Malignant breast tumor surgery. What kind of surgery is needed for breast cancer? There are also complaints such as

Removal of a breast tumor is part of a comprehensive cancer treatment method. The surgical method involves radical or partial removal of the tumor focus and is prescribed taking into account individual pathology. The most widespread in medicine is mastectomy, which has different techniques.

Indications for surgery

The mammary gland is removed partially or completely if there is a malignant or benign tumor in the breast. An operation is often performed if a woman has a high risk of developing cancer in her family history or if there is a direct indication (cancer). There are several indications for surgery:

1. large formation;
2. attachment of the inflammatory process;
3. lack of effect from chemotherapy;
4. presence of connective tissue disease.

During pregnancy, radiation therapy poses a high risk to the fetus, so radical cancer treatment is recommended.

Video

Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for independent treatment. Be sure to consult your doctor!

Until recently, when diagnosed with breast cancer, surgery was performed in a radical way. It implied the complete removal of the diseased organ with all adjacent tissues, fatty tissue, lymph nodes and pectoral muscles.

This ended with the chest being deformed and lymphostasis of the upper limb occurring. After the operation, the woman became disabled and suffered mental trauma due to her appearance.

Now there are many types of surgical intervention for this type of cancer pathology. The priority direction of surgery in this area is maximum preservation of the organ with partial resection. This helps get rid of the tumor without affecting the aesthetic appearance. It has been proven that women with this diagnosis do not need a radical approach, while the survival rate remains at the same level.

Surgery for a diagnosis such as breast cancer is carried out only after consultation with a surgeon and all necessary studies.

Modern diagnostics make it possible to accurately determine the location of the pathological focus, its size, the degree of growth of metastases and the type of tumor formation. All this plays a role in determining what surgical intervention is necessary in a given case.

What types of operations are there?

For a disease such as breast cancer, the degree of surgical intervention is prescribed depending on the form of the disease, assessing all the possibilities for maximum preservation of the organ, muscle tissue and lymph nodes.

Organ-preserving

Sectoral resection. With this intervention, the tumor is removed along with the entire segment in which it is localized. If necessary, excision of axillary lymph nodes is performed.

Quadrantectomy. The operation resembles a sectoral one, in which the breast cancer is removed along with a large amount of adjacent tissue.

Subcutaneous mastectomy. All glandular tissue is completely removed, but the skin and fiber are preserved. The nipple is excised or left depending on the lesion.

Radical (mastectomy)

Conventional mastectomy. The organ is completely removed.

Modified radical. The gland is removed together with the fascia of the pectoral muscle and the lymph nodes in the armpit.

Extended. Complete removal of the gland, along with the pectoral muscles and lymph node collectors in the axillary region.

Skin-plastic. It is carried out in the same way as radical, but with the preservation of a skin flap to cover the wound or a future prosthesis.

How is the treatment carried out?

The surgical intervention is carried out in stages. First, part of the breast, or the entire mammary gland with the lesion localized in it, is removed. Then the axillary and subscapular lymph nodes are excised.

After the operation, you can get up, in the absence of complications, already on the second day, the stitches are removed after 10-14 days, and after 3 weeks you will be able to move freely. After the operation, drainage is placed for three days, and painkillers are used.

Selection of surgical intervention

Surgery for a diagnosis such as breast cancer at an early stage, in the absence of breast cancer, is usually prescribed as sparingly as possible, since there is no risk of relapse of the disease. Sectoral resection or quadrantectomy is usually used. In some cases, other options may be offered, especially in the presence of a tumor process with high cell differentiation.

When and, various forms of mastectomy are performed, including its radical version, since an advanced process leads to the formation of metastases and damage to regional and then distant lymph nodes. But even with this, it remains possible to restore the appearance with the help of plastic surgery and the installation of a prosthesis.

At the moment, the only and priority method of treating a disease such as breast cancer remains surgical intervention at any stage of this pathological process, and the types of surgical treatment can only be offered by a specialist, taking into account:

• the presence or absence of contraindications for the use of radiation therapy in the patient;
• the degree of importance of maintaining the aesthetic appearance of the breast;
• the woman’s desire to undergo surgery to restore her shape in the future;
• the ability to prevent further relapse of the disease using minimal intervention.

Breast cancer is a relatively favorable diagnosis; as a rule, it is detected at an early stage, and the operation is successful without causing significant physical and aesthetic losses.

Price

The cost of breast cancer surgery in a good clinic ranges from 11 to 18 thousand euros. This includes anesthesia, surgical consultation and hospital stay.

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The treatment plan is drawn up taking into account the stage of the tumor process, the morphological structure of the tumor, the patient’s age, concomitant diseases, and the general condition of the patient.

The following treatment methods are used: surgical, combined (combination of surgery with radiation or drug therapy) and complex (combination of surgery with radiation, drug and hormone therapy).

The surgical method of treatment dominates. Depending on the volume of tissue removed, the following types of operations are distinguished.

1. Radical mastectomy according to Halsted - removal of the affected mammary gland along with the pectoralis major and minor muscles and their fascia, subclavian, axillary and subscapular fat tissue with lymph nodes (Fig. 1). Recently, the indication for Halstead mastectomy was breast cancer of all stages, but in recent years it has been used only for tumor infiltration of the pectoralis major muscle.

Rice. 1. Radical mastectomy according to Halsted:

a - projection of the skin incision;

b - volume of tissue removed - fiber along with lymph nodes [subclavian (1), axillary (2) and subscapularis (3)] and pectoral muscles: minor (4) and major (5).

2. Extended axillary-sternal radical mastectomy involves single-block removal of the mammary gland with or without pectoral muscles, subclavian-subscapular and axillary fatty tissue, as well as parasternal lymph nodes and internal mammary vessels, for the removal of which two or three costal cartilages are resected along the parasternal lines. The indication for extended mastectomy is cancer located in the internal and central parts of the mammary gland at stages I, IIA, IIB. The detection of multiple axillary metastases during mastectomy makes excision of parasternal lymph nodes impractical, since this does not affect the prognosis of the disease. Currently, a much less traumatic technique for video-assisted thoracoscopic parasternal lymphadenectomy has been developed.

3. Superradical extended mastectomy involves the removal of not only the parasternal collector, but also the lymph nodes and tissue of the supraclavicular region and the anterior mediastinum. This operation does not increase the survival rate of patients and was abandoned by all surgeons.

4. The Patey-Dyson modified radical mastectomy (Fig. 2) differs from the Halstead mastectomy in preserving the pectoralis major muscle or both pectoralis muscles. The rationale for leaving the pectoral muscles was the rarity of observations of tumor growth. When leaving the muscles, mastectomy is less traumatic and with less blood loss, and the postoperative wound heals better. Preservation of muscles leads to better cosmetic results and does not affect the function of the upper limb. Therefore, such operations are called functionally sparing. Indications for them are not only the initial, but also locally advanced stages of the disease, provided there is no tumor infiltration of the pectoral muscles.

Rice. 2. Patey-Dyson mastectomy. The mammary gland is removed along with the pectoralis minor muscle and regional lymph nodes

5. Mastectomy with axillary lymphadenectomy can be either radical or palliative surgery. The indications for such an operation are the initial (I-IIA) stages of the disease when the tumor is localized in the outer quadrants of the mammary gland in elderly weakened patients with severe concomitant diseases.

6. Simple mastectomy - removal of the mammary gland with the fascia of the pectoralis major muscle from an oncological point of view cannot be classified as a radical oncological intervention. Indications for such an operation are a disintegrating tumor, advanced age of the patient, and severe concomitant diseases.

7. Sectoral resection of the mammary gland as an independent method of treatment for breast cancer has no justification for implementation. It is possible for single foci of non-invasive (in situ) cancer.

Until recently, oncologists involved in the treatment of breast cancer paid attention only to 5- and 10-year survival rates. Few people paid attention to the fact that for most patients, a cure for cancer is achieved by performing mutilation operations, such as Halsted and (to a lesser extent) Patey-Dyson mastectomies.

Such operations have a significant drawback - the loss of the mammary gland, which for many, especially young women, leads to severe psychological trauma, often having a detrimental effect on their entire future life. This factor was one of the main motives for the development of new approaches to the treatment of breast cancer associated with reducing the volume of surgical intervention on the mammary gland, the development of organ-preserving surgery - radical resection of the mammary gland - in terms of combined or complex treatment.

The operation consists of removing a sector of breast tissue with a tumor, departing from its edges by at least 3 cm, in a single block with fatty tissue of the axillary, subscapular and subclavian areas with lymph nodes. During these operations, based on aesthetic expediency, it is necessary to preserve at least two-thirds of the volume of the gland. To perform such operations, it is important to comply with patient selection criteria. The main criteria are: stages I and IIA of the disease, tumor size no more than 3 cm in greatest dimension, slow rate and monocentric nature of tumor growth, as well as the patient’s desire to preserve the mammary gland. Meeting these criteria limits the widespread use of such operations.

The desire to achieve restoration of the shape and volume of the organ simultaneously with performing radical oncological intervention for breast cancer is a promising direction for modifying oncological operations. Therefore, the achievements of plastic surgery in breast reconstruction have become extremely relevant. Breast reconstruction can be performed either simultaneously with radical surgery on the gland, or in a delayed version. Simultaneous reconstruction, although it increases the severity and duration of the surgical intervention, at the same time does not subject the patient to “psychological collapse” associated with the loss of the mammary gland.

Modern methods of breast reconstruction after mastectomy face the difficult task of reshaping the shape and volume of the gland and creating the nipple-areolar complex. Therefore, radical surgical interventions on the mammary gland have been developed, alternatives to mastectomies, which are performed with simultaneous reconstruction of the gland.

1. Subtotal radical resection of the mammary gland, in which 75 to 90% of the breast tissue with the tumor is removed, along with fatty tissue and lymph nodes of the axillary, subscapularis, subclavian regions, preserving both pectoral muscles, the nipple-areolar complex, the inframammary fold and part mammary gland.

2. Subcutaneous radical mastectomy with or without removal of the nipple-areolar complex - all glandular tissue of the mammary gland is removed in a single block with fatty tissue and lymph nodes of the axillary, subscapular, and subclavian areas.

The resulting breast defect is restored with skin-muscle or muscle flaps of the latissimus dorsi muscle, skin-fat flaps on the rectus abdominis muscle, endoprostheses or a combination of them with autografts (Fig. 3). The ability to perform reconstructive operations with good results not only helps to popularize them among surgeons and patients, but also stimulates the improvement of methods of reconstructive plastic surgery.

Rice. 3. Photo of a patient after subcutaneous mastectomy with simultaneous breast reconstruction

Savelyev V.S.

Surgical diseases

Women have faced this problem before, but the treatment methods were ineffective and practically non-existent, leaving the person alone with his problem. Today, various types of operations are performed to eliminate malignant tumors, which can either completely cure or alleviate the patient’s condition.

Modern medicine is still imperfect in the fight against breast cancer, but it has some leverage. For cancer, surgery is performed to eliminate the tumor and the various consequences of its appearance. Performing surgery at an early stage allows you to completely eliminate the disease. Carrying out surgical intervention at a late stage can at least improve the person’s well-being during the remaining months or days.

Surgery for breast cancer is the only treatment method that allows a person to recover. Moreover, before and after the operation, radiation and chemotherapy are carried out as prescribed by doctors.

The following stages of treatment are important:

1. Diagnostics.
2. Before surgery.
3. Postoperative period.

At the diagnostic stage, a woman undergoes mammography, MRI, biopsy and ultrasound. Women after 40 years old also undergo an ECG. Even during the operation, additional diagnostic measures are carried out to determine the nature of the tumor and its effective removal.

Types of operations to eliminate malignant tumors

To decide on the method and type of surgery to eliminate a malignant tumor, you need to familiarize yourself with all the diseases and current conditions of the patient:

• History of illnesses for the entire period of life.
• Previous interventions.
• Existing allergies.
• Chronic diseases.
• Dietary supplements and medications taken.

There are such types of operations in the treatment of oncology, which depend on the nature and severity of the disease itself:

1. Organ-preserving operations. Prescribed for cancer at stages 1-2.
2. Reconstruction method. Appointed to restore the functions or external shape of a removed organ. We are talking about plastic surgery.
3. Mastectomy – . A radical mastectomy can be used, when the breast and muscles and tissue are removed. The degree of removal of fiber and muscle depends on the volume of the lesion.
4. Preventive operations. They are carried out in case of suspicion of cancer development in existing formations.
5. Diagnostic operations. They allow us to learn more about the nature of the tumor at the preoperative stage.
6. Cytoreductive operations. They are prescribed to remove the tumor followed by chemotherapy and radiation.
7. Palliative interventions. Prescribed for cancer in the final stages, when the tumor can no longer be completely removed or radical surgery can lead to serious risks.

The doctor focuses not only on medical indications when choosing the type of operation, but also on the following factors:

• A woman's willingness to undergo plastic surgery in the future.
• A woman’s intention to get rid of the mammary gland where the tumor has formed.
• Radiotherapy.
• Contraindications.

The operation to remove the tumor takes place in the following stages:

1. Removal of the affected mammary gland.
2. Removal of affected lymph nodes in the armpit and sometimes in the subscapularis.

Possible complications

Correct adherence to all measures in the postoperative period allows you to avoid possible complications. The main stages after the operation are:

• The operation is performed under general anesthesia and the patient is placed in the recovery room.
• Monitoring her blood pressure, pulse, breathing until the moment she wakes up.
• Upon regaining consciousness, the woman is placed in a regular ward.
• After the final anesthesia, the patient is given painkillers by injection.
• If a drainage system was installed, then it is removed on the 4th day.
• Constant dressings are carried out even after discharge from the hospital.

If some measures are not taken, then various complications arise after removal of the malignant tumor. They may be:

1. Inflammation of a wound that is poorly treated. This can be determined by swelling, redness of the wound area, and the appearance of pus.
2. A hematoma that occurred as a result of a poorly performed operation or due to prolonged bleeding. This can be determined by the accumulation of blood in the operated area, swelling and slow healing of the wound. Serous fluid may accumulate.

In both cases, the wound should be opened to drain the fluid.

Recurrence of breast cancer

Unfortunately, doctors cannot guarantee a complete recovery after the operation. Depending on luck, in some the cancer does not appear again, in others the breast cancer recurs. This can happen both before and after surgery. Relapse occurs locally, regionally or distantly.

A local relapse occurs in healthy cells after partial resection of the mammary gland. It may be in scars from a total mastectomy. It can be identified by the following signs:

1. Changes in the skin.
2. The appearance of a lump in the chest where the operation was performed.
3. The appearance of discharge from the nipple.
4. Redness of the scar.
5. Development of inflammation of the skin.

A regional relapse manifests itself in the malignancy of the cells of the lymph nodes located next to the gland that was affected.

Distant relapse is a consequence of cancer metastasis. Various organs can be affected, most often the liver, lungs or bones. You can determine it by the following characteristics:

1. Labored breathing.
2. Constant cough.
3. Increasing pain in the mammary gland or hypochondrium.
4. Migraine attacks.
5. Loss of appetite and weight loss.
6. Cramps.

What are the reasons for breast cancer recurrence?

• If the formation was large.
• If radiotherapy was not performed after surgery.
• If numerous lymph nodes were involved in the process.
• If healthy tissue involved in the cancer process was not completely removed.
• If the patient is less than 30 years old (in this case, the risk of metastases increases).

Treatment

Additional treatment methods prescribed before and after surgery are:

1. Radiation therapy.
2. Chemotherapy. The use of cytostatics that affect malignant cells.
3. Radiotherapy. Impact of high-energy rays on atypical cells.
4. Hormone therapy. It is carried out when identifying the dependence of the tumor on the level of hormones.

If diagnostic measures show the presence of a relapse, then repeated surgery may be prescribed to remove the changed tissue.

If a hormone-dependent tumor is detected, an oophorectomy (removal of the ovaries) is performed, which helps prevent tumor growth and metastasis. This method can also be used to identify mutation cells even before the appearance of cancer. Statistics show a reduction in the risk of cancer after this operation, but it is associated with the woman’s inability to have children in the future, which becomes a difficult decision. In this case, you can resort to reducing ovarian function.

At stage 4 cancer, the ovaries stop working. At stage 3, ovarian function is suppressed or an oophorectomy is performed. This method is effective, but irreversible, since infertility occurs. After removal of the ovaries, the likelihood of developing breast cancer is reduced by 50%.

Forecast

Doctors have a great responsibility for preserving the lives of patients, given the direct desire of the women themselves to preserve their round and beautiful forms. You will have to sacrifice something for the sake of recovery. Prognosis is often favorable if operations are performed in the early stages of the disease.

Two principles are followed here:

1. Ablastics is the complete removal of all malignant cells and preservation of exclusively healthy tissue.
2. Antiblastic treatment - compliance with all measures so as not to injure neighboring healthy tissues and cells and not start the process of their change into a malignant tumor.

Life expectancy largely depends on the actions of doctors who carry out treatment and surgery, as well as on the measures taken by the patient who notices breast cancer.

Nowadays, methods of non-operative treatment of malignant neoplasms of the mammary gland have been studied in detail and are widely used. Significant advances have been made in the diagnosis of cancer of the gland in the early stages. All this led to an improvement in the long-term prognosis of life of cancer patients and a decrease in the proportion of surgical interventions on the mammary gland. Despite this, surgery, particularly radical mastectomy, is still one of the main treatments for people with breast cancer.

The concept of mastectomy and its types

Mastectomy is a breast cancer operation during which the following is removed:

The operation is performed if a woman has been diagnosed with a neoplasm in the mammary gland or a purulent inflammatory process that does not respond to effective conservative treatment. Mastectomy can also be performed in men if they develop gynecomastia, which is manifested by enlargement of the mammary gland with hypertrophy of adipose tissue and glands, for the purpose of cosmetic correction.

Some patients undergo mastectomy at their own request when they are found to have genes that cause malignant degeneration of breast cells.

The main contraindications to the operation are:

What types of interventions are there?

Radical mastectomy can be performed in several ways:

Some practitioners also use the term unilateral mastectomy to refer to one-sided mastectomy in a person, as opposed to a bilateral mastectomy, where both breasts are removed.

However, this concept is more used in veterinary medicine (removal of the mammary glands of an animal located on one side).

The concept of prophylactic mastectomy

Prophylactic mastectomy is performed after special studies are carried out, during which the presence of mutations in the BRCA genes is established, which contribute to the abnormal growth and development of normal breast cells and thereby cause their malignant degeneration.

Prophylactic mastectomy can also be performed in patients who have previously undergone a course of therapy without surgery, which did not produce satisfactory results.

During the operation, those gland tissues whose cells can be sources of tumor growth are removed. Unlike radical mastectomy, after preventive surgery, the skin of the breast is preserved. This facilitates future breast reconstruction operations without any problems. Often, a prophylactic mastectomy is performed at the same time as breast reconstruction.

Prophylactic mastectomy can significantly reduce the risk of developing breast cancer, but, nevertheless, cases have been described in which the disease recurred after this operation.

Complications that occur after a mastectomy

Immediately after a mastectomy, bleeding from the surgical wound, lymphorrhea (flow of lymph from lymph nodes damaged during surgery), and suppuration of the surgical wound may develop.

Long-term consequences include lymphostasis, in which the outflow of lymph through the lymphatic vessels is disrupted, and, as a result, swelling of the arm occurs; impaired mobility in the shoulder joint on the side where the mastectomy was performed.

Complications that arise in the patient’s psychosexual sphere are not uncommon: depression and feelings of inferiority associated with the presence of a postoperative breast defect; difficulties in establishing contacts and communicating with people of the opposite sex; problems with sexual activity while maintaining sexual function.

Organ-conserving operations and postoperative recovery

When performing organ-conserving operations on the mammary gland, it is necessary, in addition to the tumor focus, to also remove healthy tissue around it with a diameter of at least two centimeters. Organ-conserving operations do not involve the removal of a large volume of unchanged tissue. After performing this type of operation, it is necessary to quickly send the excised tissue for histological examination in order to differentiate for the presence of a malignant process.

Organ-conserving operations are performed in conjunction with radiation therapy or chemotherapy. Without prescribing auxiliary therapy, that is, as an independent type of treatment, it is performed either in elderly people or in the presence of a small tumor, the growth of which is not observed.

In practice, an operation called lymph node dissection is also used. During such an intervention, only lymph nodes are removed in isolation and subsequently undergo histological examination. As a rule, the lymph node closest to the tumor is removed in order to avoid more trauma.

During the patient's hospital stay, the main function of medical rehabilitation is the prevention of possible complications after surgery.

Since a radical mastectomy is aimed at removing an organ, it often results in a cosmetic defect in the breast, which brings significant discomfort to patients both psychologically and aesthetically. This problem is solved with the help of surgical and orthopedic measures.

Restoring the shape of the breast is usually carried out simultaneously with a mastectomy.

Although reconstruction can also be performed in the postoperative period. The essence of this type of operation is to create a flap, the starting material for which is taken from the back, buttocks, anterior abdominal wall of the patient, or implantation of a prosthesis.

Of no small importance in the postoperative period is the psychological rehabilitation of patients, which should be carried out in conjunction with the above measures by a competent psychologist.

Independent restoration of mental state and social connections is realized only in a small part of patients after surgical treatment of breast cancer. Most patients, to one degree or another, need professional assistance in postoperative rehabilitation, that is, a system of medical, psychological, social and other measures.

The rehabilitation process begins from the moment of the first contact with a specialist and continues by establishing close psychological contact between the patient and the doctor for further psychological support throughout the entire period of treatment.

A good treatment result, the opportunity to perform reconstructive operations, as well as the help of a psychologist contribute to faster and better psycho-social adaptation of the patient.