Extended mastectomy. Mastectomy techniques: according to Madden, Halstead and others. Late complications after mastectomy

What is a mastectomy? This is an operation to remove the mammary gland. The main indication is breast cancer. Sometimes this surgical intervention is used for intractable inflammatory process or breast injury.

The purpose of this operation is to prevent the spread of the cancer process. Breast removal in women is achieved by completely removing the tissue of the gland itself, the surrounding subcutaneous fat and lymph nodes. Therefore, mastectomy is considered a radical operation.

Types of mastectomy

There are many ways to remove the mammary gland, but the main techniques are:

• according to Halstead-Meyer;
• by Patey;
• according to Madden.

Important! The type of mastectomy surgery for breast cancer is selected by the doctor in accordance with the stage of the cancer process.

Stages of breast cancer: 1st - the oncological process is localized within the breast tissue; 2nd - spread of tumor cells occurs in the chest The lymph nodes; 3rd - axillary lymph nodes are affected; 4th - metastases in other organs.

Madden mastectomy

This modification of the operation is considered the most gentle, because when performing it, only the gland itself with subcutaneous fat and lymph nodes is removed. However, its implementation is possible only at stages 1-2 of the oncological process.

After the incision, the wound expands, the glandular tissue is separated from the surrounding tissue and removed. The next step is to excise the subcutaneous fat, thoracic, subclavian and supraclavicular lymph nodes. The pectoral muscles are preserved.

When suturing the wound, drainage is placed, which lasts about 4-5 days. If the postoperative period is favorable, the woman is discharged home on the 4th day. The stitches are removed after 10 days.

Due to the preservation of muscles, this operation does not interfere with the mobility of the shoulder joint.

Important! After Madden breast removal, chemotherapy and radiation therapy are necessary, because... There is a risk of preserving single tumor cells, which can relapse.

Peyti mastectomy

The indication for surgery to remove breast cancer with this modification is the presence of tumor cells in the axillary nodes (stage 3).

The difference between this operation and the Madden modification is the removal of the axillary lymph nodes and pectoralis minor muscle.

After breast removal muscle intersects, which allows you to get deeper and more complete access to the subcutaneous fatty tissue and lymph nodes with metastases.

Important. This type of mastectomy is more traumatic than the previous one, because There is a partial disruption of movement in the shoulder joint due to the removal of the pectoralis minor muscle. Cicatricial changes may occur in the area of ​​the subclavian vein. Subsequent breast formation with an artificial implant is also difficult.

Halstead-Meyer mastectomy

This operation is the most traumatic and disabling. Used in stage 3 breast cancer. IN Lately its use is limited.

1. A circumferential incision is made around the gland and it is removed.
2. The wound expands to the axillary region.
3. Subcutaneous fat and lymph nodes are removed there.
4. The pectoralis major and minor muscles are excised.
5. The chest wall is cleared of remaining fiber.
6. Drainage is installed and the wound is sutured.

This type of mastectomy leads to impaired mobility of the arm. The postoperative period and rehabilitation last for long time.

Important! The only indication for performing a Halstead mastectomy is modern world is a tumor lesion of the pectoralis major muscle.

Complications

Mastectomy, like any operation, has a number of complications that can lead to negative consequences until the death of the patient:

• Bleeding. During breast removal, the integrity of tissues and blood vessels is disrupted, which leads to some blood loss. In order to minimize it, a special device is used in surgery - an electrocoagulator. IN postoperative period To stop bleeding, tight bandaging and aminocaproic acid are used.

• Infection. Wound suppuration most often occurs by the end of the first week of the postoperative period. To prevent this complication during surgery, the rules of asepsis and antisepsis are strictly observed, and a course of antibacterial therapy is prescribed.
• Exudate. The intersection of lymphatic vessels during surgery leads to the accumulation of copious amounts of fluid in the area of ​​the postoperative wound. In the absence of adequate drainage routes, it can fester. To prevent lymph stagnation, drainage is used.

These complications are observed in the early postoperative period.

Late complications include:

• dysfunction of the shoulder joint;
• lymphostasis in the hand;
• muscle weakness on the affected side.

Early initiation of rehabilitation (massage, gymnastics) reduces the likelihood of impairment of the upper limb.

What to do after breast removal?

Breast augmentation after mastectomy is possible! The timing of this operation varies. For small tumors of stage 1-2 that are removed by Madden modification, reconstruction is possible simultaneously with mastectomy.

If the cancer was operated on at stage 3, an average of six months to several years passes between the removal of the mammary gland and the installation of the implant. This time will be required to carry out full chemotherapy and radiation therapy.

Reconstructive operations are divided into two large groups:

• breast reconstruction using artificial implants;
• plastic with your own tissues.

The use of artificial implants is possible only if a sufficient amount of tissue is preserved at the site of the removed mammary gland. Most often they are used after Madden surgery.

Plastic surgery using one’s own tissues is used after more traumatic operations to remove a breast tumor (according to Patey and Halstead).

Important! The choice of one or another technique is made by the attending physician, because It is he who decides which of them will achieve the best cosmetic result. During the reconstruction process, some surgical correction of the healthy gland is possible. This will achieve maximum symmetry.

They achieve reconstruction of the nipple by using their own tissues, and the areola is recreated using dermopigmentation, or simply permanent makeup

In order for the result of plastic surgery to be permanent and the postoperative period to be easy and without complications, it is necessary to comply with some requirements:

• exclusion of any physical activity within six months;
• strict control of your own weight (with rapid weight gain, asymmetry may occur due to increased fat deposition in the healthy breast);
• avoiding smoking and alcohol;
• nutritious nutrition with a normal content of meat and vegetables in the diet;
• refusal of drugs that affect the blood coagulation and anticoagulation system;
• mandatory wearing of support bandages or underwear for six months.

Breasts are a woman's adornment! However, it is not worth risking your life because of it. When the first symptoms of concern about breast cancer appear, you should immediately consult a doctor. A mastectomy can save your life. And subsequent plastic surgery will return its former beauty.

What types of breast removal surgeries are there?

Breast removal, or mastectomy, involves two elements: removal of the breast and removal of the axillary fat that surrounds the subclavian vein. The surgery may also include muscle removal. It is according to this element that all operations are divided into three types:

• Halstead radical mastectomy involves the removal of the pectoralis major and minor muscles, axillary tissue and mammary gland. Currently, this operation is performed very rarely.
• Patey's modified radical mastectomy(“Paity mastectomy”) involves removing only the pectoralis minor muscle, axillary tissue and mammary gland. Currently the most widely used.
• modified radical mastectomy according to Madden(“Madden mastectomy”) involves removal of the breast and axillary tissue. Considering the fact that this operation is the most functionally sparing, it is becoming increasingly widespread.

As numerous studies have shown, the effectiveness of all these interventions is the same.

How is the operation selected?

Usually, for stage 1-2 breast tumors, a Madden mastectomy is performed; for stage 3, a Patey mastectomy is usually performed.

What is the progress of the operation?

After the patient has fallen asleep, the surgeon uses a marker to apply markings to the skin, along which the scalpel subsequently moves. The skin gradually peels off from the mammary gland, and the mammary gland is separated from the muscles. The surgeon then “cleanses” the subclavian vein - this is the most dangerous moment of the operation. The accuracy of its execution determines the quality of the operation. That is why I use only personal instruments made in Germany (Aesculap, Marina Medical). The high-quality steel in the scissors will not corrode or become dull for decades. German-made clamps and tweezers are gentle and gentle on fabrics.

After completing the removal stage, bleeding from small vessels that are present on the skin and muscles is stopped.

A drainage tube is installed, which is subsequently connected to the accordion vacuum tank. Drainage is necessary in order to eliminate residual blood from the wound, as well as to eliminate lymph from it, which inevitably accumulates in the wound.

A sterile bandage is applied to the wound and sealed with medical glue or a special plaster.

The drainage is removed 3-5 days after surgery.

What kind of stitches are used?

I almost always get cosmetic stitches. The advantage of such sutures is that wound healing occurs much faster. Cosmetic stitches do not need to be removed. The threads used (I usually use threads from B BRAUN, made in Germany, or Johnson&Johnson, Covidien) dissolve independently in the tissues and leave no traces behind. In addition, cosmetic stitches look more neat, and I hope that this is a small, but still joy for the patient after such a traumatic operation.

What complications can there be?

Complications from mastectomy are quite rare. This operation is one of the safest in oncology. However, you should be aware that the following early complications exist:

• bleeding. To prevent bleeding, I use a special power tool that stops bleeding from small vessels. The use of a hemostatic solution has proven itself well - a solution of aminocaproic acid (placed into the wound during surgery, then evacuated through drainage). And, of course, the main element in preventing bleeding is bandaging - after the operation, an elastic bandage is placed around the patient’s body. If blood accumulates in the wound, this requires a second operation, during which the bleeding is stopped.
• infections. They may appear 7-8 days after surgery. The main source of microbes is the patient's skin. For prevention, skin treatment with a special disinfectant solution. I also use surgical technique“minimal skin damage”, which involves minimal trauma to the skin. To prevent infection, antibiotics are administered preoperatively (on the operating table before surgery). If an infection occurs, antibiotics are prescribed. Within 2-3 days, manifestations of infection disappear.
• accumulation of fluid in the wound. Due to the intersection of the lymphatic pathways, fluid begins to accumulate in the wound. First, she is evacuated through drainage, then she is evacuated using a puncture. The accumulation of fluid in a wound is a fairly common and natural phenomenon. Typically, accumulation occurs within 3-4 weeks, which requires regular punctures (needle pricks and fluid evacuation). The use of Unovak drains, which can be installed for a long time, allows the patient not to regularly need dressings.

Late and quite natural complications of the operation include:

• impaired mobility in the shoulder joint
• decreased muscle strength in the arm on the side of surgery

Is it possible to restore the mammary gland immediately after a mastectomy or after some time?

Yes, for stage 1-2 breast cancer, it is possible to perform simultaneous breast reconstruction using an expander (temporary stretcher prosthesis) and your own tissue (thoracodorsal flap, TRAM). At stage 3, it is optimal to perform delayed reconstruction (after completion of the main treatment).

When doctors raise the question of the need for a mastectomy operation for a woman, many mammologist patients panic and try to delay the question and delay the operation as long as possible.

Meanwhile, in the dilemma of whether or not to have a mastectomy, the time of decision-making determines both the positive prognosis of the cure and the quality of further rehabilitation and recovery.

It is necessary to understand what a mastectomy is, how dangerous it is due to complications, what its consequences are, and how comforting the prognosis for a woman’s future quality of life is.

The concept of mastectomy.

Mastectomy is the surgical removal of the mammary gland and part of its surrounding tissue. There are several types of mastectomy surgery, when nearby muscle tissue, fat deposits and lymph nodes are also removed along with the tumor-affected mammary gland.

Depending on the extent of the breast cancer and the spread of metastases through the lymph nodes, one of the main types of mastectomy may be indicated.

Types and methods of mastectomy.

Mastectomy surgery is partial or complete (radical) removal of the mammary gland. surgical methods. There are three main types or, in other words, methods of mastectomy operations:
1. Patey's method, or modified radical mastectomy. provides complete removal mammary gland, plus removal axillary lymph nodes 1st and 2nd order, along with removal of the pectoralis minor muscle. This method of mastectomy according to Patey is indicated for diagnosed breast cancer, when the metastases have not yet penetrated deeply. This method is the most common and is used to perform more than half of all mastectomy surgeries.

2. Halstead method, or complete radical mastectomy. A Halstead mastectomy involves the most complete removal of the mammary gland, which is why it is called radical. This mastectomy method removes all axillary lymph nodes, as well as the pectoralis major and minor muscles, and all fatty tissue. Only the thoracic nerve is left. Nowadays, mastectomy according to the Halstead method is used only in severe late stages of cancer, in which deep penetration of metastases into the adjacent muscles is diagnosed. This type of mastectomy is highly invasive and entails forced extensive removal of the woman's body surface.

3. Madden's method, when the mammary gland itself is removed, but the nearby muscle tissue of the gland and axillary lymph nodes remain. Although often, during a mastectomy using the Madden method, the lymph nodes located directly in the mammary gland are removed along with it. Typically, a Maden mastectomy is a surgical procedure indicated for women who have ductal carcinoma. This method is also used to perform preventive operations when there is a high probability of cancer due to genetic characteristics, such as the detection of a mutated BRCA1 gene.

4. Mastectomy can be performed leaving part skin breast, if the tumor has not spread to the skin. This is done in the case when the patient plans further mammoplasty operations for breast reconstruction with the introduction breast implants- endoprostheses. If a woman does not want to wear an exoprosthesis and is ready to undergo additional plastic surgery for breast reconstruction, then this should be stated before the mastectomy. Then the surgeon-mammologist will be able to leave part of the skin. This decision on further reconstruction of the mammary glands is relevant during mastectomy using the Madden and Patey method. Now plastic surgeons work wonders and restore not only the shape and size of the breast, but also enlarge the areola and nipple.

Prophylactic mastectomy.

Since the Madden method mastectomy is the most easily tolerated of all types of mastectomy, it can be done at the reasonable request of a woman to prevent and prevent the development of breast cancer when this mutagen is diagnosed. For example, such a mastectomy was performed by Hollywood actress Angelina Jolie, Miss America Helen Rose, Russian journalist Masha Gessen and some other famous women for the purpose of prevention.

Apparently, for them, the well-founded fear of getting cancer prevailed in their choice to do or not have a mastectomy, because statistics are inexorable and predict the development with a 90 percent probability cancerous tumor if the BRCA1 gene is present in the body. To understand whether or not to do this operation, and even more so for preventive purposes, you need to decide possible complications after mastectomy and indications for its use.

Indications for mastectomy.

In the question of whether or not to have a mastectomy, the answer is usually clear - do it. Because a cancerous tumor has a tendency to progressive development and metastasis, which in most cases leads to fatal outcome. In some cases, treatment with radiation and chemotherapy with careful monitoring of its results is possible to stop cancer. More often, such therapy is carried out as preparatory or The final stage for mastectomy. The number of positive outcomes after mastectomy is steadily growing, and provides the most guaranteed result. Therefore, mastectomy is the preferred method to combat breast cancer.

1. So, as explained above, the indication for mastectomy may be the presence of a mutated BRCA1 gene, but the decision whether or not to have the operation remains with the woman.
2. Purulent inflammation breast, when no therapy helps, may be an indication for mastectomy.
3. Gynecomastia also has indications for mastectomy. Here the cosmetic effect is more important than the medical indications.
4. The main indication for surgery Mastectomy, of course, is the detection of a cancerous tumor during the diagnosis of the mammary glands, no matter sarcoma, carcinoma or other types of cancer.

Complications during mastectomy.

Complications after mastectomy are divided at the psychophysical level.
1. Complications immediately after surgical intervention associated with the wound healing process.
- Profuse bleeding from the wound. Usually occurs in the first postoperative period of mastectomy. Bleeding is stopped with coagulant medications. If the wound does not heal for a long time, repeated excision may be required.
- The healing of the wound left by mastectomy in the axillary region depends on general condition health of the patient and the presence or absence of her chronic diseases. A disease like diabetes greatly increases the overall healing time.
- The healing process can be complicated by suppuration of the postoperative wound; antibiotics are used to combat this complication.
- At the last stage of the mastectomy operation, a drainage tube is introduced into the wound to ensure the outflow of residual blood, tissue and lymph fluid, in common parlance, ichors. Complications include profuse lymphorrhea.
- Lymphostasis and lymphedema are swelling of the arm after a mastectomy.

Swelling of the hand occurs due to disturbances in the circulation of blood and lymphatic fluid, its stagnation. Since during a mastectomy, lymph nodes are removed from the body of the mammary gland and axillary region, the outflow of fluids in the parts of the body closest to the operated breast is disrupted. Lymphedema usually affects the entire arm on the surgical side. Treatment of arm swelling after mastectomy comes down to special gymnastic exercises and breaststroke swimming. There are also various expanders and lymphatic trainers, compression sleeves and bandages.

2. The second type of complications after mastectomy is associated with a woman’s psychosexual experiences, often leading to depression. This is facilitated by many factors, among which the most common are:

- suspiciousness and fears about the outcome of mastectomy
- a feeling of inferiority and inferiority and, as a result, difficulties and limitations in social contacts
- imaginary and real difficulties in the sexual sphere, due to insufficient attention from loved ones, with complete preservation of libido
- fear of a possible relapse of the disease

In addition to these causes of complications, there may be other psycho-sexual causes that can be identified and removed. experienced psychologist, therefore, getting rid of such complications necessarily involves consulting a psychotherapist.

Treatment after mastectomy.

Treatment of the patient immediately after a mastectomy mainly comes down to regular high-quality dressings and aspiration of fluid formed in the wound. The postoperative period is not complete without antibiotic treatment. In the future, if secondary complications such as swelling of the arm occur, treatment involves adding therapeutic exercises, swimming, wearing compression sleeves and bandages. Sometimes, when wearing exoprostheses, there is a need to treat skin irritations, but this does not relate directly to the mastectomy operation itself.

ABOUT beneficial properties tinctures, extracts, etc. Thyme and thyme against colds.

Purulent mastopathy and breast cancer are diseases that cannot be ignored. They require intense attention, examination and treatment. Among oncological diseases Among women, breast cancer ranks first, among other diseases - second. The consequences cannot always be predicted.

Prevention is important and timely treatment. In some cases, surgery is inevitable - a radical mastectomy.

What is radical mastectomy

Radical, i.e., removing entirely, completely, from the roots. The concept of mastectomy is of Greek origin - mastòs “breast” and ek tome “remove”. The term is over 100 years old.

Several types of mastectomy are practiced. Each of them is effective, they differ in the degree of trauma. Radical mastectomy - complex operation, but sometimes only she can solve the existing problem.

There are three main types of mastectomy:

• according to Madden,
• by Patey,
• according to Halstead.

Radical mastectomy according to Madden is considered the most gentle.

What is a radical mastectomy, you will learn from this video:

Kinds

According to Madden

The method involves preserving both pectoral muscles, which makes it as gentle as possible. The mammary gland is removed en bloc with lymph nodes and subcutaneous fat layer.

After removing the mammary gland, all nerve endings and vascular links are traced, which helps to avoid blood loss. This type of operation has significant advantages: preservation of radicality, relatively low morbidity, low percentage of complications.

According to Halstead

Halstead-Meyer mastectomy is a classic operation. The mammary gland, skin, subcutaneous tissue, pectoral muscles, subcutaneous fatty tissue (subclavian, axillary and subscapular region), lymph nodes.

The method often causes complications, the main one of which is limited mobility of the shoulder joint. It is used extremely rarely when other methods do not help cope with the problem, for example, extensive metastases affecting the pectoral muscle, lymph nodes, etc.

By Patey

Patey's mastectomy is a modification of the previous type and has the full name - modified radical mastectomy. Her founder dr Patey suggested wide excision of the skin and preservation of the pectoralis major muscle. During the operation, only a small muscle is removed, which makes the method more gentle and avoids serious complications.

According to Pirogov

The mammary gland and tissue of the axillary region are removed.

Simple mastectomy

The mammary gland and fascia of the pectoralis major muscle are removed.

Technique using tram flap

A technique for breast restoration, which is performed simultaneously with a mastectomy or six months after surgery. In this case, the patient's own tissue is moved, which is called a TRAM flap, which is tissue with preserved blood flow. This may be an iliofemoral flap or a greater omentum flap. Sometimes a pedicled rectus abdominis muscle flap (along with skin) is used.

Subcutaneous surgery technique

A technique that allows you to maintain the radicality of surgical intervention and achieve the best possible aesthetic results. This is a method of extended subcutaneous mastectomy, when the mammary gland with muscular fascia (sheath) and lymph nodes are removed, while preserving the muscles and fatty tissue. P

When using this technique, breast reconstruction surgery can be performed at the same time. This can be an operation using your own tissue or using an implant, for which a “pocket” is pre-formed.

Indications for testing

• Malignant breast tumor of varying degrees,
• Purulent mastopathy (in rare cases),
• Correction of previous treatment,
• Individual indications (prevention, etc.).

Contraindications

General contraindications:

• Severe cardiovascular failure,
• Kidney and liver failure,
• Decompensation of diabetes mellitus,
• Cerebrovascular accident.

Contraindications for tumor localization:

• Swelling of the mammary gland extends to the chest wall,
• Multiple metastases in the lymph nodes with edema of the upper limb,
• Invasion by a tumor of the chest.

Even more useful information about the operation radical mastectomy - in this video:

Carrying out the operation

Preparation

Preparation for surgery consists of several stages:

• Medical checkup, which is a fundamental point. The doctor examines the medical history and prescribes an examination,
• Survey, including a series of tests and tests: mammography (photography of breast tissue), breast biopsy, general analysis blood and urine, biochemistry, blood test for coagulation (coagulogram).
• The doctor prescribes gentle (light) diet, warns about limiting use (or stopping completely) medicines that thin the blood (aspirin, etc.). They are excluded a week before surgery. On the day of surgery, it is unacceptable to drink or eat.

Progress of the operation

The operation is carried out according to general anesthesia. Its duration ranges from 1 to 3 hours.

Algorithm:

1. Markers are used to mark the upcoming cuts.
2. The skin is cut in the necessary places,
3. Subcutaneous tissue and mammary gland are separated from the skin,
4. Removal occurs as a single block, including lymph nodes,
5. Depending on the method, the pectoral muscle, fatty tissue, etc. are sequentially removed.
6. Nerve endings and vascular links are traced,
7. A drainage is installed through a special hole, which is removed on the 5th - 6th day.
8. Stitches are applied and removed on days 10-12.

Installation of drainage is important point. The doctor monitors the outflow of fluid.

Rehabilitation

After a mastectomy, rehabilitation measures are extremely important. These include gymnastics, physical therapy, and taking medications.

Gymnastics

Gymnastics, some examples of exercises:

• Squeezing a rubber ball
• Hair combing,
• Putting your hands behind your back, as if you are trying to fasten a button at the back,
• Circular movements of the arms, rocking, etc.

Physiotherapy

If there are no complications, then physical therapy can be prescribed a week after the operation. What can be done about this:

• Pool,
• Various simulators aimed at developing the shoulder joint,
• Massotherapy,
• Hydromassage,
• Red spectrum irradiation (used to restore lymphatic drainage),
• Magnetotherapy,
• Bandage,
• Therapeutic wrap.

Rehabilitation rules

• Using an elastic bandage
• Refusal to visit the bathhouse and solarium,
• You can't lift weights for a year,
• Stay in an inclined position for a long time,
• Try to avoid injuries, do not use traumatic objects (bracelets, etc.),
• Increase the amount of fluid you drink,
• When flying by air, you must use a compression sleeve,
• An examination is required every six months,
• Wearing special underwear,
• If you feel worse, consult a doctor immediately.

Lipofilling of the mammary glands after RM

Fat grafting is a means of breast reconstruction after mastectomy, which uses the patient's tissue rather than implants. One session for the recovery procedure will not be enough; several will be required.

Lipofilling of the mammary glands is also a serious matter that requires thorough preparation.

• The surgeon determines the areas from which the necessary material can be taken,
• Prescribes an examination similar to that required for any plastic surgery,
• The operation is performed under general anesthesia,
• Before collecting adipose tissue, Klein's solution is injected into it,
• Selected fat cells are placed in a centrifuge, where they are separated into 3 parts,
• The middle part is used for direct reconstruction,
• The prepared fatty tissue is injected using a syringe in small portions into the targeted areas.

The operation is performed under general anesthesia and lasts from 2 to 5 hours. After lipofilling, swelling and hematomas form, which persist for 3-4 weeks. Repeated surgery is possible no earlier than after 4 months. For a lasting result, 2 to 5 procedures are required.

Lipofilling involves the use special system(BRAVA), which protects transplanted cells from external influences. This system is put on and worn for 7 to 14 days.

Consequences and complications

The number of complications after mastectomy continues to remain high today (from 20 to 87%), despite equipment and new technologies. Complications can be early or late.

Early

• Leakage of lymph, which may necessitate further surgery,
• Necrosis of tissue edges,
• Infection, suppuration.

Late

Late complications that are observed more often when using the Halstead method:

• Lymphostasis (impaired lymph outflow),
• Violation of the venous outflow of blood as a result of narrowing (blockage) of the lumen of the subclavian or axillary vein,
• Formation of rough scars involving the axillary nerves,
• Pain in the shoulder area
• Loss of mobility of the shoulder joint, which leads to disability.

Price and clinics

Mastectomy is a major operation that is performed exclusively in large or specialized centers. There are such centers in Moscow (for example, the CENTER OF MAMMOLOGY), St. Petersburg, Obninsk, Yekaterinburg, etc. They are often mentioned in connection with this operation medical Center in Israel - “Assuta” and the Center for Medical Diagnostics in Germany.

Prices vary greatly, which is not surprising. Each operation has its own characteristics and different methods are used. Plays a role and price policy. The estimated minimum price threshold is 35 thousand rubles. It is possible to perform a simple mastectomy for less than low price, but this is unlikely. Average prices for surgery range from 60 to 120 thousand rubles.

Radical mastectomy according to Madden is one of the types of operations to remove the breast. This operation has a number of indications, on which its technique depends. In order to have a good understanding of the course of a mastectomy, it is necessary to consider the structure of the mammary gland.

The structure of the female breast

The mammary, or mammary, gland is the main structure of the female bust. Its function is to educate breast milk necessary during the milk period of feeding a child. Each gland is a collection of small lobules that have ducts. The smallest of them are combined into large ones, which open at the nipple. The lobules are separated from each other by connective tissue.

Breast size determines not only the volume of the mammary gland, but also the amount of subcutaneous fat in this area. Around the nipple is the areola - a very delicate area sensitive skin, the color of which is usually darker than the base tone of the epidermis or matches it (from pale pink to brown).

Under the mammary gland and its connective tissue elements there is a large pectoralis major muscle, which when good development(for example, in female athletes) may protrude slightly under the skin. The pectoralis minor muscle is located under the pectoralis major muscle. Below them are the ribs and intercostal muscles.

The mammary gland undergoes significant changes throughout a woman’s life. During puberty (at 11-15 years), there is a sharp increase in the enlargement of glands and the growth of subcutaneous fat in this area, which often coincides with the onset of menstruation. During pregnancy and lactation, the breasts increase due to the constant production of breast milk, often after such changes they no longer take their previous shape, and sometimes even size.

Indications for mastectomy

The main indications for surgery to remove the mammary gland are malignant neoplasms. Breast cancer is one of the most unfavorable tumors female body. Its danger lies in very rapid metastasis, mainly to the liver. This is due to the fact that a piece of the tumor (metastasis) breaks away from its main mass and enters the lymph nodes and vessels, of which there are many in the tissues of the gland. It quickly migrates to the lymph nodes of the liver and lingers there, and then spreads to other organs with the flow of fluid.

Surgical treatment breast tumors must be combined with chemotherapy. If it is absent, the probability of relapse (recurrence of the disease) increases to almost 100%. The earlier the tumor was operated on, the better the prognosis.

The most successful treatment combination includes chemotherapy and radiation therapy And surgery. There are several options for surgery for breast cancer.

Types of mastectomy

There are several types of mastectomy:

1. 1. Radical mastectomy according to Halstead. Online access with it it has the appearance of a spindle, the incision borders the tumor and is made 5-6 cm below it. During this mastectomy, the mammary gland itself, the pectoralis major and minor muscles located underneath it, and adjacent lymph nodes from the axillary fossa are removed.
   2. Extended mastectomy according to Urban It is rather historical in nature and is extremely rarely used today. The technique for performing it is the same as for a mastectomy according to Urban, but the course of the operation includes resection of the ribs in the area of ​​the mammary gland and removal of lymph nodes along the internal thoracic artery. Such an operation can take place for extensive tumors at an advanced stage.
   3. Peyti mastectomy implies preservation of the pectoralis major muscle. It is performed when the tumor is small in size and there are no metastases to other organs.
   4. Sectoral resection breast surgery is performed only for very small tumors in the early stages of development and in the absence of metastases. In this case, only part of the lobules of the mammary gland with the adjacent connective tissue is removed.
   5. During this operation, the skin and subcutaneous fat on the chest are cut transversely, then removed mammary gland and the related subclavian, subscapular and axillary lymph nodes. Excised connective tissue between the lobules. This operation is more gentle and cosmetic in nature, since it preserves the pectoralis major and minor muscles. Today, mastectomy using this method is the gold standard in breast cancer surgery.

Postoperative period

In the postoperative period, pain relief, prophylactic antibacterial, radiation and chemotherapy (if necessary) are carried out. To prevent anemia after surgical blood loss, preparations containing iron are recommended.

Often, during a mastectomy, axillary lymph nodes are removed, which limits the mobility of the arm. Such patients wear their hand in a scarf and gradually develop it by physical therapy or physical therapy.

After treatment for breast cancer, patients are seen by an oncologist every 3-6 months for the first 5 years, then every 6-12 months.

Video

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