Breast cancer is a terrible pathology that is widespread in the modern world. Advances in medicine with such a diagnosis help save patients' lives. Mastectomy is a surgical way to solve the problem. What are the indications for operations, what is the difference between the methods used, how does postoperative recovery occur - information that is useful for women of any age.

What is a mastectomy

A tumor found in the breast becomes a physiological and psychological female problem. To resolve it, a mastectomy is used - an operation to remove the mammary gland, which has options for performing. Surgeons, trying to save a woman's breasts, choose the least traumatic method in all respects. Tasks of doctors:

• eliminate a dangerous disease;
• create conditions for the subsequent restoration of the breast;
• improve women's quality of life.

During surgery, depending on the type of technique, the removal of the mammary gland, large, small pectoral muscles, fatty tissue containing lymph nodes is performed. A cancerous tumor is dangerous because of the rapid growth of metastases. Surgical intervention has features that depend on the stage of development of the pathology, the age of the woman. Indications for breast removal are:

• the risk of oncology is more than 51%;
• sarcoma;
• purulent inflammation;
• genetic predisposition to cancer;
• gynecomastia.

There are restrictions for the removal of the mammary glands. Contraindications for performance:

• violation of cerebral circulation;
• hepatic, renal failure;
• decompensated diabetes mellitus;
• swelling in the gland, passing to the chest;
• severe form of cardiovascular insufficiency;
• multiple metastases in the lymph nodes with swelling of the hands;
• germination of the tumor in the tissue of the chest.

Types of mastectomy

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

The most minimally invasive 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 the removal of the mammary gland:

Indications

Before performing a mastectomy, doctors assess the condition of the woman, the degree of tumor development, and the structure of the cancer. This is taken into account when choosing a method of surgical intervention. Each has its own indications:

Oncologists choose a modification of mastectomy in accordance with the indications for carrying out, the degree of severity of the process:

The choice of the method of surgical intervention is a crucial moment for surgical oncologists. The need for chemotherapy is determined by the doctor. Common types of mastectomy:

A tumor in the last stage with metastases is treated with a surgical operation performed according to the following methods:

Preparing for the operation

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

• general, biochemical blood test;
• mammography of the breast;
• urine test;
• tissue biopsy;
• computed tomography;
• blood clotting test;
• research on tumor markers;
• prescribing a light diet;
• limiting the intake of drugs that promote blood thinning;
• prohibition on the operational day of drinking, eating.

Operation

When choosing a surgical intervention scheme, it is taken into account that it is carried out according to the plan - the removal of one mammary gland (unilateral mastectomy) - or both are removed. The operation is performed under general anesthesia. The duration is from one to three hours, depending on:

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

There is a general algorithm of actions when performing the removal of the mammary glands in women:

• anesthesia is performed;
• rifling is marked with a special marker;
• skin incision is performed;
• subcutaneous tissue, mammary gland is separated from it;
• tissue is removed, including, if necessary, lymph nodes;
• in accordance with the method of operation, excision of fatty tissue, pectoral muscles is carried out;
• traced vascular links, nerve endings;
• a drain is installed for the outflow of fluid;
• stitches are applied, which are removed after 12 days.

According to Halstead

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

• mammary gland;
• small, large pectoral muscles;
• subcutaneous fatty tissue - subscapular, axillary, subclavian;
• lymph nodes;
• nipple;
• skin.

The 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 the elimination of a large number of tissues, problems arise during the plastic reconstruction of the breast:

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

Radical mastectomy according to Madden

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

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

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

• there is a rapid healing of wounds;
• the mobility of the shoulder joint is not disturbed or restoration is carried out with the help of special gymnastics, massage;
• successful plastic reconstruction of the mammary glands;
• there is a possibility of recovery in a short time.

Amputation of the breast

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

• cancerous tumor stage 4;
• decaying malignant neoplasms;
• pathology of 2-3 degrees when it is impossible to perform a radical surgical intervention.

This type of surgery is used for preventive purposes in the presence of a genetic predisposition to the development of breast cancer. Indications are the large size of the neoplasm. Features of surgical intervention:

• a biopsy of nearby lymph nodes is mandatory;
• with a cancerous tumor size of up to two centimeters, the areola and nipple are not removed;
• followed by radiation and chemotherapy.

By Pati

During the operation according to the method of this doctor, the pectoralis major muscle is not removed. The Pati method contributes to the preservation of the functions and cosmetic appearance of the remaining tissues. During surgery:

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

Patey's technique - a modified radical mastectomy - is considered to be less traumatic, and is widely used in oncology. After the operation, there is a minimum number of complications. The disadvantages include:

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

Postoperative period

In order for a woman to quickly restore her shape after the operation, it is necessary to carry out rehabilitation measures prescribed by the doctor. This will help relieve 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, baths;
• avoid lifting weights;
• use an elastic bandage;
• wear special soft clothes;
• drink more fluids;
• avoid injury;
• get regular check-ups with a doctor.

The postoperative condition requires careful attention to health. A woman is recommended:

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

During rehabilitation after a mastectomy, you will need:

• normalize nutrition - use a low-calorie diet;
• carry out physiotherapy;
• perform massage, hydromassage;
• use simulators to restore mobility of the shoulder joint;
• limit prolonged stay in an inclined position;
• use a compression sleeve for air travel;
• use a healing wrap;
• drink the drug Tamoxifen to exclude relapses;
• perform reconstructive plastic surgery.

Complications

Having a mastectomy can have serious consequences. Complications appear after surgery and in the subsequent, remote period. After the operation, the occurrence of problems is not ruled out:

• suppuration of the postoperative wound;
• bleeding;
• breathing problems;
• the appearance of blood clots in the lower extremities;
• lymphorrhea - prolonged outflow of lymph as a result of injury to the lymph nodes;
• drug allergy;
• marginal tissue necrosis;
• damage to the nerve endings of the muscles of the back, arms, chest;
• infection of the abdominal cavity.

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

• pain, stiffness in the hands;
• problems of mobility of the shoulder joint;
• lymphostasis - swelling of the hands caused by a violation of the outflow of lymphatic fluid;
• rough postoperative sutures;
• proliferation of connective tissue;
• disorder of outflow of venous blood due to overlap during the operation of the lumen of the axillary, subclavian vein.

The most serious for a woman are postoperative psychosexual problems. Breast removal causes:

• depression;
• feeling of own inferiority, inferiority;
• difficulties in communicating with the opposite sex;
• restriction of social contacts;
• fear of recurrence of the disease;
• fictional and real difficulties of sexual life;
• the difficulty of establishing new acquaintances;
• problems in family relationships.

Breast reconstruction

Women go for plastic surgery to restore their breasts because of the psychological discomfort that has arisen. In addition, there are problems at the physical level associated with an imbalance of loads on the spine. After a mastectomy, there are:

• change in posture;
• omission of the shoulder on one side;
• rachiocampsis;
• violation of the lungs, heart.

Often, reconstruction is carried out in conjunction with a mastectomy, or six months after the operation. As a result of activities at the site of removal of the mammary gland, restoration is carried out:

• the volume of subcutaneous adipose tissue, skin;
• cut tissues located nearby, chest muscles;
• nipple-areolar complex;
• in addition to the operated breast, the second mammary gland to adjust the size and shape.

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

• performed after subcutaneous mastectomy;
• an expander is inserted through the incision - a special device;
• stretching of the skin occurs, the formation of a cavity for the subsequent installation of the implant;
• advantages - low trauma;
• disadvantages - the unnaturalness of the breast to the touch and outwardly, the risks of tissue necrosis, the presence of restrictions on the installation of the implant.

To create a natural in appearance and sensations of the mammary gland, transplantation of one's own tissues is used, which are taken from the back, anterior abdominal wall. This technique - the TRAM patchwork method - is characterized by:

• the complexity of the operation;
• high trauma;
• the need for prolonged anesthesia;
• the presence of a 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 cup is placed on the chest;
• a vacuum is created under it;
• stretching of the skin occurs;
• its excess is formed;
• a place is formed for the subsequent installation of a silicone implant, transplantation of adipose tissue;
• the disadvantage of the method is that it requires a long wearing of the device, the appearance of stretch marks is not excluded, it is difficult to stretch to a large implant size.

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

• replenishment of tissue deficiency by transplanting flaps of the patient's own muscles, subcutaneous tissue, skin of the patient;
• correction of the shape, size, symmetry, reconstruction of volume, elimination of cavities is carried out using silicone implants.

Price

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

The diagnosis of breast cancer for most women sounds like a death sentence – more for lifestyle than for life itself. However, in recent years, this “sentence” has been softened more and more often. Doctors have learned to detect cancer in the early stages, sometimes even when the patient herself is unaware of it.

In turn, such an early diagnosis of cancer makes it possible to avoid severe surgery in all plans - mastectomy. There is hope for more economical interventions that are easier to tolerate by the woman herself and leave more chances for the restoration of previous forms. One such operation, which differs from a radical mastectomy, is subcutaneous mastectomy.

The name alone speaks for itself! Of course, as with all other economical operations, subcutaneous mastectomy there are strict indications. The tumor should be no larger than 2 cm and located at least 2 cm from the nipple. In addition, such a tumor should not be close to the surface of the breast.

Like many other breast surgeries, subcutaneous mastectomy has several modifications, which differ in the method of cutting. The surgeon chooses which particular modification of the subcutaneous mastectomy is appropriate in this particular case. After all, the incision must also be wide enough to allow the surgeon to remove part of the cancerous gland along with the surrounding fatty tissue and the lymph nodes located in it, and at the same time allow the skin incision to heal well, since subcutaneous mastectomy allows a woman to resort to reconstructive breast surgery, that is, to restore the shape of the breast.

During subcutaneous surgery, the entire mammary gland with lymph nodes from the axillary, subclavian and subscapular regions is removed, while the nipple area with the areola remains intact.

Some patients may have a question - why then remove the entire mammary gland if the tumor is so small? The answer is to get radical! Until now, in the treatment of cancer - this is the most important thing! Well, besides, such an operation allows you to immediately restore the lost shape and volume of the breast, using your own tissues or implants, or both.

So the advantage subcutaneous mastectomy lies in the fact that the surgeon can immediately perform a plastic surgery without making additional incisions, without resorting to an additional operation, using the patient's own muscle tissue. In this case, the muscles move, and their blood supply is preserved. Well, if there are not enough own tissues to form the shape of the breast, then an implant is used. It is usually placed under the pectoral muscle.

As seen, subcutaneous mastectomy allows you to "kill two birds with one stone" - that is, to solve two problems at once - medical and cosmetic. True, there is a disadvantage in the form of a large scar after the operation, but a professional surgeon can always avoid or minimize this problem. Also, if you just leave the reconstructive surgery for later, it will add more scarring!

Note that subcutaneous mastectomy- this is not a radical intervention, therefore, after the operation, radiation therapy is mandatory. Its goal is the complete destruction of cancer cells that could remain in the breast. In radiation therapy, radiation passes through healthy breast tissue to a site where there are potential cancer cells. In most cases, these tissues, despite irradiation, retain a good ability to recover.

Usually, radiation therapy begins immediately after the healing of the surgical wound (it is not carried out during healing, as it can disrupt the healing process itself), and the course of radiation lasts from four to six weeks, several sessions per week. In addition, with subcutaneous mastectomy, intraoperative radiation therapy with the Intrabim apparatus is also possible.

In this case, in a short period of time, the entire required dose is delivered to the intended place at once. This makes it possible to preserve healthy tissues as much as possible and significantly reduce the treatment time, and, of course, to avoid many side effects associated with conventional postoperative radiation therapy.

Mastectomy is the removal of the mammary glands when the risk of developing cancer reaches 51% or more. The operation to remove the mammary gland differs in its features and age category.

Types of operations to remove glands

Mastectomy according to Madden is the removal of the breast together with the lymph nodes of the armpit. After removal, rehabilitation is prescribed. Reconstruction of the breasts is required to recreate the shape and volume.

Patey's mastectomy is the removal of the breast, tissue in the armpit, and part of the pectoral muscle.

A subcutaneous mastectomy is the removal of glandular tissue by scraping through a small incision. At the end of the operation, a prosthesis is inserted into the skin, which is sewn inside. Subcutaneous mastectomy is convenient for women in terms of the possibility of restoring the shape of the breast. This allows them to maintain volume and make inconspicuous incisions, as in plastic surgery. Subcutaneous mastectomy can be bilateral, depending on the extent of breast involvement. Subcutaneous mastectomy is also performed for sarcoma, breast cancer, and purulent inflammation.

After a double mastectomy (bilateral), a woman does not have a single mammary gland, but there is an opportunity to do plastic surgery.

Mastectomy according to Pirogov is the removal of the mammary gland with a lymphocele, when cancer is detected at stage 1-2. After surgery, lymphostasis of the arm or upper and lower limbs is often noted. After removing the wish. swelling of the hand may pass, but it is reversible, that is, it can go away in a year and a half.

Radical mastectomy is the Halsted method, which involves the removal of all muscle groups of the mammary cavity, axillary lymph nodes, fiber, and the breast itself. Radical mastectomy can be performed using different methods, it all depends on the degree of complexity of the operation. Radical mastectomy is done only after the discovery of an abscess the size of the entire pier. wish.

Indications for types of operations

According to completely different indications, the operation can be prescribed depending on the course of the disease, the structure of the cancer, the tumor, the state of health, etc. The table shows clearly which mastectomy is prescribed when, why, and what happens after the removal of the mammary gland.

Separately, there is a type of preventive mastectomy, which is carried out in order to exclude a possible complication of the current risk of developing cancer. Operations are performed when there is a high probability (from 70%) of the development of a cancerous tumor. To prevent complications, such a removal of the chest is performed.

Postoperative period

The period after the completion of the operation may be accompanied by such consequences as:

At the end of surgery, reconstructive plastic manipulations are also carried out in order to return the shape to its previous form. During the first three months, everything hurts - the head hurts, the joint hurts, the back hurts. The heart also hurts due to the load on the body. The joint hurts, gives to the nerve endings. Massage, recommendations, treatment, diets should be followed. For a speedy recovery, treatment involves a bandage, underwear and exoprostheses, exercises and much more.

Today, Anita underwear, exoprostheses and prostheses are produced for women, which have a special sleeve for comfortable wearing. Distinguish:

The bandage may have a sleeve that is worn on one side. The bandage does not include a sleeve for both sides. The sleeve is only on the side where exoprostheses are not inserted.

Exoprostheses are inserted into swimwear, bra, clothes for any occasion. Swimwear and their structure includes a sleeve, fasteners and support in the form of a belt. Swimsuits also have sleeves, bowls.

The texture hides chest problems, and the sleeve is perfectly complemented by the fabric. This structure allows you to hide the stitches left due to the mastectomy. Swimwear must be worn, these are the recommendations of doctors. So a woman can influence men, and regain her mental health.

It is swimsuits that are an open part of clothing that allows a woman, despite the circumstances, to show herself in all her glory. Observing the recommendations, nutrition, prescriptions of doctors, do not forget about femininity. Swimwear can be ordered in a store for a holiday at the sea, pool, lake, but continue to heal your "life". The main thing is to heal yourself from the inside, and think about how beautiful life is.

Many ladies are afraid of losing men with their transformations. Men have no understanding of what kind of life a woman had. Because of this, rejection appears in men, many men's families collapse, because the appearance of a woman has changed. Wives and young girls are afraid that men will lose their desire to be around, and only men if they put everything they have into a woman to restore her smile. Men do not have questions about how nutrition should be, why the body hurts and gives to the back. After all, no one knows how long a person lives or how much is left for a person. Appreciate life, give support.

Attention! The following video presents video clips of microsurgical operations.
Viewing these videos is strongly not recommended: for persons under 16 years of age, pregnant women, as well as persons with an unbalanced psyche.

With the active growth of a malignant tumor in the breast, a severe purulent lesion of the gland, the detection of sarcoma or nodular mastopathy, often degenerating into cancer, the patient is prescribed a mastectomy. What it is? Resection of the affected breast and nearby lymph nodes is performed at a high risk of metastasis and tumor growth.

Is it necessary to remove the mammary glands? How is the recovery period going? How to eliminate a cosmetic defect? What is a preventive mastectomy? Answers in the article.

general information

The operation involves the removal of the affected gland, if indicated, the excision of the axillary lymph nodes and pectoral muscles in combination with fatty tissue. The type of surgery depends on the size and stage of the tumor, the presence or absence of metastases, and the type of neoplasm.

Important nuances:

• timely removal of ductal carcinoma, sarcoma, and other types of tumors reduces the risk of an extensive pathological process and the formation of distant foci with atypical cells;
• when a mutated BRCA1 gene is detected, prophylactic mastectomy is effective - removal of the mammary glands in a precancerous condition, the presence of a family history of oncopathologies. After a preventive mastectomy, the risk of developing a malignant process is reduced from 90 to 3-4%. It is important to take into account the indications and limitations, to learn about the possible complications and consequences, the advantages and disadvantages of the operation;
• an appeal to a mammologist at an early stage of oncopathology makes it possible to get by with an organ-preserving operation. In advanced cases of cancer, the active process of metastasis requires excision of the affected mammary gland;
• you should not refuse a complete radical mastectomy if the mammolgog insists on this type of operation: the sooner the tumor stops its negative impact on the body, the more favorable the prognosis of therapy.

Breast removal requires highly qualified mammologist surgeons. A complex operation is performed under general anesthesia, the duration is 3 hours or more. The duration of surgical intervention increases during reconstructive plastic therapy.

Lifestyle

Helpful Hints:

• eat right, sharply limit the amount of fat and salt to reduce swelling. Get food with the optimal amount of proteins, vitamins, carbohydrates. Fats - vegetable, food is not spicy, almost unsalted, not very sweet, without preservatives. It is necessary to limit baking, pastries, white bread, fast food. Pickles, marinades, mayonnaise, coffee, alcohol, fried foods are prohibited. You can not gain extra pounds;
• psycho-emotional balance, support of loved ones, overcoming depression, reducing the frequency of stress - important elements of recovery, prevention of complications;
• with the permission of the mammologist, after the complete healing of the scar, you can visit a sanatorium for a speedy recovery after the operation;
• light physical activity is helpful. Be sure to develop hands, perform special exercises selected by a rehabilitation doctor. You can not overload the muscles, but the lack of movement in the rehabilitation period leads to congestion, swelling, poor lymph movement. Perform all exercises strictly with the permission of the mammologist, at the time specified by the doctor.

Possible Complications

The use of modern methods of resection of the affected mammary glands in combination with complex rehabilitation reduces the likelihood of an inflammatory process and the spread of metastases. Exact adherence to the recommendations given by the mammologist reduces the strength of negative sensations after a mastectomy.

After the operation, some patients experience complications:

• the hand swells in violation of the outflow of lymphatic fluid;
• phantom pain in the area of ​​the operation;
• bleeding and poor wound healing;
• skin necrosis, contractures;
• decreased mobility of the shoulder joint;
• erysipelas of tissue with further degeneration into more severe forms: abscess, sepsis;
• depressive states, especially in the absence of desire or opportunity for breast plastic surgery;
• curvature of the spine, provoking pain in the cervical area and impaired posture.

An important factor that reduces the risk of complications is cooperation with a qualified mammologist-oncologist and surgeon. Mastectomy is a complex operation. Inaccuracies during the removal of the gland, the choice of an inappropriate method of surgical treatment without taking into account the individual characteristics of the patient can lead to dangerous complications. You need to find a high-level clinic and an experienced doctor. Most medical institutions that use the latest equipment and an effective set of measures during the rehabilitation period offer women plastic surgery to eliminate a cosmetic defect.

Breast reconstruction

To reduce psychological discomfort, eliminate the defect after a complete mastectomy, the mammologist offers the patient to restore the shape and size of the breast after the operation. With a high qualification of a plastic surgeon, the difference between natural glands and restored organs disappears.

Two methods are applied:

• use of authentic (own) tissues of the patient. The doctor selects flaps of skin, fatty tissue and muscles from the buttocks, thighs, and abdomen. The technique is used less frequently than the second method of breast reconstruction;
• installation of implants- modern technique with high result. The doctor inserts a silicone implant into a special "pocket" to mimic the natural shape of the mammary glands.

Which method is more efficient and safe? Doctors are sure: method number 1 using their own tissues, but not every plastic surgeon will undertake such a complex operation. Installation of implants is a simpler and less traumatic method. For this reason, artificial fillers are more often used.

If there are indications for a radical mastectomy, do not panic: Removing a breast often means starting life without the pain and fear of developing or progressing to breast cancer. With a genetic tendency to oncopathology, the detection of the BRCA1 mutagen, you can consult an experienced mammologist about preventive mastectomy.

Find out more useful information about the types of mastectomy and lifestyle after the intervention after watching the following video:

The main therapeutic tactic for breast cancer is its surgical removal (mastectomy), both as an independent option and in combination with radiation, hormonal and chemotherapy. The surgical strategy of modern treatment is aimed at ensuring the solution of two main tasks - the reliability of a cure for a dangerous disease and the creation of conditions that allow for the restoration of the breast after mastectomy and improve the patient's quality of life.

Radical methods of surgical treatment

Among all oncological diseases in women, breast cancer (BC) ranks first and second after diseases of the heart and blood vessels - among the causes of death. The number of patients with breast cancer each year increases by an average of 1-2%. This testifies in favor of the need to prefer the most radical methods of treatment.

At the same time, in the initial stages, the proportion of which has increased in the last 10 years, it is possible to perform organ-preserving operations with reconstructive plastic elements or even without them, and advances in the field of endoprosthetics can significantly improve the quality of life of those who have undergone such operations even at later stages of the disease.

Mastectomy according to Halsted-Meyer

Classical radical operation. It is based on the principle of staged spread of cancer cells from the primary tumor to the regional lymph nodes through the vessels and collectors of the same name.

Therefore, the essence of the operation is to remove the mammary gland with skin and subcutaneous tissue as a single complex with pectoral muscles (small and large), as well as with lymph nodes and subcutaneous fatty tissue located in the subclavian, axillary and subscapular regions.

The nature of the skin incision during surgery depends on the site of tumor localization. An oval transverse incision is mainly used, which allows, without much tension, to connect the edges of the wound with a skin suture at any localization. This method was used in all stages of breast cancer, but led to the development of serious late complications in most patients, especially in the form of limited mobility in the shoulder joint (in 60%). Currently, the Halsted-Meier technique is performed only in cases of:

1. Germination of the tumor in the pectoralis major muscle.
2. Involvement in the malignant process of the lymph nodes located on the back surface of this muscle.
3. The need for palliative surgery in a qualitative single solution.

Patty Dyson Mastectomy

It is the result of a search for more benign solutions for surgical intervention, which is a modification of the previous type. The author of the technique was based on the fact that lymphatic capillaries and vessels abundantly penetrate the skin and subcutaneous fat layer, but are almost absent in the fascia of the pectoral muscles. Therefore, D. Patey proposed to keep the pectoralis major muscle along with a wide excision of the skin and subcutaneous tissue around the cancer. In order to remove the subclavian and apical axillary lymph nodes, they were asked to confine themselves to removing only the pectoralis minor muscle. This technique made it possible to somewhat reduce the percentage and severity of late postoperative complications.

Mastectomy according to Madden

An even more gentle method in which both pectoral muscles are preserved. Removal of the mammary gland is carried out in a single block with the subcutaneous fat layer, subclavian, axillary and subscapular lymph nodes. The operation is characterized by no less radicalism, but is accompanied by significantly less trauma (compared to the previous ones), less blood loss and better and faster wound healing.

But most importantly, as a result of the application of the Madden modification, muscle preservation makes it possible to exclude or significantly reduce the number of patients with the development of limited functional mobility of the shoulder joint and obtain a more acceptable cosmetic effect. Due to this, operational modifications of this type are considered functionally sparing.

In recent years, there has been a trend towards a decrease in the volume of surgical intervention, while maintaining radicalism in oncological terms. The possibility of moving away from aggressive tactics that have persisted for decades is explained by:

• a significant increase (among all patients with breast cancer) of women with early stages of the disease;
• improvement of instrumental and diagnostic methods;
• development and application of effective combinations of surgical treatment with targeted, hormonal, chemotherapeutic and radiation types of exposure;
• revision of the biological and clinical concepts of the development of malignant processes - they take into account not only the stage of cancer, but also the degree of its activity, the rate of tumor growth, cell heterogeneity, the hormonal state of the body and its reactivity.

All this allows predicting the course of the disease, the likelihood of complications and choosing the tactics of treatment.

The listed types of radical mastectomy make it possible to quite successfully solve the problems of a therapeutic nature. However, after their implementation, the reconstructive possibilities associated with:

1. The need to restore the deficit of soft tissues in the absence of their reserve.
2. Creation of a transitional fold and a nipple-areolar complex.
3. Creation and correction of the shape and volume of the gland.
4. Restoring the symmetry of the mammary glands.

Subcutaneous mastectomy

This is a technique that allows you to optimally solve the main tasks of treatment:

1. Preservation of a sufficiently radical surgical intervention and oncological safety.
2. Significant facilitation of the primary reconstruction of the gland in order to achieve the best possible aesthetic results.

This technique consists in almost complete separation from the skin and removal of the glandular and adipose tissue of the mammary gland. At the same time, the nipple-areolar complex is also removed, which significantly worsens the expected aesthetic results of the operation. Therefore, many oncological surgeons strive to preserve it, for which various modifications are used.

Unfortunately, this is not always possible. Preservation of the nipple and areola depends on:

• the size of the primary node;
• localization of the tumor and its distance to the nipple-areolar apparatus;
• the severity of intraductal components;
• cell type of the tumor and the nature of its growth;
• the degree of involvement of the nipple-areolar apparatus in the cancer process (according to various sources, it ranges from 5.6 to 31%).
• status of regional lymph nodes.

In subcutaneous mastectomy, various incisions are used to provide wide visual access. Depending on the conditions, an extended subcutaneous mastectomy can be used, which involves an incision under the gland from the parasternal line to the middle axillary line. It allows you to remove the gland tissue along with the muscular fascia at the base, expose the excretory ducts of the nipple, and in the armpit - it is easy to isolate and remove the processes of the mammary gland along with the lymph nodes.

Subcutaneous mastectomy makes it possible to simultaneously perform a reconstructive operation of the mammary gland by moving its own tissues or to form a pocket under the pectoralis major muscle for implant placement.

The choice of any of the listed methods largely depends on the stage of the prevalence of the tumor process.

Complications after mastectomy

Despite the constant improvement of surgical treatment methods, the number of complications remains quite high - from 20 to 87%. Complications in the immediate postoperative period contribute to the intensive development of connective tissue in the surgical area and the occurrence of late complications. Risk factors are:

1. Old age (after 60 years).
2. Obesity and even just overweight.
3. Significant volume of mammary glands (from the 4th size).
4. Concomitant diseases, especially diabetes mellitus, chronic diseases of the lungs and heart, arterial hypertension.
5. Additional preoperative radiation and/or hormonal therapy.

Major early complications

• lymphorrhea (lymph leakage) that occurs after radical mastectomy in all patients;
• marginal necrosis with subsequent divergence of tissue flaps at their junctions; this occurs mainly due to excessive tension of soft tissues with their deficiency;
• accession of infection and suppuration of the wound.

The causes of lymphorrhea, regardless of the volume of the operation, are the removal of lymph nodes and the inevitable intersection of the lymphatic vessels connecting them. Ligation of all vessels during the operation is impossible, since most of them remain invisible. The duration of abundant lymphorrhea can be 1 month or more, which creates conditions for infection and the development of marginal necrosis, delaying the timing of additional anticancer therapy, the formation of a seroma (lymphocele) in the axillary zone, which is a cavity surrounded by a capsule and filled with lymph. Its formation requires repeated surgical intervention.

Late complications after mastectomy

They occur in all patients and with any technique, but they are especially pronounced when using the Halstead-Meier method. The complex of the most typical complications, called post-mastectomy syndrome, includes:

1. Violation of the outflow of lymph from the tissues of the limb (lymphostasis).
2. Narrowing or complete closure of the lumen of the subclavian and / or axillary veins, as a result of which the outflow of venous blood is disturbed.
3. The development of rough postoperative scars involving the axillary nerves.

These complications are the cause of prolonged or even permanent pronounced swelling of the limb, the development of adductor contracture of the shoulder (in 60%), which limits mobility in the shoulder joint and is accompanied by frequent pain, and permanent disability.

Gymnastics

A certain positive result has gymnastics after a mastectomy, recommended by the US Association for Breast Cancer and Mastectomy. Gymnastics includes exercises such as combing hair, squeezing a rubber ball with a brush, rotating and swinging arms, putting them behind your back with a towel and fastening a bra.

Breast reconstruction

Breast reconstruction after a mastectomy is carried out simultaneously with the main operation or, if this is not possible, approximately six months after it. Many different reconstructive techniques have been developed, which are conventionally divided into 3 groups:

1. Reconstruction with the tissues of the patient himself, which is the movement of a tissue flap with preserved blood flow - iliofemoral, flap of the greater omentum, flap of the rectus abdominis muscle with skin (TRAM flap) on a leg or free and others.
2. Use of expanders and silicone implants.
3. Combined methods - the use of methods of the first and second groups. For example, tissue deficiency is filled with a flap from the back of the back, and silicone implants are used for additional volume, shape and symmetry correction.

Reconstructive methods in terms of their capabilities and effectiveness are arranged in the following sequence:

1. The maximum use of organ-preserving techniques is possible, followed by volume replacement by moving local tissues. This option in most cases allows you to recreate the volume, shape and even symmetry of the mammary glands.
2. Reconstruction of the gland using endoprostheses after subcutaneous mastectomy with preservation of the nipple-areola complex. It is also possible to combine the same mastectomy method with a muscle (without skin) flap from the back and the addition (if necessary) of an endoprosthesis.
3. TRAM-patchwork method, which is used when it is impossible to apply the above options, since its technical implementation is much more complicated. In addition, it causes significant damage to the donor area.

Treatment of breast cancer is planned by an oncologist surgeon with the participation of other specialists - a morphologist, a chemotherapist and a radiologist, which allows for the optimal choice of the method of surgery, systemic treatment and postoperative rehabilitation.