods exist in modern medicine for lifting the mammary glands without implants, read the link.

Are you wondering if you can breastfeed your baby with silicone? That way.

Before and after photos

Your feedback

I don’t understand why bra inserts are bad? Such a serious operation, and even with anesthesia.

And without a bra then how? And it's good if an even scar remains. And if the scars are rough and thick. In any case, you will have to clean up. And the laser will not always work. This means that it is still an operation, and still anesthesia.

I did it myself. To be honest, I was very afraid and very doubtful. And she did it only for her husband, as she was very shy of him. The second operation, which was to restore, was more than a year after the removal. All the time I just wore a pillow sewn into a bra, without any silicone inserts. I can say that the second operation was worse than the first (skin, fat and muscles were transplanted from the back). Maybe because it is so difficult, or maybe because all this burden with hospitals exhausted me. And my husband did not really support me either. Now I think that I would not agree to such a serious operation, since I am still recovering from it. I was bribed by the fact that there would be no problems with implants later, but it would be better if I chose an expander.

And they didn’t take me to reconstructive surgery. They said because of arterial hypertension and something with the rhythm of the heart. Now I am treating my heart and blood pressure and I hope that they will take it for the second time.

The topic is very difficult, this situation touched me a year and a half ago, they removed my left breast, I am not married and have no children, a very large complex was formed, at first I also put a small pad in my bra, but as a matter of a young man I just had a stopper before intimacy, in the end, I decided on such a difficult operation in order to establish my personal life, fortunately all the medical indications were in my favor! I was operated on by the best Moscow surgeon Vladimir Sazhienko, at the beauty trend clinic, the operation was easy for me and without complications, now everything is fine, I came to my senses and began to enjoy life again!)

Breast (breast) removal, an operation that causes fear in women diagnosed with breast cancer.

What is important to know about this operation, and in what cases will it help eliminate the inevitability of developing breast cancer? When is the removal of the mammary glands performed?

Reasons for breast removal (mastectomy)

The first reconstructive surgeries after mastectomy were undertaken in the late 19th century. But a large number of complications made these operations unclaimed until 1963, when a mastectomy was successfully performed, followed by reconstruction of the mammary gland with silicone endoprostheses.

Over the next decades, plastic surgeons have been improving the reconstructive technology of the breast. Today, a more demanded operation is a one-stage reconstruction of an organ after a mastectomy.

Mastectomy, types and methods

A mastectomy is the radical removal of the breast and some surrounding tissue through surgery. In accordance with the extent of the spread of cancer in the breast and metastasis, the following types of operations are performed:

1. The Payty Method, which allows you to radically remove the breast affected by cancer. This removes not only the glandular tissue, but also the axillary nodes and the pectoralis minor (pectoralis minor). Such an operation is indicated with a confirmed oncological diagnosis, with the presence of metastases. Most mastectomies are performed using this method.
2. Halstead method- also a radical operation, with excision not only of the gland, but also of the axillary lymph nodes, and pectoral muscles with adipose tissue. The pectoral nerve is retained. This method is indicated for severe stages of cancer, with deep metastases to the muscles adjacent to the mammary gland.
3. Madden's method, a less radical operation, since only the mammary gland is removed. The nearby muscles and lymph nodes are retained. Such an operation is prescribed for women with a diagnosis of ductal carcinoma. Also, Madden's method is used in prophylactic operations for patients for genetic indications.

Today, the newest technique is the removal of the breast while preserving the skin.

Plastic surgeon Heather Richardson

Today there is more than one criterion for the volume of transactions. This can be a lumpectomy (partial or segmental mastectomy).

It is defined as complete surgical resection of the primary tumor in order to achieve significant negative margins (ideally 1 cm).

This can be accomplished with specific palpation guidelines or imaging guidelines and is applicable for most patients with stage I or II invasive carcinomas.

There are relative contraindications, which are presented below.

CONTRAINDICATIONS

1. small breast size;
2. large tumor size (> 5 cm);
3. collagen-vascular disease.

Absolute contraindications include the following situations.

CONTRAINDICATIONS

1. multifocal disease;
2. history of previous radiation therapy in the treatment area;
3. inability to undergo radiation therapy for invasive disease;
4. first or second trimester of pregnancy;
5. constant positive histological tests for the presence of tumor cells after attempts to preserve the organ.

You can have a mastectomy about six months after you stop breastfeeding completely.

Plastic surgeon Daniel Barrett

Breast reconstruction options after partial mastectomy include the following:

1. Fascio-cutaneous grafts to improve local tissue.
2. Breast parenchyma flaps.
3. Musculocutaneous flap from the latissimus dorsi muscle.

A complete mastectomy for cancer involves the complete removal of all breast tissue.

Studies were conducted (in 2017), which showed that the risk of cancer recurrence after total breast removal and surgery with preservation of tissues, nipple, areola is almost the same. That is why more and more surgeons are leaning towards the second option.

Plastic surgeon Kenneth Francis

The following options are performed:

1. Modified radical mastectomy - axillary lymph node removal (ALND) mastectomy.
2. Radical mastectomy - mastectomy plus en-block resection of the pectoralis muscle with ALND.
3. Extended radical mastectomy - radical mastectomy with resection of the internal lymph nodes of the breast.
4. Cutaneous-preserving total mastectomy (SSM).
5. Areolo-sparing mastectomy (NSM). During the operation, all breast tissue is removed, but the nipple remains in place.

Indications

The main indication for breast removal is a confirmed diagnosis of breast cancer. In addition, mastectomy is indicated when the BRCA1 gene is detected in the patient.

Today, prophylactic mastectomies are increasingly being performed on patients who have the BRCA1 gene in their bodies, which practically does not give a chance to avoid the development of breast cancer.

How is breast removal surgery performed (step by step)?

To carry out this surgical intervention, it is used. The duration of the operation is about 3-4 hours.

If the lymph nodes are also removed, then the surgeon will need more time to work.

Initially, the doctor cuts the skin and removes the affected tissue.

These are complex manipulations that require high qualifications from a doctor. At the end, the surgeon sutures with absorbent sutures or staples.

In order to be able to pump out the accumulated fluid, reduce swelling, accelerate recovery, drainage is used, which is placed in the chest.

There are different situations, so the nipple can be left in or removed as well. After some time, the patient may be referred for a biopsy. It will help to check the operated area for the presence of cancer cells.

After surgery, a woman will need to stay in stationary conditions for several days.

Recovery after surgery

After the breast tumor has been removed, the woman needs to recover. At first, the patient will feel pain. After breast removal surgery, you must not move abruptly, do not carry heavy things, do not raise your hands.

If a woman is tormented by strong painful sensations, then the doctor will prescribe pain medications.

Quite often, the doctor prescribes chemotherapy in conjunction with surgery. Radiation therapy may also be needed.

When the drain tubes are removed, you may encounter a small amount of fluid build-up. But there were times when medical attention was required. In such a situation, the doctor drains the excess "water" using a needle.

After the operation, you run the risk of bleeding, infection, soreness, swelling in the upper extremities, hardness in the scar area, hematomas, numbness (this happens when the lymph nodes are removed).

Plastic surgeon Barbara Persona

In most cases, a woman is depressed after breast removal. Depression can last for a long time, sometimes psychological treatment is required.

People in such a situation need to understand that life does not end, but they are given a chance to become healthy.

You need to try not to start to complex and close in yourself, but to find a way to hide your flaw. In addition, there is reconstructive surgery that can help create new breasts that are close to real ones.

Returning to your previous life is possible at 6-8 weeks of recovery, if complications do not appear. It is worth having sex after 1.5-2 months.

If the breast is to be removed completely, the patient may be offered reconstruction. But not everyone agrees to it. In addition, some people do not have the opportunity to conduct it, because it is not cheap.

In this case, you can use prosthetics. What it is? Bras are produced today that give the appearance of normal natural breasts.

For the recovery to go quickly, without complications, you cannot:

• take a shower before;
• load your body, carry weights;
• go to any injection in the affected area;
• swim in the pool, river, sea for about 2 months after the operation;
• have sexual intercourse for about 1.5-2 months.

Working out the arms after removing the stitches

When the woman's stitches are removed, she should start working out her arms. To do this, you need to perform certain exercises:

• raise your hands up and in different directions (you can be in a standing or sitting position), throw them back behind your head;
• stand up, bend the limbs at the elbows, place them in front of the sternum, and then move them apart;
• try to close your hands behind your back.

All of these exercises can only be performed with the approval of a doctor.

Question answer

If you are concerned, then you need to talk to a breast surgeon to review your risks, and if they are high, you should review surgical options.

Unfortunately, there is usually a loss of nerve sensation after mastectomy and lymph node dissection. Only time will tell - it can take up to 2 years for nerves to recover completely, so you need to be patient. If the situation does not improve in two years, most likely, it will remain so.

Most of the time, itching can be controlled with topical or oral steroids, cold compresses, or antihistamines after surgery. In more significant cases, neurologically active drugs such as Neurontin may be used.

Preventive mastectomy

Many women learned about the possibility of preventing the development of breast cancer from media reports. Hollywood celebrity Angelina Jolie had a mastectomy (after which she inserted) in order to avoid the risk of developing breast cancer.

Other famous women followed her example. Now, not only doctors know about preventive mastecomia.

To determine the need for a preventive mastectomy, it is worth learning about its indications and all possible postoperative complications.

Indications for preventive mastectomy

In our country, preventive mastectomy has been officially carried out since 2010. The basis for its implementation is the presence in the body of a diagnosed breast cancer mutagen (BRCA1 and BRCA2), or a malignant tumor of one of the mammary glands.

A family history of oncology confirmed by genetic testing is also a valid indication for preventive mastectomy. The operation is indicated in the presence of signs of precancerous pathology of the organ.

In private clinics, such an operation can be performed even without a confirmed diagnosis, only guided by the patient's desire. In such cases, she is required to provide legal confirmation of her waiver of further claims regarding the outcome of the transaction.

Contraindications for preventive mastectomy

Breast removal is not carried out as a preventive measure if the patient has certain contraindications.

CONTRAINDICATIONS

1. Mature age (over 65 years old);
2. Lipomatosis 2-3 degrees;
3. Arterial hypertension;
4. Diabetes;
5. Cardiovascular pathology;
6. Bronchial asthma;
7. Psychiatric diagnosis.

The decision to perform a preventive mastectomy on a patient is made collectively by several specialists. She gives written consent to the operation, which is legally certified.

Operation

One-stage organ reconstruction after mastectomy is carried out in stages:

• Direct mastectomy - removal of glandular tissue without skin;
• Organ reconstruction - the transfer of a graft from its tissues, or an implant, with the further formation of the contours of the gland.

Breast reconstruction methods

The restoration of the mammary gland with the tissues of the patient's body, according to plastic surgeons, is the most urgent. During breast reconstruction, tissue flaps (skin, muscles, subcutaneous tissue) are used from various areas of the body: abdomen, thighs, buttocks.

They are transplanted to the place of the removed glandular tissue. And although from a technical point of view, this type of reconstruction is a more complicated procedure, but it is considered more reliable in terms of graft survival.

However, in 9 cases out of 10, another method of reconstruction is chosen - with the help of implants. The fact is that during reconstruction with your own tissues, you have to carry out additional operations to correct the breast, since its aesthetics cannot be achieved immediately.

In my practice, the overwhelming majority of women are inclined towards the method of reconstruction using implants (this is up to 80%).

Plastic surgeon Michael Zenn

Breast reshaping with implants. For this, the so-called "pocket" for the endoprosthesis is first prepared, which is a pectoralis major muscle and a skin area stretched with an expander. There are other technologies that allow using artificial fabrics in case of a lack of skin.

The second method of reconstruction, for all its low trauma, also has drawbacks. This is the development after implantation of capsular contracture.

Which of the options for the operation gives a better result? A more reliable result and long-term effect is provided by the option of carrying out reconstruction with authentic body tissues. But technically, this technique is more complicated and requires high professionalism of a plastic surgeon.

As practice and research in 2014 show, most women do not undergo reconstruction after the intervention. This is 59% of patients in urban areas and 71% in villages.

Dallas Buchanan Plastic Surgeon

Rehabilitation

Recovery after mastectomy and breast reconstruction may vary in duration.

It depends on such factors as the technique of the reconstruction operation, the individual characteristics of the patient, and the professional skills of the plastic surgeon.

The postoperative period lasts longer due to restoration with its own tissues.

It takes place in several stages, since after primary plastic surgery, 3-5 months later, the patient needs a correction of the volume and shape of the breast. Additional operations are also performed to create a new areola and nipple from their own tissues.

Complications

The most commonly observed complications after mastectomy are as follows:

• Temporary swelling of tissues located near the site of the removed organ;
• Soreness of the postoperative wound;
• Infection of the wound cavity;
• Bleeding;
• Constant swelling of the hand from the surgical intervention as a result of lymphostasis;
• Severe swelling of the hand from the side of the surgical intervention;
• Phantom pain in the area of ​​the removed breast;
• Seroma is an accumulation of serous tissue fluid in the postoperative cavity.

Complications after reconstructive surgery are more likely to occur during the installation of endoprostheses. Suppuration of the wound cavity and rejection of the implant are possible. More severe complications are observed in the form of skin necrosis and contractures.

Cost of preventive mastectomy

The average cost of a preventive radical mastecomia in Moscow is from 80,000 to 110,000 rubles. Modified version - 160,000 rubles. Surgery with endoprosthetics - 31,790 rubles.

In addition to chemotherapy, women with breast cancer often undergo mastectomy - an operation to remove the breast. Sometimes only the tumor is excised, but some have to remove the entire breast.

Four women who underwent radical mastectomy told "Paper" how the operation changed their attitude towards themselves, why they decided not to insert implants and how their loved ones reacted to it.

Irina (name has been changed), 47 years old

Programmer from Moscow

I have two children, a prosperous family, I am very athletic. And I went to doctors mostly with injuries. My shoulder muscle was torn, and I first treated my shoulder, then I found something in my chest, and the doctors told me that it was most likely a bruise. But just in case, we did a test. It was in December 2016. And suddenly they call from the clinic and say that I need to come urgently. And so they insist.

For a long time I could not believe what they were telling me, could not understand the meaning of the words "atypical cells". Then I talked to the surgeon, he said that the diagnosis does not cause the slightest doubt, the only question is what kind it is and what kind of treatment regimen. I remember a state of absolute panic and confusion: what to do, where to go? The panic lasted, probably, a week.

At work they said that they would pay for my treatment in Herzen (Moscow Research Institute of Oncology named after Herzen - approx. "Papers"). The operation took place on August 4, 2017. At first, I was determined to immediately do a one-step reconstruction, because I simply had no idea how to live without a breast. I had a panic from the pictures that I saw on the Internet: I looked at them and sobbed.

But the surgeon said that he does not recommend doing it all at once: I have the third stage with metastases - the reconstruction will suffer with radiation therapy. Technically, reconstruction can be done six months after therapy. I was determined to restore the breast, but only with my own flap (a method of restoration, in which instead of implants, the patient's own tissues are used: a part of the muscle from the anterior abdominal wall or a flap from the back - and moved to the chest area - approx. "Papers"). However, then I was already tired of the past treatment: eight chemotherapy is very difficult. If after the first chemotherapy I was "out of shape" for the first two days, then after the eighth - ten days at all.

This is such a vicious treatment that the body has not yet recovered. Understanding this slows me down to do something with the chest. And when asked to do the most expensive operation, the surgeon said that it did not suit me. And then, there are a lot of details that you will learn about only by delving into the topic. For example, I underwent radiation therapy and lost a lot of weight. They told me, it's good that I didn't get an implant: if I lost 15 kg and changed my body, it could be on my back.

Illustration: Elizaveta Semakina / "Paper"

Implants are recommended to me, but I do not want to: I hope to do swimming and aikido again, and [during physical exertion] they can be injured, torn inside. And the question is their durability. What will happen to them in 10 years, in 20? I'm not an old person, it bothers me that this thing will live inside me for a long time. Most likely, I will not do the operation.

When I had the sixth or seventh chemotherapy, a woman was brought to the ward, who did not do a radical mastectomy. Now she has metastases all over her body. How much is left for her and what can be done? Looking at her is painful and scary. I decided for myself that this is a hint from above: [this is] what will happen if I regret removing my breasts.

It was scary to the last, I could not even look at myself in the mirror after the operation. Now I'm used to it. My husband said that it was absolutely unimportant to him, but these were not the words that I wanted to hear. When it was really hard, I called the hotline. And I want to say that the employees fulfill their mission perfectly. When I was on the verge of despair, I heard [from them] the words that a person probably wants to hear at such a moment.

Suddenly I realized that I was not alone. The girls in the support group said that this [breast removal] is just bullshit, that of all aspects of treatment, it is the least traumatic.

Now I go to the pool and still cannot undress in front of everyone: I hide and change clothes separately. I cannot undress in front of my husband, although he assures that it does not matter. It matters.

She coped with the operation, but the long treatment greatly changes her outlook. Now I appreciate myself, life has acquired bright colors. I no longer freak out about the unwashed floor, the unwashed linen - to hell with that. I couldn't do it for a year and realized that [family members] would get along anyway; I will not cook a three-course dinner - they will cook dumplings for themselves.

Most importantly, I would like to stop being afraid of a relapse. No one can explain why this happened to me. And the way of life, and the diet - everything was. I did not drink, did not smoke, gave birth to children, fed them myself - I do not fall into the risk group. One of the factors why I do not go for implants: some oncologists say that this increases the risk of recurrence. I will restore my previous form: I am a purposeful person. But how can I stop being afraid that I will be diagnosed again, I don’t know.

Alexandra, 39 years old

Works in the social sphere in Moscow

In November 2015, I was diagnosed with breast cancer and had a complete mastectomy of my left breast at the end of the year. Now I am in remission.

My grandmother had breast cancer; Because of this disease, my mother died when I was 16 years old. Then I lived in the oncology center on Kashirka (National Medical Research Center of Oncology Blokhin, Russian Oncology Center - approx. "Papers"). I have always been “on the alert”: all my life I was afraid of getting sick - to the point of mental breakdowns (and I went to a psychologist who tried to smooth out this fear). Nevertheless, the disease did not pass, although I was regularly observed.

First, I was diagnosed with fibroadenoma (benign tumor - approx. "Papers"), but it ended up being cancer. The tumor was discovered by her husband. The next day we went to the mammological center for examination, but I knew: this is a diagnosis, cancer.

I was diagnosed with the second stage, and I understood that I needed to do everything radically, remove [the mammary glands] to the maximum. There was no thought that I was losing my chest and would experience any inconvenience or suffering. I just grouped myself together and gave myself a directive: you have to hold on to life.

I am a mother of a 13-year-old child, I have a family. The husband immediately said: “Sasha, don't even say a sound about the reconstruction. I need you alive: with a breast, without a breast, crooked, oblique - it doesn't matter, as long as you are here with us. "

The girls with whom I was in the hospital and with whom I now communicate did not see themselves without breasts and decided to undergo reconstruction. But [reconstruction] is not without consequences. The treatment was very difficult, the body needs a lot of strength to withstand it. And for myself I decided that I was not ready for this either physically or mentally. Reconstruction is a six-hour operation with anesthesia, a two-week take-away from life that I cannot afford. Is the breast worth the pain? Not for me.

I have no complexes and discomfort, I calmly look at myself in the mirror. I have a prosthesis inserted, I wear beautiful underwear, I feel great at sea in swimsuits. It is clear that I cannot wear some kind of neckline or something else, but this can be sacrificed. The more I live, the more I understand that I don't need reconstruction.

In general, there is no sentimentality in me, I didn’t even cry [because of the illness]. The only thing, she said to her husband: “Igor, well, e-mine, at 38 years old!”. And then I saw women who fell ill with oncology at 38, and at 28, and at 20 years old. I'm not fixated on myself, I look around and understand: there are heroine girls who have gone through so much. And I? Well, I underwent surgery, underwent a course of chemotherapy, and I am undergoing an examination. What is the absence of breasts, what are the complexes? In my thoughts - only to survive, to go forward, to live to the age of the child, God forbid, to learn it. If there was a possibility, I would take my second breast to hell.

Katerina (name has been changed), 42 years old

Alternative medicine specialist from Moscow

When I found out about the diagnosis, of course, I was shocked. But I don't even have any questions about [why this happened]. In my case, psychosomatics was the cause of the illness. As we usually do: it doesn't hurt anywhere - and okay, but emotions are not so important in life. It turned out to be very important.

I had a small swelling in my chest and it didn't bother me. At that time, I was helping a friend [with her depression], whose husband died of cancer at 42. And suddenly she began to think, what do I have there [in my chest]? It began to bother me not even physically, but emotionally. I went to the doctor, and I was immediately diagnosed, the analysis confirmed everything, although there was no pain, there was nothing. The second stage was diagnosed.

When I was told before the operation that complete removal is possible, I burst into roars and tears. But then [the doctors] said: “No, we can do with resection (partial removal of the breast - approx. "Papers") ". We were still thinking in which direction to make the seam, how I would hide it under a swimsuit.

On the operating table, it turned out that I had intraductal cancer, and the breast was removed completely. It was very difficult for me, and the process of getting out of this state was very difficult. I had both chemotherapy and rays, but I think that I am keeping myself at the expense of alternative medicine: bioenergetics, biodynamics, working with myself, drawing out my emotions, I also draw mandalas.

I had a wild depression, an incessant stream of tears. And if it were not for my friends who pulled me out of this state, I don't know how it would have ended. The hand after the operation did not work, could not lift a cup of water. Now, more or less, I can do everyday tasks.

My husband took breast removal more calmly than me. It so happened that our relatives who were diagnosed with cancer, all died. And therefore the loss of a breast, and not of a wife, was the lesser evil for him, he spoke about it directly. But this did not calm me down much.

I don’t know yet if I’ll do plastic surgery, I’m not allowed to do it for a year. The worries softened. But it's not me that smart beauty - they just helped me.

For me, breasts are associated with sexuality, and a woman without breasts is no longer a woman. Therefore, breast loss is the loss of both sexuality and beauty, everything in general. But now I understand that in a bra, for example, it is not visible that I am without a breast. Therefore, nothing has changed for strangers. The absence of breasts can be seen in an intimate moment, in a bath. But now I can't go to the bathhouse anyway. There are fitness centers where there is not a shared shower, but booths, I went to one. But the theme of the beach has not yet been decided for me.

Pros of reconstruction: I will have breasts, and this question will no longer bother me. And the disadvantages: it is not known how the hand will behave and take a flap of the abdomen ... Implants do not suit me, because I will feel something foreign in my body. And the effect of anesthesia on the brain is also very frightening: then you walk away from it for a long time, the ability to bioenergetics decreases - this stops me.

Julia, 46 years old

Worked at a plant in St. Petersburg

I found out about the diagnosis by accident: last April I washed in the shower and found a seal. I turned to the gynecologist, but she didn't even look at me, she said: go to the surgeon, to the therapist and, in general, wherever you want. I did an ultrasound, and the doctor said that it was very similar to a tumor. As a result, I went to the oncological dispensary on Udelnaya, where they gave me a referral to Pesochnoe (Petrov National Medical Research Center of Oncology in the village of Pesochnoe - approx. "Papers").

There, all the surgeons unanimously said that it was a tumor. Now I have the third stage, I went through a bunch of examinations, and none of them revealed the tumor itself, only metastases. It was a shame to remove the breast, realizing that the tumor might not be there, that it might be in a completely different place. But the biopsy showed that the metastases were from the breast.

There was a variant of resection, but since it is not clear where the tumor is located, it was possible to cut out some part at random [it was ineffective]. And where is the guarantee that it is not elsewhere? The head of the department said that if it is not fundamentally important for you, then it is better to remove the entire breast. My husband and I consulted and decided that we would delete it completely.

Any woman is not ready to part with her breasts, I was sorry to the last. But I tried to persuade myself that it would help to survive. That if I don't do this, then the tumor may remain - and then I will have to start all over again.

The husband did not believe in what was happening to the last. He's a man of few words, for these months he has "grown old". The children - I have two boys, already adults - at first did not even understand what had happened. At first we didn't tell the youngest [details], we didn't even say the word "cancer".

Most likely, I will not do the reconstruction: I do not consider it necessary to expose my body to additional stress. All this is not as simple as they say: serious preparation is needed - not a month or two, it will be painful, it is impossible to achieve absolute symmetry, that is, it is necessary to operate on the second breast as well. I believe that with a condition like cancer, the fewer interventions the better. But maybe I'll change my mind in three or four years.

I have only men in my family, so I do not give slack. All these thoughts that I am disabled, I try to drive away from myself, so as not to cry and not get upset. When dressed, it seems like nothing, but when I undress, it's hard. I can't undress in front of my husband, show him all this. He says: “Why are you doing stupid things? What are you hiding for? " But I can’t overpower myself yet.

At first I rested. And then I realized that if I lay down, I would lose my mind: all my muscles were weakened, I could not keep my posture. From April to January, when I was undergoing chemotherapy, there was not a moment when I didn't think about the diagnosis. It got to the point that in November I stopped sleeping. And after the operation - as if cut off, as if the body said: "That's it, I have no cancer."

Now, because of radiation therapy, I am not allowed to play sports, but from September I will go to the pool: I have to work out my hand all the time. I call a woman [who also had a mastectomy], she goes to the pool and says, "I go to the toilet and change into a swimsuit, no one notices." Of course, with everyone it will not be very easy, but when you experience such an illness, a lot changes in your attitude. If I have nowhere to change, I will change in front of everyone, because it is necessary for my health. Who will think what is of little interest to me. Maybe they will think about it and go to the doctor. What happened to me prompted my acquaintances to go to be examined.

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Breast pathologies are found in both women and men. Most of them pose a threat to health and require compulsory medical intervention. When conservative therapy of diseases is ineffective or impossible, surgical treatment is performed - mastectomy. What it is, in what cases it is prescribed and what you need to know about the postoperative period, we will find out further.

What it is

A mastectomy is a surgery to remove a breast. Together with it, the adjacent lymph nodes and subcutaneous adipose tissue are excised. Depending on the type of intervention, the pectoralis minor and / or pectoralis major is also removed.

The purpose of the operation is to prevent the spread of pathological processes in the mammary gland.

This is a serious traumatic procedure associated with risks and possible postoperative complications, but in some breast diseases, only a mastectomy performed gives a chance for life.

Indications for mastectomy

Radical intervention in the treatment of breast diseases is carried out mainly in women (97% of all cases) and is prescribed:

• in the presence of ;
• at ;
• with multiple;
• at ;
• with and its complications (phlegmonous or gangrenous forms);
• to prevent the development of breast cancer, if the patient is at risk for a genetic predisposition.

Less commonly, mastectomy is performed in boys and men. The indication for its appointment is gynecomastia - an increase in the mammary glands associated with hormonal disorders in the body.

Types of surgery

Even in the recent past, mastectomy was performed in one standard way - radically according to Halstead-Meier. During the operation, the affected mammary gland was removed completely along with the muscles, lymph nodes and subcutaneous fat located in the axillary, subclavian and subscapularis regions.

Advances in surgery have expanded the possibilities of surgical intervention in the treatment of breast diseases - more gentle (but no less effective) solutions have been found.

Several types of mastectomy are currently used:

• partial;
• radical (classical and modified);
• preventive.

The choice of intervention depends on the stage and degree of breast pathology, as well as on the age and general health of the woman.

Partial mastoectomy

In a partial mastectomy, only the part of the breast in which the tumor is found is removed. Such an operation is possible at an early stage of cancer, with purulent forms of mastitis, fibrocystic mastopathy.

In cancer, to prevent further spread of malignant cells, a course of radiation therapy is required. After the operation, constant monitoring of the condition of the breast is necessary, and in case of relapse, a radical removal of the gland is already indicated.

Radical mastectomy

The classic version of the radical mastectomy (according to Halstead) is used to this day. The operation is performed in the following cases:

• involvement of the pectoralis major muscle cells in the process of tumor spread;
• metastasis to the lymph nodes located along the posterior surface of the muscle;
• in palliative medicine to relieve the patient's condition.

The method often leads to postoperative complications, especially limitation in the mobility of the shoulder joint.

If a woman does not have indications for a classic radical mastectomy, the choice is made in favor of more sparing modified options for interventions:

• according to the Paty-Dyson method with the removal of the mammary gland, lymph nodes, adjacent tissues and pectoralis minor;
• according to the Madden method, in which both chest muscles are preserved.

Operations are accompanied by significantly less blood loss and faster healing of stitches. The main advantage is the reduction in the incidence of postoperative complications.

Prophylactic mastectomy

Mastectomy in order to prevent the onset or development of breast cancer is prescribed for women with a genetic predisposition to the disease (if the BRCA gene mutation was detected in the tests) or those who have already had cancer of one breast.

The intervention is carried out both radical and partial with the preservation of the nipple and areola of the breast. Can be one-sided or two-sided. During a mastectomy, it is possible to simultaneously reconstruct the mammary glands.

Analyzes and preparation for surgery

Mastectomy is prescribed only if the corresponding diagnoses are confirmed after laboratory tests, tests and hardware examinations of the patient.

Before the operation, the following is prescribed:

• general and clinical blood test;
• X-rays of the breast and armpits (mammography, axilography);
• Magnetic resonance imaging;
• breast biopsy.

Preparation before surgery also includes ECG and fluorography. A personal examination of the patient by a specialist is required. The doctor should be advised of the following:

• on taking all medications or dietary supplements, even if they are herbal tinctures or vitamin complexes;
• about existing chronic diseases and previous serious illnesses;
• about a possible allergic reaction to drugs or general anesthesia.

In the presence of inflammatory processes in the body, 2 weeks before the operation, the patient must undergo a course of antibiotic therapy.

If you are using blood thinners a week before your mastectomy, you must stop taking them.

Before the operation, you should not eat (12-16 hours) and drink (2-4 hours), it is recommended to do a cleansing enema the night before.

In addition, care needs to be taken of who will pick up from the hospital and take care of the postoperative care.

Risks associated with mastectomy

Like any other surgical intervention, mastectomy is associated with risks and possible complications during the procedure:

• the risk of pulmonary embolism (formation and separation of a blood clot);
• breathing problems;
• allergy to anesthesia or drugs;
• bleeding and blood loss;
• heart attack.

Complications can be prevented if the doctor is warned about allergic reactions and past illnesses in advance and the recommendations for preoperative preparation are carefully followed.

How is the operation performed

Mastectomy is performed under general anesthesia, the duration is 2-3 hours, depending on the type of intervention. The operation time will increase if reconstructive surgery is performed at the same time.

The surgeon makes an oval incision under the breast with a scalpel from the inner side at the sternum to the armpit 12-16 cm long. The breast tissue is removed together with the subcutaneous tissue, subclavian, subscapularis and axillary lymph nodes, if necessary, with the pectoral muscles.

Then the incision is sutured, absorbable sutures or staples are applied, which are removed by the doctor after 12-14 days. To remove excess fluid and speed up wound healing, drainage is installed under the skin of the chest - one or two plastic tubes.

At the end of the operation, the woman is transported to the ward, where during the first 36-48 hours she is under the close supervision of medical personnel.

Postoperative period

Mastoectomy is considered a complex surgical procedure. The postoperative recovery period lasts 2-3 months. Within the walls of a medical institution, you will have to spend no more than 4 days, if it was done - about a week. During the first month, you will have to regularly visit the hospital for dressings and examination.

The day after the operation, you can get up and start walking slowly. It is recommended to start rehabilitation activities as early as possible, which will be prescribed by the doctor. This will prevent the risk of complications and speed up recovery.

Immediately after recovering from anesthesia and the next 3-4 days, intense pain in the chest area will be felt. To reduce their severity, the doctor will prescribe pain relievers.

They are discharged home with drainage tubes, they are removed after 5-7 days during a control examination. The nurse should teach you how to handle the drain and provide guidelines for maintaining body hygiene without damaging the dressings and drainage.

Consequences of a mastectomy

After removing the mammary gland, a woman develops an extensive wound surface in the breast area, which requires proper care. Such an intervention rarely leaves a trace for the physical and psychological health of a woman.

Experts identify several of the most common consequences of mastectomy.

• early and late complications;
• relapses of diseases;
• psychological trauma associated with loss of attractiveness, disability.

Knowing about the possible consequences of the operation and the methods of overcoming them in advance, you can avoid panic and it is easier to deal with them.

Complications after mastectomy

Despite the fact that surgical techniques are constantly being improved, the number of various complications remains high.

Patients most at risk are:

• elderly (over 60 years old);
• overweight;
• with chronic diseases (cardiovascular system, diabetes mellitus, hypertension);
• having large breasts (from the 4th);
• after radiation or chemotherapy.

Preoperative preparation of this group of patients should be carried out even more thoroughly, and rehabilitation procedures should be more attentive.

There are early and late postoperative complications. The early (arising during the first 3-4 days) include:

• bleeding due to poor blood clotting, suture divergence;
• outflow of lymph (lymphorrhea);
• marginal necrosis with seam dehiscence;
• infection and suppuration of the wound surface (occurs when the rules of asepsis and antiseptics are violated during surgery or during the dressing process).

In addition to early complications, women often experience long-term consequences of mastectomy:

• violation of the outflow of lymph from the hand, which leads to stagnation of lymphoid fluid and a strong increase in limb volume (lymphostasis);
• violation of venous circulation due to damage to the subclavian or axillary veins;
• erysipelas, provoked by lymphostasis and the addition of streptococcal infection;
• the appearance of keloid scars that cause pain when moving;
• swelling of the shoulder area, loss of skin sensitivity;
• limitation of mobility of the upper limb;
• phantom chest pains.

The prevention of the development of complications and the period of the recovery period after the operation largely depends on the qualifications of the surgeon and on the patient herself.

Relapses after mastectomy

Even after a successful operation to remove the breast, cancer recurrence sometimes occurs. They appear 6-12 months after surgery and are more aggressive and more aggressive than the first time.

The causes of relapses are:

• insufficient diagnosis (during the examination, it was not possible to identify individual malignant cells, therefore they were not removed);
• operations carried out in the late stages of the disease;
• metastasis to regional lymph nodes;
• no radiation or chemotherapy after mastectomy;
• poorly differentiated form of the tumor.

If no relapses of the disease were detected within five years after the operation, the cancer is considered defeated.

Psychological trauma

For some women, the most serious complication after mastectomy is depression, associated with the realization that they have become sexually unattractive, inferior, defective. Also, stress can be caused by a forced change in lifestyle, which occurs in the postoperative period due to the weakening of the body and the inability to perform the usual chores around the house, work.

In overcoming psychological trauma, the support of family and loved ones, friends, treating doctors is important. In severe cases, it is recommended to seek help from specialist psychotherapists. In order not to complete because of the lack of a breast, it is imperative to purchase special corrective underwear or to decide on the reconstruction of the breast.

Suture problems after mastectomy

Slow healing of postoperative wounds (suture inflammation, pain) is a problem faced by half of women after mastectomy for cancer. This is due to the inhibition of metabolism in cancer. The situation is complicated by postoperative treatment with the use of drugs that inhibit or completely suppress cell division (chemotherapy).

For the healing of stitches, it is necessary to treat them with antiseptic, anti-inflammatory and wound-healing ointments:

• Baneocin;
• Solcoseryl;
• Stellanin;
• Methyluracil;
• Eplan;
• Woolnazan.

Compliance with the rules of hygiene and the treatment regimen will contribute to the speedy tightening of the seams.

Lymphostasis and swelling of the hand

Stagnation of lymphatic fluid in the hand (lymphostasis) after mastectomy occurs as a result of the removal of lymph nodes during the operation, as a result of which lymph circulation is disrupted. In this case, there is swelling and pain in the limb, a decrease in muscle tone. The hand can increase in size several times compared to the healthy one.

To eliminate lymphostasis, a whole range of measures is used:

• massage and self-massage;
• wearing a compression sleeve;
• photodynamic therapy (using a monochromatic emitter);
• taking medications (diuretics and venotonics);
• metabolic therapy (use of natural antioxidants);
• diet;
• physiotherapy.

Swelling of the hand usually goes away a month after the onset of the pathology, but it can persist for several years without giving in to treatment.

Contraindications after surgery

The complex of rehabilitation measures helps to avoid postoperative complications and shorten the recovery time. But the success of restorative therapy is greatly influenced by the implementation of the doctor's recommendations on the rules of behavior and the regimen after mastectomy.

1. It is necessary to avoid crowded places, injuries. Due to the malfunctioning of the lymphoid system and weak immunity, any infection or scratch can lead to serious health consequences.
2. For three years after the operation, it is impossible to lift by hand from the side of the removed breast a weight of more than 1 kg, the other - more than 3 kg.
3. Do not raise your hands up, bend low, mop floors or wash by hand.
4. The first three months should abstain from sexual activity.
5. You can not visit baths or saunas, take hot baths.
6. If the operation was performed for the removal of a cancerous tumor, it is not recommended to become pregnant for 2 - 3 years - hormonal changes in the body can lead to a relapse of the disease.
7. Within three years, it is not recommended to change the climatic zone of residence, to go on vacation to hot countries.
8. The diet should not contain smoked products, canned food. It is best to switch to a salt-free diet.
9. No smoking or alcohol consumption.

It is impossible to do without the help of relatives and friends in the postoperative period. Relatives should take care of all household chores (gardening) to ensure that the mastectomy patient is able to recover as quickly as possible. The care of relatives and the common sense of the woman herself are the key to complete recovery in a short time.

How to hide stitches after a mastectomy

After removal of the mammary gland, any woman experiences discomfort about the changed appearance, embarrassed by postoperative scars and scars. In this case, underwear for women who have undergone mastectomy can help improve the psycho-emotional state. Its main task is to maintain an exoprosthesis of the mammary gland and mask the sutures.

Corrective bra

After a mastectomy, it is recommended to use a bra with a special exoprosthesis pocket. It can be put on immediately after removing the drain. The special design of the underwear does not cause discomfort during wearing and contributes to an even distribution of the load on the spine.

Swimwear after mastectomy

To hide the seams and lack of breasts, you can purchase a shapewear swimsuit. It is convenient to do physical therapy in the pool, hydrokinesiotherapy or just go to the beach.

The leotard fits comfortably on the figure, has a pocket for a prosthesis, does not squeeze or squeeze the chest.

Before choosing special underwear, you should consult with your doctor about the type, size and shape, especially if breast reconstruction is planned.

Breast reconstruction after removal

After a mastectomy, women often resort to reconstructive surgery to restore the volume and shape of their breasts - mammoplasty. The operation allows patients to return to full life and has a positive effect on their psychological state.

Reconstruction is carried out according to different methods, the timing of the possible completion of the operation also varies. The choice of breast reconstruction method depends on the type of surgery performed to remove the breast, the presence of postoperative complications and the wishes of the woman herself. Simultaneous mammoplasty is possible with subcutaneous and prophylactic mastectomy. After radical removal of the mammary gland, it is necessary to wait 8-12 months to restore its previous shape.

Modern plastic surgery offers several methods for breast reconstruction.

1. Endoprosthetics method. This involves placing silicone or saline prostheses in the space between the muscles and the chest. To perform this type of breast reconstruction, you need a sufficient amount of your own tissue at the site of the removed breast. It is most often used after subcutaneous mastectomy or Madden's method and is performed in several stages.
2. Thoracodorsal transplantation. This method is suitable for breast reconstruction after radical mastectomy. It is based on cutting off a section of one's own skin and adipose tissue from the abdomen, back or buttocks area and stitching it to the breast area.
3. Reconstruction with a pedunculated SEIA flap. The latest advancement in plastic surgery. To form the future breast, abdominoplasty is performed (excess fat is cut from the abdomen along with the skin) and a blood vessel is released, which is dragged inside the abdomen and then sutured into the thoracic artery. Thanks to this, the flap takes root well, and the new breast will feel as warm to the touch as its own. Over time, it is even possible to restore skin sensitivity.

Each method has its own nuances and contraindications, so the choice of reconstructive surgery should be entrusted to a qualified specialist. It is recommended to consult several plastic surgery clinics and choose the best option for yourself.

A mastectomy should not be accepted by a woman as a tragedy in life. Successfully completed postoperative rehabilitation and subsequent mammoplasty will become the basis for starting a new full-fledged life.