Breast removal (mastectomy) and plastic surgery
Breast removal an operation causing fear in women diagnosed with breast cancer. What is important to know about this operation, and in what cases it will help to eliminate the inevitability of breast cancer? When is the mammary gland removed?
THE REASONS FOR BREAST REMOVAL (MASTECTOMY)
Breast removal or mastectomy is at this stage of oncology development almost the only way to preserve health and life for a woman diagnosed with breast cancer (BC).
One of the reasons for the development of breast cancer is the presence of the mutated BRCA1 gene, which is inherited. Such patients from 5 to 8% of the total number of patients with breast cancer.
The disease primarily affects women of active age, which affects the psychological health of patients. In connection with this, the urgency of reconstructive-plastic therapy is growing.
The first reconstructive surgery after breast removal was undertaken in the late 19th century. But a large number of complications made these operations unclaimed until 1963, when a breast removal was successfully performed, followed by the reconstruction of the breast with silicone endoprostheses.
All subsequent decades, plastic surgeons are improving the reconstructive technology of the breast. Today, a more demanded operation is a one-stage reconstruction of the organ after a breast removal
MASTECTOMY, TYPES, AND METHODS
Mastectomy is a radical removal of the breast and some adjacent tissues by surgical intervention. In accordance with the extent of breast cancer and metastasis, the following types of operations are performed:
The Patea method, which allows you to radically remove the mammary gland, affected by cancer. This removes not only the glandular tissue but also the axillary nodes and pectoralis minor (small pectoralis muscle). Such an operation is indicated with a confirmed oncological diagnosis, with the presence of metastases. Most of the mastectomy is performed by this method.
The Halstead method is also a radical operation, with excision of not only the gland, but also the axillary lymph nodes, and the pectoral muscles with fatty tissue. It is left by the thoracic nerve. This method is indicated for severe stages of cancer, with deep metastases to the muscles adjacent to the mammary gland.
The method of Madden, a less radical operation, since only the mammary gland is removed. The surrounding muscles and lymph nodes are left. Such an operation is prescribed for women with a diagnosis – ductal carcinoma.
Also, the method of Madden is used in preventive operations to patients on genetic indications.
To date, there is no one criterion for the volume of operations. This can be a lumpectomy (partial or segmental breast removal). It is defined as a complete surgical resection of the primary tumor in order to achieve significant negative margins (ideally 1 cm).
This can be done with the help of special palpation manuals or with the help of a visual diagnostic guide and is applicable for most patients with invasive carcinomas of stage I or II.
There are relative contraindications, which are presented below.
- small breast size;
- large tumor size (> 5 cm);
- collagen-vascular disease.
Absolute contraindications include the following situations.
- multifocal disease;
- history of the previous radiotherapy in the field of treatment;
- impossibility to undergo radiation therapy for an invasive disease;
- the first or second trimester of pregnancy;
- permanent positive histological analyzes for the presence of tumor cells after attempts to preserve the organ.
Options for reconstruction of the breast after partial mastectomy include the following:
- Fascial skin flaps for improving local tissue.
- Flaps from the parenchyma of the breast.
- Skin and muscle flap of the latissimus muscle of the back.
A complete mastectomy with cancer involves the complete removal of the entire breast tissue.
The following options are available:
- Modified radical mastectomy – mastectomy with removal of axillary lymph nodes (ALND).
- Radical mastectomy – mastectomy plus en-block resection of the pectoral muscle with ALND.
- Extended radical mastectomy is a radical mastectomy with resection of the internal lymph nodes of the breast.
- Skin-preserving total mastectomy (SSM).
- Areole-preserving mastectomy (NSM). During surgery, all of the breast tissue is removed, but the nipple remains in place.
The main indication for breast removal is the confirmed diagnosis of breast cancer. In addition, a breast removal is indicated if the patient has a BRCA1 gene.
Today, preventive mastectomies are being carried out more and more often in patients with BRCA1, which practically does not give a chance to avoid the development of breast cancer.
HOW IS THE OPERATION TO REMOVE THE BREAST (STEP BY STEP)?
General anesthesia is used to perform this surgical intervention. The duration of the operation is about 3-4 hours.
If lymph nodes are also removed, then the surgeon will need more time to work.
Initially, the doctor cuts the skin and eliminates the affected tissue.
These are complex manipulations that require high qualification from a doctor. In the end, the surgeon applies seams, using resorbable filaments or staples.
In order to pump out the accumulated liquid, reduce swelling, speed up recovery, drainage is applied, which is placed in the chest.
There are different situations, so the nipple can be left or also removed. After some time, the patient can be sent for a biopsy. It will help to check the operated zone for the presence of cancer cells.
After surgery, a woman will need to stay in the hospital for several days.
RECOVERY AFTER BREAST REMOVAL
After the removal of the breast tumor, the woman needs to recover. At first, the patient will feel pain. After surgery to remove the breast, you do not have to move sharply, do not wear heavy things, do not raise your hands.
If a woman is tormented by severe pain, then the doctor will prescribe painkillers.
Quite often the doctor prescribes chemotherapy in conjunction with the operation. Radiation therapy may also be necessary.
When the drainage pipes are removed, it may be possible to accumulate a small amount of liquid. But there were cases when medical help was required. In this situation, the doctor drains excess “water” by applying a needle.
In most cases, the woman is depressed after breast removal. Depression can last a long time, sometimes requiring psychological treatment.
People in this situation need to understand that life does not end, but they have a chance to become healthy.
You need to try not to start complexing and closing yourself, but to find a way to hide your shortcoming. In addition, there is reconstructive surgery, which will help create a new breast, close to the real one.
Return to the old life is possible on the 6-8 week of recovery if there were no complications. Entering sexual relations is 1.5-2 months later.
If there is a complete breast removal, the patient may be offered a reconstruction. But not everyone agrees to it. In addition, some people do not have the opportunity to hold it, because it is not cheap.
In this case, you can use prosthetics. What is it? Today, bras are produced that create the appearance of a normal natural breast.
To recover quickly, without complications, you can not:
- take a shower before the stitches are removed ;
- load your body, carry weights;
- to be sent to an injection in the affected area;
- swim in the pool, the river, the sea about 2 months after the operation;
- to have sexual intercourse for about 1.5-2 months.
THE DEVELOPMENT OF HANDS AFTER THE REMOVAL OF STITCHES
When a woman is removed from the seams, she should start developing her hands. For this it is necessary to perform certain exercises:
raise your hands up and in different directions (you can be in a standing or sitting position), tilt them over the head;
get up, bend the limbs in the elbows, place them in front of the sternum, then push them apart;
try to close your arms behind your back.
All these exercises can be performed only after approval by the doctor.
About the opportunity to prevent the development of breast cancer, many women learned from media reports. Hollywood celebrity Angelina Jolie, in order to avoid the risk of developing breast cancer, made a mastectomy (after which she inserted implants ).
Her example was followed by other famous women. Now not only doctors know about preventive mastectomy.
To determine the need for a preventive mastectomy, it is worthwhile to find out about her indications and all possible postoperative complications.
Indications for preventive mastectomy
preventive mastectomy began officially in 2010. The basis for its implementation is the presence in the body of a diagnosed mutagen of breast cancer (BRCA1 and BRCA2) or a malignant tumor of one of the mammary glands.
Also, a family history of oncology, confirmed by genetic research, is a valid indication for preventive mastectomy. The operation is indicated if there are signs of precancerous organ pathology.
In private clinics, such an operation can be performed even without a confirmed diagnosis, only guided by the patient’s desire. In such cases, it requires legal confirmation of the refusal of further claims regarding the outcome of the operation.
Contraindications for preventive mastectomy
Breast removal is not carried out for preventive purposes if the patient has certain contraindications.
- Mature age (over 65 years);
- Lipomatosis of 2-3 degrees;
- Arterial hypertension;
- Cardiovascular pathologies;
- Bronchial asthma;
- Psychiatric diagnosis.
The decision to conduct a preventive mastectomy in a patient is made jointly by several specialists. She gives written consent to the operation, which is legally certified.
One-time reconstruction of the organ after mastectomy is carried out in stages:
- Direct breast removal- removal of glandular tissue without skin;
- Reconstruction of the organ – transfer of the graft from its tissues, or an implant, with the further formation of the land contours.
BREAST RECONSTRUCTION METHODS
Restoration of the breast by the tissues of the patient’s body, according to plastic surgeons, is the most urgent. During breast reconstruction, flaps of tissues (skin, muscles, subcutaneous tissue) are used from various areas of the body: abdomen, thighs, buttocks.
They are transplanted to the site of the removed glandular tissue. And although from the technical point of view carrying out this variant of reconstruction is a more complicated procedure, but it is considered more reliable with respect to the survival of transplants.
You can see also breast augmentation
However, in 9 cases out of 10, another method of reconstruction is chosen – using implants. The fact is that when reconstructing your tissues, you have to perform additional operations for correction of the breast, as its aesthetics cannot be achieved immediately.
Restoring the shape of the breast with the help of implants. To do this, the so-called “pocket” for the endoprosthesis is first prepared, which is a large pectoral muscle and a skin area stretched by an expander. There are other technologies that allow using artificial tissues when there is a lack of skin.
The second method of reconstruction, with all its low traumatism, also has drawbacks. This development after implantation of capsular contracture.
Which of the variants of the operation gives a better result? A more reliable result and a long-term effect are provided by the variant of carrying out the reconstruction with authentic body tissues. But technically this technique is more complex and requires the high professionalism of a plastic surgeon.
The recovery of the patient after breast removal and breast reconstruction may be different in duration.
It depends on factors such as the procedure for the reconstruction operation, the individual characteristics of the patient, the professional skills of the plastic surgeon.
Longer the postoperative period is due to the restoration of its own tissues.
It passes in several stages, since after the primary plastic surgery, after 3-5 months the patient needs a correction of the volume and shape of the breast. Additional operations are also carried out to create a new areola and nipple from their own tissues
The most frequently observed complications after mastectomy are manifested in the following:
- Temporary swelling of tissues located near the site of the removed organ;
- Soreness of the postoperative wound;
- Infection of the wound cavity;
- Permanent swelling of the hand from the side of surgery as the result of lymphostasis;
- Severe swelling of the hand from the side of surgery;
- Phantom pain in the area of the removed breast;
- Seroma – a cluster of serious tissue fluid in the postoperative cavity.
Complications after reconstructive surgery often occur with the installation of endoprostheses. Possible suppuration of the wound cavity and implant rejection. More severe complications are observed in the form of skin necrosis and contractures.
Mastectomy (breast removal) is an operation to remove the entire breast. The most common cause of mastectomy is the treatment or prevention of breast cancer. Depending on the required individual treatment, nipple or lymph nodes may need to be removed. Some patients choose breast reconstruction to restore the shape of their breasts during the initial operation of a mastectomy or as a second operation later.