Research and development in the field of breast oncology is gradually leading to the fact that previously thought effective means the fight against breast cancer fades into the background, giving way to more advanced techniques. Despite this, radical mastectomy is still one of the most common ways to combat breast cancer.

The essence of the operation is the complete removal of the mammary gland along with adjacent lymph nodes and pectoral muscles. Axillary and subscapular region, as well as lymph nodes located under the sternum. And although other diseases of the mammary glands (advanced mastitis, mastopathy) can be treated with mastectomy, a similar method is used much more often for breast cancer.

Types of radical mastectomy

Since the inception of this operation, doctors and scientists have not ceased to develop more advanced techniques. Today there are several types of radical mastectomy:

Halstead mastectomy;
mastectomy according to Urban;
Peyti mastectomy;
Madden mastectomy;
subcutaneous mastectomy.

The first option (Halstead mastectomy), in addition to amputation of the gland itself, involves the removal of both pectoral muscles, axillary tissue, and also affects the subscapular region.

This operation has been the standard for a century surgical treatment. Now, due to the occurrence of severe side effects(decreased motor activity of the hands, deformation chest, weakening of muscles) the Halstead operation is used extremely rarely. The indication for radical mastectomy according to Halstead is the growth of tumor cells into the pectoral muscles.

Urban's operation is similar to the previous type of surgical treatment. The only difference is that during an Urban mastectomy, the parasternal (located near the sternum) lymph nodes are also removed. Used when severe forms cancer with the formation of dangerous metastases.

Patey's radical mastectomy is a more advanced version of the operation. At this time, the gland itself, the pectoralis minor muscle and axillary tissue are removed. Now this method is the most common.

Radical breast mastectomy according to Madden also involves complete removal of the affected gland along with axillary and subscapular tissue at two levels. But unlike the previous two methods, the pectoral muscles are not removed during the Madden operation. This helps to save motor function hands. Similar treatments are increasingly used in the fight against breast cancer.

Subcutaneous mastectomy is relatively modern look surgery and is used for small tumors located away from the skin and nipple. The tumor is removed through a small incision, followed by plastic surgery. After similar treatment necessary radiation therapy.

Why is radical mastectomy performed?

The purpose of the operation is to remove tissue into which cancer cells could have spread. And since tumor cells most often affect nearby lymph nodes, they are removed first.

In this case, only one or two nodes are removed, which are then sent for histological examination to identify cancer cells in them. And if none were found, then there is no need for further excision of lymph nodes.

The type of operation is selected by the doctor depending on the stage of the disease. Thus, for cancer of the first and second stages, the Madden operation is performed, for cancer of the third stage, the Patey operation is performed.

As for breast reconstruction after radical mastectomy, in the first and second stages the breast can be restored during the operation itself. In the third degree, reconstruction is carried out only after the end of the main treatment.

Contraindications for surgery

Contraindications to radical mastectomy include tumor tissue growing into the sternum, swelling of the gland and limbs, and the presence of ulcers on the skin. Also, surgery is not performed for cardiovascular dystonia, diabetes mellitus, in case of circulatory disorders, as well as if the patient reaches very old age.

Complications

Among the complications that most often occur after surgery are bleeding, fluid accumulation and infection in the wound.

To stop bleeding, doctors use special hemostatic devices and solutions. Bandaging is also used: the patient’s body is wrapped in an elastic bandage. If blood accumulates in the wound, the operation is repeated.

The accumulation of fluid is the result of excision of lymph nodes. The drainage of lymph from the wound is carried out using drainage, and then by puncture - punctures through which the fluid is removed.

A week after surgery, the wound may become infected. It penetrates through the skin and to reduce the risk of infection, doctors try to minimize incisions during surgery. The patient is also given antibiotics before surgery to prevent infection.

TO postoperative complications This also includes swelling of the arm, impaired activity of the shoulder joint, and weakening of the arm muscles from the operation.

As you can see, deleting mammary gland is in every sense a rather traumatic operation. Therefore, you should not delay its implementation. After all, the sooner it is carried out, the less complications it will cause and the sooner the patient can return to normal life.

This option of radical intervention is possible at any stage of the disease, except metastatic or primarily inoperable infiltrative-edematous process extending beyond the gland into the tissue chest wall. As a rule, for all operable tumors, RME is performed at the first stage of treatment.

Dr. Shapovalov D.A. A radical resection of the left breast with reconstructive plastic elements was performed for left breast cancer T1N1M0, stage IIA. Regional lymph nodes of levels I-III according to Berg were removed. Photo on the left - dressing the next day after surgery; on the right - view after 25 days:

A year ago, RME was performed on the right side with preservation of the pectoral muscles for cancer of the right breast T3N1M0. The next photo is the second stage of reconstruction (replacement of the expander on the right with an endoprosthesis and reduction mammoplasty on the left). The photo on the left is before surgery; on the right - a week after surgery (sutures removed). Next, it is planned to perform nipple formation on the right side of this patient with tattooing of the areola.

In the case of primary spread of the tumor beyond the gland, the so-called infiltrative-edematous form of the tumor, chemotherapy is performed at the first stage and, after reducing the carcinomatous lesion, radical surgery is performed with complete removal of the gland and axillary lymph nodes.

The difference between mastectomy and radical resection

Mastectomy is performed at any stage of cancer and any size of the cancer node, in contrast to radical resection - removal of part of the gland with a small tumor.

With small breasts, resection is problematic even with a node size of 3 cm, since it is necessary to retreat several centimeters in all directions from the primary lesion in order to minimize the possibility of relapse.

The immediate aesthetic result after resection is undoubtedly better than after RME, but subsequent mandatory irradiation compacts the tissue, and over time the scarring process worsens, which significantly changes the shape of the breast and its size. Subsequently, the deformation will require the use of special pads in the bra; it is extremely problematic to smooth out the lack of tissue in other ways.

Reviews from our patients

Patient Lyubov Vasilievna was admitted to the clinic in extremely serious condition. The underlying disease (stage 4 breast cancer) was accompanied by metastatic bone lesions. The patient could not move independently. Lyubov Vasilievna notes the high professionalism of the attending physician, Pyotr Sergeevich Sergeev. She talks about how, first of all, she was given hope for a full life. “This is the first time I saw a doctor...

“Special thanks to our attending physician, Andemir Olegovich Akhov, firstly, for the treatment provided. Secondly, for being attentive to patients and their relatives, who ask many different questions. He answers them in great detail. We really enjoyed. That's why Thanks a lot to all your clinic staff." The patient was admitted a week ago. Was fully examined within three days. Diagnosis,...

Tamara Petrovna came to the clinic for stage 4 breast cancer with metastatic foci in other organs. Surgical treatment was not indicated for the patient. To reduce the volume of the tumor, the clinic doctors prescribed radical chemotherapy. From March to September, Tamara Petrovna underwent 16 courses of chemotherapy. According to subjective sensations, the patient notes a significant decrease in tumor volume. An MRI study should show what dynamics...

Cancer is always a very scary diagnosis, both for the patient and for his family. Especially when the disease is detected at stage 4 and most medical institutions refuse treatment. Our patient found herself in this situation: “The children brought me here in a very terrible state. I have stage 4 breast cancer with metastases<...>Now I feel great: I am undergoing chemotherapy...

A patient with suspected breast cancer contacted the manager surgical department clinic "Medicine 24/7", oncogynecologist Dmitry Alekseevich Shapovalov, Ph.D. After comprehensive survey the doctor confirmed the diagnosis and prescribed surgical treatment. “When my mother found out that she had a very very severe and terrible disease, our local doctor from Dmitrov advised us to consult with another oncologist. Through friends we found Shapovalov...

Clinical case Patient: V., 46 years old. Diagnosis: lobular breast cancer. Combined treatment 2007. Progression 2017. History: 2007 combined treatment of stage I breast cancer. 10 years of observation. The appearance of ascites (fluid in the abdomen), shortness of breath. Diagnostic laparoscopy. Discrepancy in diagnoses based on cytological and histological examination(3 different diagnoses). Refusal of treatment. Symptomatic therapy local...

Iraida Alekseevna was admitted to the Medicine 24/7 clinic with severe pain and difficult mobility due to metastases in the pelvic bones due to stage 4 breast cancer. The main metastasis of breast cancer compressed large nerve trunks in the spine, causing pain that was intractable with conservative treatment, and also led to dysfunction of the corresponding nerves....

Is radiation therapy given after surgery?

Clinical studies have demonstrated equal life expectancy for patients after mastectomy and radical resection, but the rate of recurrence in the remaining breast tissue after resection is much higher, so in all 100% of cases, resection is necessarily supplemented with postoperative radiation therapy.

Complete removal of a breast with a tumor up to 7 cm does not require postoperative radiation. The question of additional radiation therapy is raised only for initially unresectable cancer, when preoperative chemotherapy has reduced the size of the tumor to an operable size.

Content

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

What is a mastectomy

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

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

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

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

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

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

Types of mastectomy

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

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

Indications

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

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

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

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

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

A tumor in the last stage with metastases is treated with surgery performed using the following methods:

Preparing for surgery

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

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

Carrying out the operation

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

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

There is a general algorithm of actions when removing mammary glands in women:

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

According to Halstead

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

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

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

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

Radical mastectomy according to Madden

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

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

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

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

Breast amputation

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

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

This type of operation is used for preventive purposes if there is genetic predisposition to the development of breast cancer. The indications are also large sizes neoplasms. Features of surgical intervention:

A biopsy of the nearest lymph nodes;
with sizes cancerous tumor up to two centimeters of the areola and nipple are not removed;
subsequent radiation and chemical therapy is prescribed.

By Patey

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

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

Patty's technique, a modified radical mastectomy, is considered low-traumatic and is widely used in oncology. After the operation, a minimal number of complications are observed. The disadvantages include:

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

Postoperative period

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

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

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

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

During rehabilitation after a mastectomy you will need:

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

Complications

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

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

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

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

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

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

Breast reconstruction

Women go to plastic surgery for breast reconstruction due to psychological discomfort. In addition, problems arise in physical level associated with imbalance of loads on the spine. After mastectomy the following are observed:

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

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

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

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

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

To create a mammary gland that is natural in appearance and feel, they use transplantation of their own tissues, which are taken from the back, front abdominal wall. This technique, the TRAM flap method, is characterized by:

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

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

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

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

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

Price

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

Video

The main direction of modern surgical methods cancer treatment mammary glands is aimed at solving two main problems, which can be presented as follows:

, which will not allow further consequences to occur.
Usage modern methods to restore the shape of the mammary gland.

The first of these tasks, namely therapeutic, is effectively and successfully accomplished by the use of radical mastectomy. Along with this, the second task - reconstruction of the shape of the breast, is difficult to solve, since it is necessary to reconstruct not only almost the entire volume of removed tissue, but also to create a nipple-areolar zone, as well as an inframammary fold.

If we talk about the size of the incision that is made during this operation, then this matters. The width of the incision should be wide enough to allow the removal of the area of the cancerous gland and at the same time the surrounding fatty tissue with the lymph nodes located in it.

Subcutaneous mastectomy also provides for the second side of the problem, which is the possibility of high-quality healing of the skin incision. IN in this case a woman is given the opportunity to get her previous breast shape, that is, to use surgery to give

With the subcutaneous method of surgery, a complete excision of the mammary gland with lymph nodes, which are located in the subscapular, subclavian and axillary areas, is performed. However, the nipple area with the areola remains intact.

Consequently, the question arises: “Why is it necessary to excise the entire mammary gland when it is not enough?” The answer is obvious and it lies in achieving radicality and the absence of relapse, since this is one of the main goals in treatment.

Another main distinctive feature subcutaneous mastectomy from radial is what is necessarily prescribed for it. The main purpose of which is to remove cancer cells in the breast that remain after surgery.

As a rule, radiation therapy begins when the healing process after surgery has passed. It is not carried out during the healing period, since it is possible at this stage.

The course of radiation therapy lasts an average of six weeks. In this case, several procedures are used per week.

Evidence from studies on the use of subcutaneous mastectomy

When using the subcutaneous mastectomy method, many patients are interested in whether there is a risk possible manifestation relapses in comparison with the use of a radical method.

Some studies have insisted on the oncological safety of subcutaneous mastectomy with preservation of the nipple and areolar zone. There is also a strict selection of patients in which surgical interventions of this type were performed.

Based on the data obtained, it was suggested that with or without preservation of the nipple and areola area in combination with breast reconstruction, it can satisfy the principles of safety in oncology. It provides favorable conditions for the use of breast reconstruction methods and facilitates the process of its implementation.

Some researchers, on the contrary, question the protective and preventive ability of subcutaneous mastectomy. They believe that the purpose of the operation is to eliminate the cancerous tumor by completely eliminating glandular tissue.

Therefore, this elimination should be a reliable method of preventing secondary cancer formation. As a result, the likelihood of cancer depends on the amount of remaining glandular tissue.

When performing a subcutaneous mastectomy, there is a possibility of retaining some amount of glandular tissue affected by malignant cells. Research data gives figures of 95-98% possibility complete removal tissue, even with careful surgery.

Since absolute removal of glandular tissue is not possible, many believe that subcutaneous mastectomy has no guarantee of preventing recurrence.

There are opinions that are even more categorical in their expressions in relation to subcutaneous mastectomy and show a negative attitude towards this method of operation.

Along with insufficient provision of prevention of secondary cancer, carrying out this method surgery is prescribed when the patient understands that this method he is not provided reliable protection from cancer. Some patients prefer to preserve the integrity and external shape of the mammary glands.

Today, radical mastectomy is the main standard in the treatment of breast cancer.

Subcutaneous mastectomy is Alternative option surgical treatment, which will save some

Along with this, according to some research data, it shows almost the same number of relapses compared to radical mastectomy.

Preserving the external appearance of the mammary glands allows, to some extent, to ensure the quality of life of patients undergoing subcutaneous mastectomy. This fact is beyond doubt. However, ranging from 9 to 20%, gives most oncologists a reason to refuse the widespread use of this type of operation in medical practice.

Also according to medical research It has been established that breast restoration after radical mastectomy is difficult.

Thus, subcutaneous mastectomy allows for further complications in a way that radical mastectomy does not. However, the number of cases of relapse is significantly lower with a radical approach in relation to this indicator and organ-preserving treatment.

State institution "Dnepropetrovsk Medical Academy"

Ministry of Health of Ukraine

Essay

"Mastectomy"

Performed

2nd year student, group 103b

Salivonchik V.A.

Dnepropetrovsk

Plan

1.Definition

2.Types of operations

3. Indications for mastectomy

4. Performing surgery

5. Postoperative period and complications

6.Literature used

Definition

A mastectomy is a surgical procedure to remove the breast. The main and predetermining indications for this surgical intervention are: breast cancer or sarcoma and gangrene resulting from a purulent process in the chest. The latter is extremely rare. Also, removal surgery is indicated in the following cases: when the tumor is found in more than one area of the breast; when the patient has very small breasts, as a result of the operation there will be very little tissue left and there will be a pronounced deformation of the mammary glands; when it becomes impossible to carry out a course of radiation therapy after lumpectomy (removal of a palpable tumor within healthy tissue without extensive excision of tissue).

According to statistics from the Ministry of Health, breast cancer is the most common malignant neoplasm in Russian women. And this incidence rate is growing every year. Cancer treatment is usually divided into local (surgery and radiation therapy) and systemic (chemotherapy, hormone therapy, “targeted” therapy). To date, surgical techniques for breast cancer have made great progress. However, it is always necessary to remember that any operation is stress for the body, which can bring a number of consequences.

Surgical treatment of breast cancer is specific and requires the oncologist to have certain skills, knowledge and experience. If an adequate, radical operation is performed in accordance with the individual characteristics of the growth and spread of the patient’s tumor process, the method is called radical. Treatment of breast cancer should be carried out only in specialized medical institutions, which fully include the Kartasheva Clinic, where mammology is a priority area of activity.

Types of operations

There are several options for radical mastectomy - according to Halstead, according to Patey, Madden, Urban-Holdin, etc. Currently, in most cases, mastectomy is used in the modification of Patey and Madden, as it is less traumatic and disabling compared to the Halstead operation. It is to them that the article is largely devoted.

Mastectomy according to Halstead (Halstead-Maer) involves the removal of the mammary gland, as well as axillary tissue with the pectoralis major and minor muscles. Due to the fact that these muscles play an important role in the movement of the arm, postoperative period patients often experience dysfunction upper limb. In numerous studies, scientists have proven that the radicality of the intervention does not increase due to muscle removal, so this operation is currently abandoned in most cases. A Halstead mastectomy is performed if the tumor has grown into the pectoralis major muscle.

Extended radical mastectomy (with removal of parasternal lymph nodes) During this operation, the mammary gland is removed along with the pectoralis major and minor muscles, fatty tissue of the axillary, subscapular, subclavian and parasternal areas. Technically, it is performed like a Halsted operation, with the exception of adding one more stage - opening the chest and removing the lymph nodes lying with inside sternum.

Patey's mastectomy involves removing the mammary gland with axillary tissue in a single block with the pectoralis minor muscle.

A Madden mastectomy involves removing the breast with axillary tissue, but without removing the pectoralis major and minor muscles. Mastectomy according to Madden combines sufficient radicalism and at the same time functionality. Preservation of the pectoral muscles significantly reduces the number of complications such as impaired mobility of the shoulder joint.

Simple mastectomy. The operation involves removing the mammary gland with the fascia (thin elastic tissue covering the muscle) of the pectoralis major muscle, but without removing the pectoral muscle and fatty tissue of the armpit.

Mastectomy according to Pirogov

The operation consists of removing the mammary gland with tissue from the axillary region.

Hemimastectomy with lymphadenectomy. One half of the mammary gland with fatty tissue of the axillary, scapular and subclavian zones is removed. The pectoralis major and minor muscles are not removed.

Simple mastectomy, mastectomy with lymphadenectomy, hemimastectomy with lymphadenectomy are currently not widely used, due to the fact that they often fail to completely remove fat, tissue and lymph nodes.

Subcutaneous mastectomy with simultaneous reconstruction

The mammary gland is removed en bloc with the fascia of the pectoralis major muscle, subcutaneous fatty tissue and lymph nodes of the axillary, subclavian and subscapularis areas. This operation involves a one-stage reconstruction. Skin incisions are made taking into account the location and size of the tumor.

Subtotal radical resection of the mammary gland with one-stage mammoplasty

When performing a subtotal radical resection of the mammary gland with subsequent reconstruction after dissection of the skin of the mammary gland, at least 75% of its tissue with the tumor is removed, the area of skin above it is removed at a distance of at least 5 cm. Mandatory removal of the subareolar zone of the gland is necessary. Excision is carried out throughout the entire thickness of the mammary gland along with the fascia of the pectoralis major muscle. The nipple-areolar complex is not removed.

Radical mastectomy with simultaneous mammoplasty using a transverse myocutaneous flap of the anterior abdominal wall on one rectus abdominis muscle

It is possible to reconstruct the breast with a free TRAM flap using vascular anastomoses between the lower deep epigastric vessels with the subscapular and intrathoracic vessels.

Organ-preserving operations

Lumpectomy (tumorectomy) – removal of a breast tumor within healthy tissue (indentation – 1 cm) + lymph node dissection of 1-3 levels (for medial localization, the operation is performed using two incisions)

Quadrantectomy (segmentectomy) – removal of the sector including the tumor node (distance from the edge - 3 cm) with the fascia of the pectoralis major muscle + lymph node dissection of 1-3 levels (for medial localization, it is performed using two incisions).

In domestic practice, AOM is usually called radical resection - removal of a sector of breast tissue with the fascia of the pectoralis major muscle, including a tumor node, lymph node dissection of 1-3 levels.