Breast removal: the main types of operations and their consequences

In many cases, the removal of the mammary gland (mastectomy) is an inevitable stage in the treatment of cancer of this localization, and sometimes the only possible way to get rid of the oncologic problem or prolong life. Although the cancer is unpredictable, and even such an operation, alas, does not guarantee the cessation of the pathological process ...

[1], [2], [3], [4], [5]

Indications for the removal of the breast

Accepted in clinical mammology, indications for the removal of the breast are mainly associated with malignant neoplasms. Most doctors insist on a mastectomy if:

• a woman has a tumor in more than one quadrant of the breast;
• Radiation therapy of the affected breast was already performed;
• the tumor size is more than 5 cm in diameter, and it did not decrease after neoadjuvant chemotherapy;
• a biopsy showed that the initial segmental resection of the tumor did not remove all cancer tissues;
• the patient has connective tissue diseases such as systemic lupus or scleroderma, in which very serious side effects of radiation therapy occur;
• the tumor is accompanied by inflammation;
• a woman is pregnant, but radiation therapy is not possible because of the risk of damage to the fetus.

This method is recognized as the main way to prevent recurrence of breast cancer, especially with the identified mutation of BRCA genes. At the same time, the world's leading experts in the field of mammology note that the complete removal of cancer affected by breast cancer reduces the risk of recurrence of the tumor in the same breast, but does not exclude the possibility of the appearance of cancer in the other breast.

Preparing for the removal of the breast

The operation is appointed when the patient is diagnosed with a diagnosis, that is, a mammogram was performed and a tumor biopsy was performed. Therefore, the preparation for mastectomy is reduced to a general analysis of the blood, repeated chest fluoroscopy and chest, and the removal of the electrocardiogram (ECG).

Referring to a woman for surgery, the doctor should make sure that a few days before the scheduled operation (and, best of all, a couple of weeks before it), the patient did not take medications that help dilute the blood (aspirin, warfarin, phenilin, etc.). Also, the surgeon and anesthesiologist should be informed of the patient's use of any medications based on medicinal plants or herbal decoctions. Thus, nettle, nettle, yarrow, leaves of ginkgo biloba may increase the risk of bleeding and, therefore, they should not be used at least two weeks before any surgical intervention.

To prevent inflammation, a dose of antibiotics can be administered. 8-10 hours before surgery, the patient should stop eating.

Surgery for the removal of the breast

Such surgical intervention as the removal of mammary glands in women has various modifications that are designed to solve specific problems, taking into account the diagnosis of a particular patient, the clinical picture and stage of the detected disease, the degree of damage to the gland itself, as well as involving the pathological process of surrounding tissues and regional lymph nodes .

The removal of breast cancer, primarily large tumors in later stages of the disease or when tumors can occupy a significant area within the contours of the breast, can be produced by simple or general mastectomy. That is, the surgeon removes all breast tissue and skin ellipse (including the skin of the nipple), but does not remove the muscle tissue under the breast. In this type of operation, a biopsy of the nearest (control or watchful) lymph node is necessarily done. Postoperative scar, as a rule, transverse.

The skin-friendly approach to the removal of the mammary gland (subcutaneous mastectomy) is practiced, in which the tumor, all tissues of the breast, nipple and areola are removed, but almost 90% of the skin of the breast, the incision and, consequently, the scarring is preserved. However, if the chest is large, a cut is made down, and then the scars after removal of the breast will be greater.

Resection of the gland with preservation of the nipple and areola is also performed, but this is possible only when the tumor is at a considerable distance from the nipple zone. In this case, the incision is made on the outer side of the breast or on the edge of the areola and all tissues are removed through it. In modern clinics, this method involves either the simultaneous reconstruction of the gland, or the placement on the site of its seized structures of a special extender expander for breast reconstruction in the future.

When radical resection of a common malignant neoplasm, not only all the structural parts of the gland, but also the underlying muscles of the chest, fiber from the underarm area, axillary lymph nodes, and often deeper lying tissues, must be removed. If the milkworm is removed along with the internal thoracic lymph node, an extensive radical mastectomy is performed.

All these operations have a clear methodology, and experts know what is at issue when it is necessary to conduct a mastectomy according to Halstead, according to Patey or Madden.

When forming an anomaly in the axillary region such as an additional mammary gland, the additional mammary gland is removed. Usually, glandular and fatty tissues predominate in the structure of the superfluous organ; they cut out, the muscle tissue is stitched, and a seam is applied from above, which is removed after about a week. If the size of the additional gland is significant, the fat can be removed by pumping it.

It should be noted that the cost of a mastectomy operation depends on the stage of the disease, the size and location of the tumor and, of course, on the status of the treatment facility and the prices of the pharmacological agents used.

Removal of two mammary glands

The aforementioned surgical methods are performed and the removal of two mammary glands by a double or bilateral mastectomy. The need for such an operation can be caused by the presence of a tumor in one breast and a woman's fear of the risk of developing cancer in another, contralateral chest. Most often, such fears persecute women who have a tendency to develop oncology pathologies in the genus.

As you remember, for a long time Angelina Jolie's topic was discussed and removal of mammary glands, as the operation of contralateral mastectomy, performed by the actress in 2013, was preventive, that is, pre-emptive development of breast cancer. In addition to the fact that her mother and grandmother (Marchelin and Lois Bertrand) died of ovarian and breast cancer, the results of a genetic analysis on the BRCA confirmed a high (up to 87%) risk of a breast cancer actress in the chest. As reported, after resection of both breasts, the likelihood of cancer in Jolie decreased to 5%.

According to the National Cancer Institute, even with full double mastectomy, not all of the breast tissue that can be at risk of becoming cancerous can be removed. In addition, during such surgery, the tissue of the chest wall and the supraclavicular area can not be removed by the surgeon, but the presence of stromal cells of the breast is possible in them.

Sectoral removal of the breast

To the retaining gland and less invasive surgical methods is the sectoral removal of the mammary gland (segmental resection or lumpectomy), when the tumor itself and part of the surrounding normal tissues (not having atypical cells) are resected. In this case, the removal of regional axillary lymph nodes can be performed through a separate incision. This technique is applicable for oncology of stages I-II, and after surgery should be conducted 5-6-week radiation therapy.

By resection from the breast can remove the focus of chronic purulent mastopathy, as well as a large hormone-dependent benign formation of cystic or fibrous. However, mandatory resection is subject only to malignant phylloid fibroadenoma of any size and prone to degeneration of significant fibrocystic neoplasia. Although fibrosis of the breast tissue in almost 15 cases out of 100 appear again.

In other cases, enucleation (exudation) or laser therapy is performed, and removal of the mammary gland cyst can be performed without excision: sclerosing its cavity by aspiration.

Breast removal in men

In the case of breast cancer, mammary glands are removed from men. Regardless of age, a mastectomy is considered a medical necessity, when there is a fear that a breast enlargement in a man can have a breast carcinoma. Naturally, the final decision on the need for surgery is taken only after a comprehensive examination - with mammography and biopsy.

Also, abnormally enlarged glandular tissues are removed in gynecomastia in men over 18 years of age when hormone therapy with testosterone is ineffective.

In adolescence - against a background of hormonal imbalance of the pubertal period, mastectomy is not performed, since this pathology can spontaneously regress with time. In addition, mastectomy before the end of puberty can cause a relapse of gynecomastia.

In elementary obesity in adult men, which is often manifested by excessive deposition of adipose tissue in the area of the breast, liposuction can be used.

[6]

Effects of mammary gland removal

The natural consequence is pain after removal of the breast, for the removal of which take painkillers (primarily, NSAIDs). Also for this operation is the secretion and accumulation in the wound cavity and under the skin of significant volumes of serous fluid. To drain her, the wound must be drained for a minimum of seven days. In addition, a dense bandage is applied around the chest with an elastic bandage, and it should be worn for at least a month.

Specialists note such major complications after removal of the breast, such as:

• postoperative bleeding and bruising;
• associated with suppuration of a postoperative wound or necrosis of poorly supplied blood tissues at the site of the incision temperature;
• lesions of the skin of the breast with beta-hemolytic streptococcus, which causes erysipelas;
• due to scarring of incised tissues scars are formed, often this process causes discomfort and is painful;
• development of a longer neuropathic pain syndrome, which is manifested by stabbing pain, numbness and tingling in the chest wall, armpit or in the arm;
• a depressive mood, a sense of own inferiority.

Almost always after a month and a half, there is a violation of the natural outflow of the interstitial fluid and lymphostasis develops. This disorder is especially pronounced due to the cessation of normal lymph flow with the removal of axillary lymph nodes. Lymphostasis leads to the fact that not only the swelling of the hand appears from the side of the remote organ, but also numbness of the skin on the inner surface of the hand. There is also a frozen shoulder syndrome - a short-term or longer limitation of the range of arm movements in the shoulder joint. This syndrome can occur within a few months after the operation, and its cause lies in the damage to nerve endings in the surgical intervention zone.

[7], [8], [9], [10], [11]

Recovery after removal of the breast

Only 1.5 days after the operation, you can get up and walk, but it is not recommended to force the restoration of motor activity: it should go gradually, as the sutures are removed about 1-2 weeks after the operation.

In most patients, recovery after removal of the breast persists for 4-6 weeks, but may take longer (in many respects this depends on the complexity of the operation and overall health).

The list of what can not be done after a mastectomy includes bans on:

• taking a shower (and washing in a bath) until the stitches are removed;
• physical exertion, weight lifting and vigorous movements;
• exposure to heat and UV irradiation;
• any injection in the hand from the side of the removed breast;
• bathing in water and pool (at least two months);
• sexual contacts (within 1-1,5 months).

In connection with lymphostasis, mammal surgeons give their patients such recommendations after removal of the breast:

• observe personal hygiene and cleanliness of hands;
• avoid damage to the integrity of the skin of hand injuries, and in the case of the most minor scratches, use antiseptics;
• Do not sleep on the side of the operated gland;
• wear a special elastic band (providing a soft compression to improve lymph flow and reduce swelling);
• regularly do massage: in the form of ascending stroking hands in the direction from the fingers to the shoulder joint.

After the removal of the joints, it is necessary to develop a purpose purposefully. Gymnastics consists of such exercises:

• in the standing or sitting position, the lifting of the arms to the sides and upwards;
• in the same position, placing an arm behind the head (at first you can help with the other hand);
• in a standing position, bend your arms in the elbows in front of the chest and raise your elbows to the sides as high as possible;
• in standing or sitting position of the arm behind his back.

The food should include enough calories, but be light, that is, fat and spicy use is not recommended, as are sweets. It is useful to eat more often, but in smaller portions, the diet should include the usual foods (cereals, meat, fish, sour-milk products, vegetables and fruits). Should animal fats be replaced by vegetable fats, reduce the intake of salt and sugar.

Treatment after removal of the mammary gland

Oncological patients undergo treatment after removal of the mammary gland - adjuvant therapy. At any stage of the cancer, after complete or partial removal of the breast, to eliminate the remaining atypical cells and avoid recurrence, chemotherapy (Cyclophosphamide, fluorouracil, Mafosfamide, Doxorubicin, Xeloda, etc.) and radiotherapy are prescribed.

If the tumor is related to hormone-dependent neoplasms, hormonal drugs are used. Tablet anti-estrogen remedy Tamoxifen (other trade names: Zitazonium, Nolvadex, Tamoplex, Tsitofen, Zemid, etc.) are taken 1-2 times a day for 20-40 mg.

Toremifene (Fareston) is prescribed to women after menopause; the standard daily dosage is 60 mg, but the doctor can increase it 4 times (up to 240 mg).

The drug Letrozole (Femara, Letrosan) also suppresses the synthesis of estrogen in the body; it is prescribed only to patients aged once a day on a tablet (2.5 mg). Tablets Anastrozole (synonyms - Arimidex, Anaster, Selana, Egistrazol, Mammozol, etc.) are not prescribed to women in the premenopause, the drug should be taken 1 mg once a day.

The anti-cancer effect of drugs for targeted therapy is achieved by an effect that is precisely directed at the cancer cell molecules that support the development of the tumor. Thus, drugs of this group are able to stabilize the pathological process and prevent relapse of the disease. Target drugs Bevacizumab (Avastin), Trastuzumab (Herceptin) are administered intravenously every two or three weeks; Lapatinib (Tyverb) in tablets (inside at 1000-1250 mg per day).

Life after removal of the breast

One should remember the main thing: life after removal of the breast continues, although for all women who have undergone such an operation, this is a slightly different life ...

First, a woman gets a disability after a mastectomy. Concretely, unilateral mastectomy, transferred by a woman due to a malignant neoplasm, is unquestionably the basis for the establishment of the third group of disability-life-long (that is, without the need for a periodic mastectomy), which is approved by the order of the Ministry of Health Protection of Ukraine (No. 561 of September 5, 2011), "Institutionalization for the Establishment of Groups" re-examination).

Secondly, it concerns the reconstruction of the lost gland (plastic surgery) or the appearance of its presence. The second option, of course, is much cheaper and can be temporary.

You can choose or order pads on the chest, as well as a removable denture - textile or silicone.

To date, the so-called exoprosthesis for women who have lost their breasts are produced by many companies in a wide range: they are fabric prostheses for the first time, and silicone prostheses for permanent use, various sizes and modifications.

There is also a wide choice of orthopedic underwear, as you will need a bra - to fix the breast prosthesis. This is quite elegant and at the same time functional and comfortable bras with "pockets", in which the prosthesis is inserted, and wide straps. Special swimsuits are also sold.

Plastic surgeons themselves argue that plastic surgery after a mastectomy is a complicated and rather expensive operation. This can be a plastic surgery to install a silicone implant or mammoplasty using the tissues (skin, subcutaneous tissue, muscles) taken from other parts of the body. But in any case, the woman appears very similar to the natural organ of the breast, which, of course, positively affects the overall emotional and psychological state of patients who have suffered the removal of the breast.