One of the common operations in medicine is breast removal or mastectomy, which has several different techniques.
Mastectomy is a radical removal of part of the breast surrounding tissue, using surgery. Depending on the extent of the cancer, removal of the mammary gland can be complete or partial.
Indications for breast removal
A mastectomy is performed if a woman is diagnosed with benign or malignant tumor in the chest area. The procedure is often prescribed if a woman has a family history of a risk of developing a breast tumor.
In addition, if there is a possibility oncological pathology (aggressive cancer) or the following indications for surgical surgical intervention:
- Inflammation in the mammary glands.
- Lack of chemotherapy options.
- Education large sizes and unknown character.
If during pregnancy a woman is diagnosed with cancer, and it is not possible to carry out standard radiation (so as not to harm the child), a mastectomy is prescribed.
Is it possible to avoid surgery?
Removal of the mammary gland is prescribed only if it is laboratory proven that benign tumor develops into malignant, and this threatens with serious consequences for the woman.
Therefore, for an accurate diagnosis, a breast biopsy is performed.
If the diagnosis is not confirmed, surgery can be avoided.
Otherwise under ultrasound examination A small piece of tissue is removed to be sent to study the presence of atypical cells.
Only after confirmation of the diagnosis does the attending physician prescribe planned training and surgery. Otherwise, the specialist prescribes effective treatment and standard therapy methods.
Types of breast removal surgery
Depending on the individual indicators, the degree of development of the oncological disease, the doctor will be guided by a certain technique of the surgical procedure.
The accuracy of determining surgical intervention depends on the following characteristics:
- Patient's age.
- Stage of the disease.
- Involvement of surrounding soft tissues and lymph nodes.
- Location of the tumor.
- Breast size.
- The presence of chronic pathologies.
- General condition of the patient.
Today, many doctors practice choosing treatment methods together with the patient. Thanks to the development of new techniques and equipment, in many cases, the patient is able to completely maintain the aesthetics of her breasts. If this is not possible, the doctor suggests that women install implants. Innovations in the field of medicine today make it possible to carry out this organ-preserving procedure while preserving the mammary glands. In this case, the essence comes down to partial removal of the breast at the location of the malignant tumor. The technique allows you to completely excise the cancerous tumor, but at the same time maintain an aesthetic appearance. appearance woman's breasts, maintain milk activity and reproductive function.
Lumpectomy
The minimally invasive procedure involves sectoral resection or segmental and excision of the mammary glands.
Features of the operation:
- This procedure is quite common for patients with small cancers that are detected at an early stage. It allows you to preserve the mammary glands, breasts in her natural form, so it suffers less emotional condition women, the patient’s rehabilitation period is significantly reduced.
- To prevent recurrent cancer, specialists prescribe radiotherapy after lumpectomy. In most situations, such a comprehensive technique allows you to achieve excellent results, completely getting rid of problems.
Quadrantectomy
If cancer tumor size exceeds 2.5 cm. A quadrantectomy procedure is prescribed, during which partial excision of the mammary gland occurs, at least 1/4 of the part. But, in addition to this, the doctor must remove the lymph nodes from the armpit.
As rehabilitation, to prevent relapse, a course of radiation therapy is prescribed.
Mastectomy
It is the most common breast excision operation in women diagnosed with cancer. In this case, the glands, lymph nodes and nodes in the armpit area are removed.
But, despite the fact that a woman’s breasts are removed, her aesthetic appearance can be easily restored using modern methods plastic surgery. Of course, in order to prevent the recurrence of cancer, a course of chemotherapy and radiation is prescribed after a mastectomy. Otherwise, there is a high probability of relapse and subsequent complications.
The mastectomy procedure, depending on the patient’s individual indications, can be performed using 4 main methods:
Possible risks
Despite the fact that many types of procedures are minimally invasive, it is nevertheless an operation and, like any surgical intervention, has risks:
Contraindications
Before the procedure, a woman must familiarize herself with the list of restrictions and contraindications:
- Small breasts (it is difficult to get plastic surgery).
- Collagen-vascular diseases.
- The size of the seal exceeds 5 cm.
- Multifocal diseases.
- Histological diseases.
In each specific case, the doctor conducts a detailed consultation.
Preparing for surgery
The procedure for excision of part of the breast requires careful and lengthy preparation, both physiological and moral.
Let's consider the basic rules of preparation:
Survey
Before the date for breast removal is set, the patient will be prescribed a number of tests and examinations that will help make an accurate diagnosis:
Before removing the mammary gland, the anesthesiologist may perform some manipulations in order to select a suitable anesthetic substance, depending on individual indications and age.
How is a mastectomy performed?
At the very beginning of the breast removal, the patient will be given an anesthetic to completely numb the entire procedure.
On average, breast removal can last 2-3 hours, no more. Longer operation is carried out only if reconstruction therapy is immediately planned after mastectomy.
The essence of the breast removal procedure is as follows:
Anesthesia
General anesthesia is performed, the woman is unconscious and the entire procedure for removing the mammary gland is completely painless.
What stitches are used?
Almost always, if a woman has no individual contraindications, the surgeon applies cosmetic light sutures.
This solution allows you to further speed up recovery and wound healing. You don't need to remove them yourself.
Doctors often use high-quality, hypoallergenic threads from B BRAUN, manufactured in Germany, or Johnson & Johnson, Covidien.
Their advantage is that they dissolve over time during the woman’s rehabilitation and do not leave behind stitches or scars.
Cosmetic stitches have a more aesthetic appearance, look much neater, and in the future this will cause a psychologically traumatic situation for the woman after surgery.
Postoperative period
Immediately after breast removal, the patient should be in inpatient conditions hospitals so that the doctor constantly monitors the healing and restoration of tissues. After 3-4 days, if everything went well, the woman can be discharged home, subject to systematic medical examinations.
Before discharging a woman, the surgeon conducts a thorough examination of the sutures and the level of healing. The doctor must also remove the drainage and carry out antiseptic treatment of the wound and perform proper dressing.
Subsequent treatment and recovery after breast removal takes place at home; it is mandatory to take the following medications during the rehabilitation period:
- Analgesics necessary in the first few days of discharge to eliminate pain and discomfort after surgery.
- Antibiotics are needed after removal of the mammary gland, which prevent the development of infection and inflammatory process.
- Sutures can only be removed 10-14 days after the surgical procedure.
First days
Initially after breast removal, you may experience some unfavorable symptoms that you should definitely be aware of:
Possible complications
The development of some complications is not uncommon after breast removal; you need to familiarize yourself with them in advance:
It is worth noting that removal of mammary glands is an unpleasant and painful procedure, which affects the aesthetic appearance and the formation of some discomfort.
How to avoid consequences?
To prevent the development of complications and adverse symptoms, you should strictly follow the doctor’s recommendations and follow the prescribed rules.
The presence of pathologies in postoperative period requires knowledge of how to deal with this:
- Women during the post- and pre-operative period should avoid exposure to ultraviolet rays on their breasts., which means limiting your time in the sun or visiting a solarium. In general, this rule also applies to healthy women.
- Minimize physical exercise, loads, avoid stressful situations. To recover quickly, a woman should remain in a state of peace and try to surround herself with positive emotions. This will help you get back to normal after breast removal.
What about beauty?
Due to the fact that the procedure for removing the mammary glands in many cases involves complete excision of the breast, women have a question: what about beauty and aesthetic appearance? Violation of integrity and cosmetic defects cause patients many problems psychologically.
Breast plastic surgery and the work of a professional plastic surgeon will help solve this situation.
Orthopedic measures will also be of considerable importance in this matter. Often, if there are no restrictions, breast plastic surgery and reconstruction are carried out in parallel with the procedure for removing the mammary glands.
Although in some cases, according to a doctor’s indication, breast reconstruction is carried out already in the postoperative period. The principle of breast reconstruction is to create a special flap from the original material for implantation of a prosthesis. Often, such a flap is taken from a woman’s back or buttocks.
Psychological moment
In combination with all the procedures described above, after removal of the mammary gland, psychological rehabilitation of the woman must be carried out. For this purpose, clinics have a full-time psychologist.
Self-recovery for women is difficult and takes quite a long time, so it is rarely practiced. In this case, the condition may worsen, implant rejection and many other adverse consequences.
In most cases, after removal of the mammary gland, each patient, to one degree or another, needs the help of professionals in the postoperative period, in a specially formed system of social and psychological measures.
Breast reconstruction
Reconstruction of a woman's breasts after removal of the mammary glands will result in the creation of a visible presence. In some cases, at the client’s request, the doctor reconstructs the lost gland.
The second option is more expensive and complex, has a number of contraindications and is therefore used much less frequently.
In the first option of breast reconstruction, the patient can independently choose the size and breast pads, as well as the material itself, textile or silicone, for the manufacture of a removable prosthesis.
Today the majority medical centers is engaged in the manufacture and production of special prostheses for women who have lost breasts. This is a wide range of fabric, silicone prostheses, permanent and temporary prostheses. Depending on the patient’s preferences, it is possible to choose different size and the shape of the new breast.
To ensure that the prosthesis takes root, does not cause discomfort, and subsequently becomes an integral part of the woman’s body, the doctor prescribes the use of orthopedic underwear for the first time after reconstruction.
These are functional and very beautiful sets with special inserts for the prosthesis, wide straps for better fixation.
Breast surgery
Plastic experts claim that the restoration procedure female breast is complex and expensive. But, this is an opportunity for the patient, after removal of the mammary glands, to acquire a healthy and beautiful appearance with the help of her own skin.
The beauty of a woman's breast lifts the mood, improves the emotional and psychological background after undergoing mammary gland removal.
So that the physiological and emotional recovery of a woman goes without problems and side effects, the patient must adhere to the doctors’ recommendations:
On this moment There are many indications for breast removal, both completely and partially. It is defined as complete surgical resection of the tumor.
Removal is performed using modern high-precision instruments by experienced surgeons, and the woman has no reason to worry. In many cases this necessary procedure, and it must be done immediately, despite all the stress factors.
Price
Surgeries to remove breast cancer are performed free of charge according to indications in public clinics.
If the procedure is carried out in private clinics, the average cost will be approximately as follows:
- Sectoral breast resection(removal of breast fibroadenoma) - from 35,000 rub.
- Radical mastectomy — 90000-100000 rub.
- Simultaneous mastectomy and reconstruction with own tissue — 150,000 rub.
- Reconstructive surgery to reconstruct the mammary gland using an anterior flap abdominal wall — 120,000 rub.
- Breast reconstruction:
- Stage 1: Installation of the expander - 90,000 rub.
- Stage 2: Implant installation - 85000-115000 rub.
- Stage 3: Formation of the nipple - 35,000 rub.
A mastectomy is an operation necessary to preserve or prolong the patient’s life. It is indicated in the case of the development of a malignant tumor - sarcoma, lymphoma, cancer. Removal of the mammary gland is necessary, since spreading tumors affect not only the breast, but also neighboring organs: lungs, heart, esophagus.
Over time, the cells spread through the vessels and lymph nodes to other organs and bones, so the task of doctors is to completely remove primary focus and preventing the occurrence of metastases.
Hundreds of thousands of breast removal operations are performed around the world every year. Any woman has a psychologically difficult time accepting the need for such surgical intervention, since breasts are a symbol of femininity and attractiveness, which also performs the function of feeding a child. However, you need to understand that this is sometimes the only chance for salvation.
Indications
In what cases is the breast removed: this question is asked by many patients to the attending physician, hoping that the organ can be preserved.
Removal mammary glands performed in the following situations:
- for breast cancer, starting from the second stage;
- with phlegmon - a purulent process in the gland;
- at fibrocystic mastopathy in case of multiple breast lesions.
Types of surgery
There are several types of breast removal operations; when choosing a specific type, they take into account age characteristics and the patient's health status.
Simple
Happening complete removal tissue affected by the tumor, the capsule and axillary lymph nodes are excised.
Radical
Indicated when the tumor has spread extensively and is removed damaged tissue, regional lymph nodes, as well as the pectoral muscle, which is primarily affected by cancer cells. The incision is closed with a flap of the remaining skin; after the operation, a scar of about 15-20 centimeters remains on the body.
Improved
Involves complete removal of the mammary gland and all affected tissues malignant formation, lymph nodes in the armpits, pectoralis major and minor muscles. An incision is made around the areola; in rare cases, it and the nipple can be saved. Depending on the size of the breast, there may be several incisions.
Preparing for surgery
Deciding on the choice of species surgical intervention is taken by the surgeon together with an oncologist and a plastic surgeon. At this stage, the types of procedures that can be used are determined and other issues that breast amputation implies are resolved.
Some factors require increased attention from specialists, they are:
- patient’s age, menopause;
- general health;
- family history;
- breast size;
- shape and size;
- area of damage and localization of formation;
- presence of other pathological processes in the chest;
- the need for breast reconstruction.
Surgery to remove a breast tumor requires full examination, the complex consists of:
- Breast ultrasound;
- mammography;
- biopsies;
- urine and blood tests;
- blood clotting test;
It is very important to inform your doctor if you are pregnant, if applicable, and if you are taking any medications or herbs that have not been prescribed by a specialist.
How is the operation performed?
The operation to remove breast cancer lasts about 3 hours, the duration increases significantly if it becomes necessary to perform it on the lymph nodes in the armpits. Breast reconstruction after a mastectomy also requires additional time, so you need to expect a longer surgery period.
Operation stages:
- Surgical intervention is performed under general anesthesia and in the presence of an anesthesiologist. The surgeon makes an incision from the inside of the chest to armpit, the length of which is about 20 cm. The direction of the incision may be different if it is necessary to hide scars remaining from previous operations.
- Next, the breast tumor, all damaged tissues are removed and sutures are applied; absorbable sutures or special staples are used for this purpose. To reduce swelling and prevent fluid accumulation, a drain is inserted into the chest.
- To check the area affected by cancer, it is sometimes necessary to send material from the lymph nodes for a biopsy. Upon completion of the surgical intervention, the patient remains under the supervision of a doctor.
Recovery period
After the operation, all vital signs of the body: arterial pressure, heart rhythm and others are under observation. Only after 2-3 days is the woman allowed to get up and walk, but without forcing movements. Full recovery after mastectomy lasts approximately 4-6 weeks, although depending on general condition body and the complexity of the operation performed, this period may last. The stitches are removed after 1-2 weeks.
Women often experience painful sensations in the chest area that haunt them quite for a long time, sometimes sensitivity decreases skin in the operated area. They are prescribed painkillers to reduce pain.
It is very important to monitor the wound in the postoperative period after breast removal, as it can become infected.
Signs of infection are:
- elevated temperature;
- swelling;
- redness;
- increasing pain.
When the first symptoms appear, you should immediately see a doctor, and you should also pay attention to precautions in the period after surgery.
- take a shower or bath before removing stitches;
- undergo physical activity, lift weights;
- be exposed to ultraviolet radiation;
- injections into the arm on the side of the operated breast;
- swim in rivers, lakes, pools (2 months after surgery);
- sleep on your side;
- intimate contacts (1-2 months).
- maintain hygiene, keep your hands clean;
- use antiseptic drugs even in cases of minor scratches, and it is better to try to avoid any injuries;
- wear a bandage to reduce swelling and improve blood circulation;
- massage the arm in the form of stroking movements in the direction from the hand to the shoulder joint.
Life after mastectomy
Every woman who has endured all the difficulties of illness and surgery should know that a new stage in her life has arrived, which will require her to rethink events. Special attention You need to pay attention to your own health and psycho-emotional state.
Rehabilitation after breast cancer is a rather long process that completely transforms a woman’s usual course of life. She receives a disability group; in addition, due to the loss of mammary glands, there is a need for plastic surgery, which consists of breast reconstruction after a mastectomy.
A cheaper analogue is an option that involves creating the appearance of breasts. Modern medicine offers special onlays or removable dentures made of textile or silicone. Such exoprostheses are produced in wide range, so choosing the required size and modification is not difficult.
Special types of bras are available that are designed to secure breast prostheses. These are very elegant and comfortable items, which are equipped with special pockets and wide straps. Women are also offered a choice of swimsuits that will hide external flaws.
A more expensive and complex option is breast reconstruction after mastectomy, which will undoubtedly give confidence and have a positive effect on psycho-emotional state any woman, because now she has breasts that are very similar to a natural organ.
Psychological problems occur in all patients who have undergone breast removal surgery. The formed inferiority complex degenerates into prolonged depression, which negatively affects the quality of life.
In order to prevent the situation from worsening, you need to undergo appropriate training in advance, before the operation, from a highly qualified specialist who will help you cope with a negative attitude. In some cases, antidepressants or sedative therapy are prescribed.
Breast reconstruction
Breast reconstruction is an operation that restores the shape of the breast through the use of various techniques. Modern medicine ensures that plastic surgery is performed immediately after the main operation; for this purpose, a team of oncological surgeons is immediately replaced by a group plastic surgeons. This surgical solution saves the patient from the need for repeated surgery and wearing special prosthetic underwear.
If for some reason it is impossible to carry out reconstruction together with a mastectomy, then plastic surgery is planned after six months.
There are several types of reconstructive techniques:
- Method using patient tissue. Breast reconstruction is carried out by moving tissue with preserved blood flow to the operated area, and rectus abdominis, greater omentum or iliofemoral flaps can be used as donor areas.
- Use of implants or expanders. To create additional volume, special expanders or silicone implants, which guarantee symmetry and shape correction.
- Combined technique. Combines the methods of the previous groups depending on the purpose of the operation. Implants are used to create the required shape, and the tissue deficiency is filled with the skin.
Care and rehabilitation
Rehabilitation after a mastectomy consists of taking measures to exclude the occurrence of complications, as well as gradual recovery motor activity patients. Gymnastic exercises for developing the arm and hand have a positive effect; for these purposes, it is recommended to squeeze a rubber ball, comb your hair, rotate your arms, place your hands connected with a towel behind your back - a movement similar to fastening a bra.
The exercises are performed in a standing and sitting position, starting with the simplest - raising your arms up and to the sides, raising your elbows to the sides and ending with the more complex - placing your hands behind your head or behind your back.
Proper nutrition is also an important issue. It should contain enough calories, but not be fatty, spicy or overly sweet. Instead of animal fats, it is better to consume vegetable fats and limit the use of salt for cooking. The diet should include enough vegetables, fruits, fermented milk products, fish, cereals, meat.
After removal of the mammary glands, patients are prescribed adjuvant therapy, which is aimed at destroying the remaining atypical cells and preventing the development of relapse. If the formation is hormone-dependent, special antiestrogenic agents are used. Women who are in menopause are additionally prescribed special maintenance medications. Pharmaceutical industry offers a number of medications with anti-cancer effects that block the occurrence of relapse and stabilize the pathological process.
Possible complications
Unfortunately, various complications often appear in the postoperative period. Their occurrence is facilitated by:
- The patient's age is over 60 years.
- Excess body weight.
- Large volume of mammary glands.
- Availability concomitant diseases. For example, diabetes mellitus, arterial hypertension, chronic heart and lung diseases.
- Hormonal or radiation therapy given before surgery.
In the initial postoperative period, the following complications may occur:
- lymphatic drainage;
- infection and suppuration of the wound;
- marginal necrosis and divergence of flaps of connected tissue.
This situation occurs due to the removal of lymph nodes and the impossibility of ligating all vessels due to their invisibility. If lymphorrhea lasts for more than one month, then negative changes occur: a seroma is formed in the axillary zone in the form of a cavity, which is filled with lymph. Subsequently, to remove it, repeated surgery will be required.
To subsequent late complications can be attributed:
- lymphostasis – impaired lymph outflow;
- disruption of the outflow of venous blood, occurring as a result of narrowing or closing of the lumen of the veins in the subclavian or axillary zone;
- shoulder contracture.
All these complications are accompanied pain syndrome which is very often the cause of disability.
Mastectomy in modern medical practice is performed at a high professional level with the participation of qualified specialists; new technologies are used that allow simultaneous breast reconstruction. Strict medical indications are required for surgical intervention.
Video
You will learn how to choose a breast prosthesis after a mastectomy in our video.
Our expert is an oncologist-mammologist of the Federal scientific and clinical center specialized types medical care and medical technologies FMBA of Russia, doctor highest category, Candidate of Medical Sciences Yuri Khabarov.
Operation
All types of breast removal operations can be reduced to two types of intervention:
- removal of the entire gland along with adjacent lymph nodes;
- removal of part of the gland, but also with lymph nodes.
The lymphatic system is the main route for cancer cells to spread in the body. And if a tumor has arisen, nearby nodes will be the first to “catch” these cells.
Removing the entire gland, although it seems like a more traumatic operation, actually brings better results. With partial removal, the likelihood of tumor reappearance is many times higher. In addition, partial removal must be accompanied by radiation therapy, after which there are frequent cases of lymphostasis - a violation of the outflow of lymph, due to which the arm on the operated side swells.
Today, when removing the gland, the surgeon does not affect pectoral muscles, as this has been done for almost a hundred years, so the arm on the side of the diseased gland is not limited in mobility, it retains the same functionality.
The operation lasts about an hour and is performed under general anesthesia.
First days
The patient is in the hospital for 15 days. On the first day, in order to avoid complications - the formation of blood clots in the vessels of the legs or the development of pneumonia (older people are especially susceptible to complications) - the patient should sit down, and then get out of bed and walk. The patient does not feel pain. At first she receives painkillers, but not very strong ones. In such operations it is never prescribed narcotic drugs, which are prescribed after surgical interventions on abdominal cavity or chest. And by the time of discharge there is no longer any need for painkillers. All days of the patient's hospital stay axillary region there is drainage for lymph drainage and rib cage tightly bandaged with an elastic bandage so that the skin on the operated site fits tightly to the muscles and lymph does not collect here.
Sometimes lymph continues to accumulate after the stitches and drainage are removed, after discharge from the hospital. It has to be removed from time to time using a puncture by a surgeon at the place of residence. How long the lymph will travel depends on individual characteristics body. U fat people this happens a little longer than in thin people.
Treatment continues
After the operation, the patient will undergo further treatment. The oncologist decides what it will be depending on the extent of the process (whether there were metastases in the axillary lymph nodes) and the sensitivity of the tumor to hormones. If the tumor was hormone-dependent, hormone therapy is prescribed. This treatment is the easiest: the patient will take 1-2 tablets of the hormonal drug per day for several years.
It does happen, although not often, that there is such a happy option when it is enough to just surgical treatment. This happens if the tumor was caught at the 1st stage of development and there were no metastases in the lymph nodes. After the operation, the patient only needs to undergo dynamic observation by an oncologist.
Some patients will have to undergo chemotherapy. The 1st course is often carried out in the hospital, and upon discharge the patient receives recommendations on further treatment at the oncological dispensary at the place of residence. And in some regions the most modern treatment: targeted therapy (from English word target - “target”), when the drug acts precisely on cancer cells and blocks their growth.
Let's take care of beauty
It is not always possible to simultaneously remove the mammary gland and replace it with prosthetics. In such cases, Dr. Khabarov tells his patients: “First we will deal with saving lives and preserving health, and at the 2nd stage - aesthetics and beauty.” As a rule, 9-12 months after removal of the mammary gland, you can install an implant and even take the opportunity to make both breasts larger or, conversely, smaller, thus correcting nature’s plan. And if a woman knows that very soon she will be able to regain her attractiveness, she will not experience depression.
Elderly women (and among cancer patients they are the majority) can and even need to purchase special underwear with removable dentures. This must be done not only for aesthetics, but also to balance the load on the spine.
Active women return to their normal lives immediately after discharge from the hospital, the rest - after about a month.
Sometimes, when the weather changes or after heavy physical activity, a woman may feel nagging pain in the area of the removed gland.
What can they do
Do your usual housework.
Play sports (as soon as the lymph stops accumulating). In this condition it is good to swim in the pool. Now they produce swimsuits with prosthetics inserted into the cups; they do not even allow one to suspect that the woman has undergone surgery.
Have an intimate life immediately after discharge from the hospital.
Give birth to. But it is better to first discuss this decision with an oncologist and gynecologist.
What not to do
At first, carry a weight of more than 2-3 kg in your hand on the side of the removed gland.
Taking a steam bath and sunbathing on the beach - now you will have to give up this forever.
Give any injections in the arm from the side of the removed mammary gland, put IVs on it, take blood from it for tests. For all these manipulations there is a healthy hand.
What causes breast cancer?
- Heredity.
- Hormones.
- Microtrauma of the gland.
- Degeneration of fibroadenoma - a benign tumor.
- Degeneration of cysts. And they appear when the mammary gland does not fulfill its purpose: a woman does not give birth and does not feed children every year.
- Impaired milk flow when feeding a baby.
There are many factors that play a role in the development of cancer; it is impossible to single out just one to try to avoid it. There is no prevention that would 100% protect a woman from this disease. Therefore, the only way to protect yourself is to get checked regularly. Once a year, go to a mammologist, have a mammogram, and for women under 35 years old, have an ultrasound of the breast.
In addition to chemotherapy, women with breast cancer often undergo a mastectomy, an operation to remove the breast. Sometimes only the tumor is removed, but some have to remove the entire breast.
Four women who suffered radical mastectomy, told "Paper", how the operation changed their attitude towards themselves, why they decided not to get implants and how their loved ones reacted to it.
Irina (name changed), 47 years old
Programmer from Moscow
I have two children, wealthy family, I'm very athletic. And I went to doctors mostly with injuries. I was torn brachialis muscle, and I first treated my shoulder, then I found something in my chest, and the doctors told me that it was most likely a bruise. But just in case, we did a test. This was in December 2016. And suddenly they call from the clinic and say that I need to come urgently. And so they insist.
For a long time I could not believe what they were telling me, I could not understand the meaning of the words “atypical cells”. Then I talked with the surgeon, he said that the diagnosis does not raise the slightest doubt, the only question is what type it is and what treatment regimen. I remember the state of absolute panic and confusion: what to do, where to go? The panic lasted probably a week.
At work they said that they would pay for my treatment at Herzen (Moscow Research Oncology Institute named after Herzen - approx. "Papers"). The operation took place on August 4, 2017. At first, I was determined to immediately undergo one-step reconstruction, because I simply could not imagine how to live without breasts. I panicked from the pictures I saw on the Internet: I looked at them and cried.
But the surgeon said that he did not recommend doing it at once: I have the third stage with metastases - the reconstruction will be damaged by radiation therapy. Technically, reconstruction can be done six months after therapy. I was determined to restore my breasts, but only with my own flap (a reconstruction method in which the patient’s own tissue is used instead of implants: part of the muscle from the anterior abdominal wall or a flap from the back - and moved to the chest area - approx. "Papers"). However, later I was already tired of the treatment I had undergone: eight chemo treatments are very difficult. If after the first chemotherapy I was “out of shape” for the first two days, then after the eighth I was not in shape at all for ten days.
This is such a vicious treatment that the body has not yet been restored. Understanding this slows me down from doing anything with my breasts. And when asked to do the most expensive operation, the surgeon said that it was not suitable for me. And then, there are a lot of details that you learn about only by delving into the topic. For example, I underwent radiation therapy and lost a lot of weight. They told me it was good that I didn’t get an implant: if I lost 15 kg and changed my body, it could have ended up on my back.
Illustration: Elizaveta Semakina / “Paper”
They recommend that I get implants, but I don’t want to: I hope to go back to swimming and aikido, and [if physical activity] they can be injured, torn inside. And the question is their durability. What will happen to them in 10 years, in 20? I am not an old person, it bothers me that this thing will live inside me for a long time. Most likely, I will not have the operation.
When I had my sixth or seventh chemo, a woman was brought into the ward who did not have a radical mastectomy. Now she has metastases throughout her body. How long does she have left and what can she do? It's painful and scary to look at her. I decided for myself that this was a hint from above: [this is] what will happen if I regret removing my breasts.
I was scared until the very end; I couldn’t even look at myself in the mirror after the operation. Now I'm used to it. My husband said that it was absolutely unimportant for him, but these were not the words I wanted to hear. When it was really hard, I called on the phone hotline. And I want to say that the employees fulfill their mission perfectly. When I was on the verge of despair, I heard [from them] the words that a person probably wants to hear at such a moment.
Suddenly I realized that I was not alone. The girls from the support group said that this [breast removal] was just bullshit, that of all aspects of treatment it was the least traumatic.
Now I go to the pool and still can’t undress in front of everyone: I hide and change clothes separately. I can’t undress in front of my husband, although he assures me that it doesn’t matter. It matters.
I managed to cope with the operation, but the long treatment greatly changes my worldview. Now I value myself, life has gained bright colors. I no longer freak out about unwashed floors, unironed laundry - to hell with that. I couldn’t do this for a year and realized that [the family members] would live like this; I won’t cook a three-course dinner - they’ll cook dumplings for themselves.
Most importantly, I would like to stop being afraid of relapse. No one can explain why this happened to me. And the lifestyle, and the diet - everything was there. I didn’t drink, didn’t smoke, gave birth to children, fed them myself - I don’t fall into the risk group. One of the reasons why I don't go for implants: some oncologists say that it increases the risk of relapse. I will restore my previous form: I am a purposeful person. But I don’t know how I can stop being afraid that I will be given such a diagnosis again.
Alexandra, 39 years old
Works in social sphere in Moscow
I was diagnosed with breast cancer in November 2015 and had a full mastectomy on my left breast at the end of the year. I am now in remission.
My grandmother had breast cancer; Because of this disease, my mother died when I was 16 years old. Then I lived in the oncology center on Kashirka (National Medical Research Center for Oncology Blokhin, RONC - approx. "Papers"). I have always been “cancer-wary”: all my life I was afraid of getting sick - to the point of mental breakdowns (and I went to a psychologist who tried to smooth out this fear). Nevertheless, the disease did not go away, although I was regularly monitored.
First, I was diagnosed with fibroadenoma (benign tumor - approx. "Papers"), but in the end it turned out to be cancer. The tumor was discovered by my husband. The next day we went to the mammology center for an examination, but I knew: it was a diagnosis of cancer.
I was diagnosed with the second stage, and I understood that everything needed to be done radically, to remove [the mammary glands] as much as possible. There was no thought that I was losing my breast and would experience any inconvenience or suffering. I just grouped myself and gave myself the following instructions: we must hold on to life.
I am the mother of a 13-year-old child, I have a family. The husband immediately said: “Sasha, don’t even say a word about reconstruction. I need you alive: with breasts, without breasts, crooked, oblique - it doesn’t matter, as long as you are here with us.”
The girls with whom I was in the hospital and with whom I now communicate did not see themselves without breasts and decided to undergo reconstruction. But [reconstruction] is an operation not without consequences. The treatment was very difficult, the body requires a lot of strength to withstand it. And I decided for myself that I was not ready for this, either physically or mentally. Reconstruction is a six-hour operation with anesthesia, a two-week removal from life, which I cannot afford. Are breasts worth the pain? For me no.
I have no complexes or discomfort, I calmly look at myself in the mirror. I have a prosthesis installed, I wear beautiful underwear, I feel great at sea in swimsuits. It’s clear that I can’t wear some kind of neckline or anything else, but this can be sacrificed. The longer I live, the more I understand that I don’t need reconstruction.
In general, I have no sentimentality, I didn’t even cry [because of my illness]. The only thing she said to her husband: “Igor, well, at 38 years old!” And then I saw women who fell ill with cancer at 38, and at 28, and at 20 years old. I’m not focused on myself, I look around and understand: there are heroic girls who have gone through so much. And I? Well, I had surgery, underwent a course of chemotherapy, and am undergoing examination. What absence of breasts, what complexes? In my thoughts - only to survive, move forward, live until the child comes of age, God willing, learn it. If there was an opportunity, I would remove the other breast to hell.
Katerina (name changed), 42 years old
Specialist in alternative medicine from Moscow
When I found out about the diagnosis, of course, I was shocked. But I don’t even have any questions [why this happened]. In my case, the [cause] of the disease was psychosomatics. As we usually do: it doesn’t hurt anywhere - and that’s okay, but emotions are not so important in life. It turned out that they were very important.
I had a small tumor in my chest and it didn't bother me. At the time, I was helping a friend [with her depression] whose husband died of cancer at 42. And suddenly I started thinking, what’s in there [in my chest]? This began to bother me not even physically, but emotionally. I went to the doctor, and I was immediately diagnosed, the analysis confirmed everything, although there was no pain or anything. Stage two was diagnosed.
When they told me before the operation that complete removal was possible, I burst into tears and roared. But then [the doctors] said: “No, we’ll get by with resection (partial removal of the breast - approx. "Papers")". We were still thinking about which direction to make the seam and how I would hide it under my swimsuit.
On the operating table it turned out that I had intraductal cancer, and the breast was completely removed. It was very difficult for me, and the process of getting out of this state was very difficult. I've had chemotherapy and radiation, but I think I'm holding on alternative medicine: bioenergy, biodynamics, working with yourself, drawing out your emotions, I also draw mandalas.
I was wildly depressed, a constant stream of tears. And if it weren’t for my friends who pulled me out of this state, I don’t know how it would have ended. After the operation, my hand did not function; I could not lift a cup of water. Now, more or less, I can perform everyday tasks.
My husband took the breast removal more calmly than I did. It so happened that our relatives who were diagnosed with cancer all died. And therefore, the loss of his breast, and not his wife, was the lesser evil for him, he spoke about it directly. But this did little to reassure me.
I don’t know yet whether I will do it plastic surgery, you can’t do it for a year. The feelings have subsided. But it’s not me who is such a smart beauty - they just helped me.
For me, breasts are associated with sexuality, and a woman without breasts is no longer a woman. Therefore, the loss of a breast is a loss of sexuality, beauty, and everything in general. But now I understand that wearing a bra, for example, doesn’t show that I’m breastless. Therefore, nothing has changed for outsiders. The absence of breasts is visible in an intimate moment, in the bathhouse. But I still can’t go to the bathhouse now. There are fitness centers where there are not shared showers, but cubicles, I went to one of these. But the theme of the beach is not yet resolved for me.
Pros of reconstruction: I will have breasts, and this issue will no longer bother me. And the disadvantages: it is unknown how the arm will behave, and taking a flap of the abdomen... Implants are not suitable for me, because I will feel something foreign in my body. And the effect of anesthesia on the brain is also very frightening: then you recover from it for a long time, the ability to produce bioenergy decreases - this stops me.
Yulia, 46 years old
Worked at a factory in St. Petersburg
I found out about the diagnosis by accident: in April last year I was taking a shower and found a lump. I turned to a gynecologist, but she didn’t even look at me, she said: go to the surgeon, to the therapist, and, in general, wherever you want. I did an ultrasound and the doctor said that it looked very much like a tumor. As a result, I went to the oncology clinic on Udelnaya, where they gave me a referral to Pesochnoye (National Medical Research Center of Oncology named after Petrov in the village of Pesochnoye - approx. "Papers").
There, all the surgeons unanimously said that it was a tumor. Now I am in the third stage, I went through a bunch of examinations, and none of them revealed the tumor itself, only metastases. It was a shame to have the breast removed, realizing that the tumor might not be there, that it might end up in a completely different place. But the biopsy showed that the metastases were from the mammary gland.
There was an option for resection, but since it is unclear where the tumor is located, cutting out some part at random [was ineffective]. Where is the guarantee that it is not in another place? The head of the department said that if this is not fundamentally important for you, then it is better to remove the entire breast. My husband and I consulted and decided that we would remove it completely.
Any woman is not ready to part with her breasts, I felt sorry to the last. But I convinced myself that this would help me survive. That if I don’t do this, the tumor may remain - and then I’ll have to start all over again.
My husband didn’t believe what was happening until the very end. He is a man of few words; he has “aged” over these months. The children - I have two boys, already adults - at first did not even understand what had happened. At first we didn’t tell the youngest [details], we didn’t even say the word “cancer.”
Most likely, I will not undergo reconstruction: I do not consider it necessary to subject my body to additional stress. All this is not as simple as they say: serious preparation is needed - not a month or two, it will be painful, it is impossible to achieve absolute symmetry, that is, you need to operate on the second breast. I believe that with a disease like cancer, the fewer interventions the better. But maybe I’ll change my mind in three or four years.
My family is all men, so I don’t give in any slack. I try to drive away all these thoughts that I am disabled, so as not to cry and get upset. When I’m dressed, it seems okay, but when I undress, it’s hard. I can’t undress in front of my husband and show him all this. He says: “Why are you doing such nonsense? Why are you hiding? But I still can’t overcome myself.
At first I rested. And then I realized that if I lay down, I would go crazy: all my muscles were weakened, I couldn’t maintain my posture. From April to January, when I was undergoing chemotherapy, there was not a moment when I didn’t think about the diagnosis. It got to the point where I stopped sleeping in November. And after the operation, it was as if the body had said: “That’s it, I don’t have cancer.”
Now, due to radiation therapy, I can’t play sports, but starting in September I’ll go to the pool: I need to exercise my arm all the time. I call a woman [who also had a mastectomy], she goes to the pool and says: “I go to the toilet and change into a swimsuit, no one notices anything.” Of course, it won’t be very easy for everyone, but when you experience such an illness, a lot changes in your worldview. If I have nowhere to change clothes, I will change clothes in front of everyone, because it is necessary for my health. Who thinks what - it doesn't interest me much. Maybe they'll think about it and go to the doctor. What happened to me prompted my friends to go get examined.
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It is considered a fairly common occurrence. There are statistics that in our country every year more than 50 thousand women are diagnosed with this disease. One of the methods of treating this pathology is breast removal. Photos of mammary glands with a tumor are familiar to every surgeon. Initially, when a woman is faced with such a diagnosis and prognosis for removal, she falls into state of shock. How the stages of treatment actually take place will be discussed below.
Types of surgical intervention
Operations can be divided into 2 types.
- The first type of surgery involves complete removal of the breast. The lymph nodes that are adjacent to it are also cut out.
- The second type differs from the first in that the breast is not completely removed, but only part of it. But the lymph nodes that are adjacent to it must be removed in any case. This is necessary because they are the main distributor of cancer cells. If the tumor begins to progress, the lymph nodes will be the first to pick up metastases.
You should know that complete breast removal is the most effective method cancer treatment than cutting out part of it. Although the second type of surgical intervention is considered less traumatic for the patient. If a woman undergoes partial breast removal, then she will have more high risk the occurrence of cancer cells in the body. When it is completely cut out, there is less chance of a relapse. After removal of the breast (or part thereof), it is prescribed radiation therapy. This type may cause complications. They are associated with the possibility of lymphostasis. This disease means that the outflow of lymph will be hampered. A clear sign presence of this disease in the human body there is swelling of the arm on the side where the mammary gland was removed.
Modern medicine does not involve affecting the muscles thoracic. This has never happened before with this operation. Then this led to the fact that the arm on the operated side was limited in movement. This method of breast removal surgery was carried out for quite a long time, namely about a hundred years. Nowadays, such a problem does not exist thanks to medical progress. After a woman undergoes breast removal surgery, her arm is not subject to any restricted activities.
Diagnosis of cancer quickly and efficiently
The duration of the operation is short. As a rule, it takes approximately one hour. Surgery is performed under general anesthesia.
Oncology: breast removal and subsequent rehabilitation
You should know that after surgery, the woman will need to stay in the hospital for two weeks. An important point is that on the first postoperative day the patient needs to take a sitting position, then stand up and walk around. These measures are necessary to ensure that complications such as pneumonia and thrombosis in the legs do not arise in the body. The risk of developing the first named disease is higher in older women.
As a rule, no pain the patient does not. At first she is given painkillers, but they are not strong. This type of surgery does not involve taking medications with narcotic substances. Such drugs are prescribed to patients who have undergone operations on the chest and abdominal cavity. By the time a person is discharged from the hospital, there will be no need to take painkillers.
During the postoperative period, while the patient is in the hospital, there is a special drainage in the axillary area. It is necessary for lymph to flow in the required quantity. Also, the patient’s chest is tightly tied using an elastic bandage. This is necessary to ensure that the skin fits tightly at the site of the operation so that lymph accumulation does not form, otherwise additional treatment will be required
Lymph accumulation
Sometimes, after the patient's drainage is removed and the tight bandaging is stopped, lymph begins to accumulate. In this case, it is necessary to contact a surgeon to remove it through punctures. This procedure You can do it in or go to a paid medical institution. The period of lymph accumulation depends on the individual characteristics of the body. You should know that in people with greater body weight this process takes longer than in thin people.
What treatment is necessary after such an operation?
Breast removal in women is not the final stage of treatment. The patient will have to continue the recovery process. The further treatment regimen is determined by the doctor. Indicators such as the presence of metastases in the axillary lymph nodes, the body's reaction to hormonal drugs. If the tumor was hormone-dependent, the patient is prescribed a course of appropriate medications.
This treatment regimen is considered the simplest. It consists in the fact that the patient will need to take medications that contain hormones. The duration of the course is 2 weeks. The number of tablets you will need to take is one or two per day. The dose of drugs depends on the individual characteristics of the woman and is determined by the attending physician.
The effectiveness of breast removal surgery
There are cases when an operation is sufficient for complete cure cancer patients. As a rule, this happens when the disease is detected at the first stage. Also important point for a complete cure after surgery is the absence of metastases in the lymph nodes. Then, in the postoperative period, it will be enough for the patient to be constantly monitored by an oncologist.
If there were metastases, the patient will need to be treated with chemotherapy. It consists of several sessions. The first session is carried out in the hospital during the postoperative period. The rest of the course can be continued at your place of residence or medical institution where the patient is being observed.
Targeted therapy
Medicine does not stand still, and oncology is no exception. There are regions where it is used modern method treatment of oncological diseases. It's called targeted therapy. This name comes from the English word "target". This treatment method aims to ensure that the drug's effect extends directly to the cancer cells. It blocks them and prevents them from growing.
Is it possible to restore breasts after breast removal surgery?
It is clear that losing a breast is a disaster for a woman. This is due to the fact that this body associated with beauty and attractiveness. Without breasts, a woman will feel inferior.
Simultaneous removal and prosthetics cannot always be performed. Women need to be patient. If they have been exposed to a disease such as cancer, then first of all they should take all measures to cure this disease. Next, after a certain time, namely after 9 months or a year, you can have an operation to place the implants. The latter can be the size you always wanted to have. For example, you can enlarge your breasts or reduce them. It will also be possible to give it the desired shape. The positive attitude of the patient during the treatment of cancer is important factor in the process of recovery. Therefore, plans for ideal breasts will come in handy in this case.
If an older woman does not plan to insert implants after the operation, then she should buy special underwear with imitation. In such a bra she will look aesthetically pleasing. It will also correct the load on the spine.
If a woman is active, she returns to her normal lifestyle immediately after discharge from the hospital. Other representatives of the fair sex return to normal a month after surgery.
