In what cases the breast is removed completely. Complete breast removal or organ-sparing surgery? The choice of surgical technique is a joint decision of the operating surgeon and the patient

Surgery is an important part of the treatment of breast cancer. There are many options for performing breast cancer surgery, and one of the tasks of a professional surgeon is to explain to the patient possible options operation and together with it choose the most optimal option. Possibilities plastic surgery allow not only to remove the cancer, but also to achieve a good aesthetic and functional result.

Some patients with breast cancer are shown organ-preserving surgery, some - mastectomy (complete removal of the breast). Also recovery operations performed by various techniques. How to choose the right surgical technique?

“Each case of breast cancer is different. This means that if one surgical technique works for a patient, it does not necessarily work for another patient. For each woman, we plan the operation individually, depending on the characteristics of the formation, the size of the breast, the wishes of the woman, her age, life situation and the presence of other diseases. I explain to each patient her risks when choosing one or another type of operation and the advantages, says Jari Viinikainen, a surgeon specializing in the treatment of breast cancer at the Docrates Cancer Clinic.

Increasingly, breast-sparing surgery is being performed on women with breast cancer.

Many women think that it is safer to undergo a complete removal of the breast or even both breasts. This is due to uncertainty and fears that over time the disease will appear again. However, complete breast removal does not guarantee the best good treatment results. Partial resection of the so-called. organ-sparing surgery today is safer, even safer, and this technique is used much more often; it is carried out much more often. During the operation, the surgeon removes the tumor while preserving healthy breast tissue.

– When performing an organ-preserving operation, a woman is prescribed a postoperative radiation therapy. Such complex treatment gives good results, and sometimes even better results than with mastectomy alone. Therefore, it is often not necessary to completely remove the breast, says Dr. Viinikainen.

Various options for performing breast reconstruction

Women who are still recommended to have a complete removal of the breast should not be upset. The possibilities of modern surgery make it possible to restore the mammary gland, to carry out reconstruction, and already during the main operation to remove the cancer. This means that at best, in one go, the surgeon can remove the tumor and reconstruct the breast. But, nevertheless, in certain cases, in order to achieve good results, it is safer to first carry out prompt removal cancerous tumor, and only then receive adjuvant therapy ( drug treatment and radiotherapy), after which the surgeon performs breast reconstruction surgery.

To achieve the best results in plastic surgery when performing an organ-preserving operation, various techniques breast modeling. If the mammary gland is completely removed, a new breast can be built from the patient's own tissues, with the help of implants, or with the help of implants and the patient's tissues. The surgical technique is chosen by the surgeon together with the patient, depending on the type of woman's figure and her wishes. Here, the size of the breast and the presence of adipose tissue in the patient, for example, in the lower abdomen, matter. If the operated breast differs in shape or size from the second breast, then the second breast can be reduced or reshaped.

Organ-preserving surgery allows you to save the breast and self-confidence

Breast-conserving surgery may be important for a woman to maintain her self-confidence. . As a result, the mammary gland, which has undergone a partial resection, retains its functionality and naturalness better than the breast completely removed and restored with the help of plastic surgery. As a rule, breast reconstruction is not required after breast-conserving surgery.

- Breast cancer is a serious disease, so often at the initial stages of treatment, the issue of the appearance of the breast goes by the wayside. However, the functionality and aesthetic appearance of the breasts become important for most women, and many patients appreciate the overall result and express gratitude after undergoing surgical treatment. Both factors further affect the quality of life of the patient. It is certainly nice when nothing visually reminds of the disease and nothing needs to be hidden, and a person from the outside will not guess that the woman underwent an operation to remove a breast cancer, says surgeon Jari Viinikainen.

Various Breast Reconstruction Methods

patchwork reconstruction. During such an operation, reconstruction is carried out by transplanting the adipose tissue and skin of the patient from one place to another.

With techniques reconstruction DIEP, TRAM & SIEA adipose tissue from the patient's abdomen is used to build the breast. It is during the transplantation of adipose tissue of the lower abdomen that the best result is obtained, because. from this area, the surgeon receives the necessary amount of material to build the breast. In addition, thanks to this surgical technique, the breast retains its natural appearance and retains sensitivity.

In the case of using techniques TMG, LAP, I-GAP & S-GAP reconstructions Is a skin flap used to build breasts? inner thighs, buttocks, or lower back. This technique can be used when there is not enough adipose tissue in the lower abdomen to modulate the breasts. Usually, in thin women with small breasts, adipose tissue is taken from the inside of the thighs.

With technique LD reconstruction a flap of the latissimus dorsi muscle, adipose tissue and skin of the upper back are used. If the resulting tissue is not enough, an implant or fat grafting can be used in the reconstruction.

Reconstruction with implants- a technique in which silicone implants are placed under the pectoral muscle. Reconstruction with implants is especially suitable for women with small breasts, if their own fat tissue is not enough for transplantation.

Fat transfer is a procedure in which fat cells are pumped out and with the help of a cannula are moved to the chest area. Most often, adipose tissue grafting is used when it is necessary to increase the volume of the breast, to correct small irregularities, asymmetries, and to build the breast.

Terminology(translated from Finnish)

· Partial resection (sectoral resection)– surgery to remove breast cancer while preserving the breast. To achieve the best treatment results after a sectoral resection, radiation therapy is almost always performed.

· Mastectomy- complete removal of the mammary gland. Mastectomy may be necessary in cases where the tumor big size in relation to the mammary gland or in the mammary gland there are multiple metastases. Because young women are at high risk of cancer coming back, young women are more likely to have mastectomy.

· Breast reconstruction- surgical reconstruction of the breast after surgery. Breast reconstruction can be performed using different surgical techniques. The choice of surgical technique is influenced by the size of the breast, the type of figure of the patient and the wishes of the patient. The new breast can be formed from the subcutaneous fat and skin of the abdomen, back, thighs, and muscle tissue.

· Onco Plastic surgery – breast reconstruction simultaneously with organ-preserving surgery to remove breast cancer. In case of asymmetry, it is possible to correct the second breast at the same time.

At the Docrates clinic, a whole team of breast cancer specialists, including a Russian-speaking nurse, works with patients. For treatment and additional information You can contact Victoria Zafataeva +358505001899

Sources: plastic surgeon Jari Viinikainen and the Finnish Breast Cancer Society Rintasyöpäyhdistys Europadonna.

Content

Breast cancer is a devastating disease modern world wide use. Advances in medicine with such a diagnosis help save patients' lives. Mastectomy is a surgical way to solve the problem. What indications do operations have, what is the difference between the methods used, how postoperative recovery– information, useful to women any age.

What is a mastectomy

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

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

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

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

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

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

Types of mastectomy

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

The most minimally invasive method with the possibility of subsequent breast reconstruction is subcutaneous mastectomy. The affected glandular tissue is scraped out through a small incision. Modified types of radical intervention are used together with elimination mammary gland:

Indications

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

Methodology	Indications for holding	Performance	Chemotherapy
Subcutaneous	Neoplasm close to the nipple, size up to 20 mm	Access to the tumor through a small incision	Not required
According to Pirogov	1.2 stage of cancer, cellular damage	Remove part of the chest and muscles
By Madden	Stage II cancer with lymphedema	Removal of breasts, lymph nodes	Required

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

Methodology	Indications for holding	Performance	Chemotherapy
Bilateral (bilateral mastectomy)	Multiple tumors of stage 3-4 with lesions of both mammary glands, genetic mutations	removal	Done before surgery
	The size of the tumor is not more than 4 cm, the presence of pain, burning	The mammary gland is removed with subcutaneous tissue, chest muscle	Not assigned
Radical	third stage cancer with pain	Elimination of all chest muscles

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

Tumor in last stage with metastases are treated with surgical operation carried out according to the following methods:

Preparing for the operation

Before performing a mastectomy, your doctor will initial inspection women, collects anamnesis. An examination is scheduled, and the method of the operation is selected based on the results. Preoperative measures include:

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

Operation

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

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

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

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

According to Halstead

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

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

The Holder-Meyer mastectomy is used when other methods are powerless. Contraindications for surgery must be taken into account. The technique causes a serious complication - limited mobility of the shoulder joint due to muscle removal and nerve damage. As a result of the elimination of a large number of tissues, problems arise during the plastic reconstruction of the breast:

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

Radical mastectomy according to Madden

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

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

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

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

Amputation of the breast

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

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

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

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

By Pati

During the operation according to the method of this doctor, a large pectoral muscle. The Pati method contributes to the preservation of the functions and cosmetic appearance of the remaining tissues. During surgery:

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

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

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

Postoperative period

In order for a woman to quickly restore her shape after the operation, it is necessary to carry out rehabilitation measures prescribed by the doctor. This will help relieve pain syndromes, increase the mobility of the shoulder joint, restore lymph flow, and eliminate complications. In the postoperative period it is necessary:

• refuse to visit the solarium, baths;
• avoid lifting weights;
• use an elastic bandage;
• wear special soft clothes;
• drink more fluids;
• avoid injury;
• get regular check-ups with a doctor.

The postoperative condition requires attentive attitude to health. A woman is recommended:

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

During rehabilitation after a mastectomy, you will need:

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

Complications

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

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

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

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

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

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

Breast reconstruction

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

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

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

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

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

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

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

• the complexity of the operation;
• high trauma;
• the need for prolonged anesthesia;
• the presence of a possibility of tissue rejection;
• long recovery period;
• no problems associated with implant displacement.

Another reconstructive method is the use of vacuum devices. When using them:

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

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

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

Price

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

Video

She told BeautyHack why she voluntarily decided to have a mastectomy, and explained where to go and what tests to take if you have a high probability of malignant tumors.

How it all began

Now I am 25 years old, and in February I made the decision to have an operation to remove the mammary glands and replace them with implants. But this story began much earlier. 3.5 years ago my mother got ovarian cancer. Before that, my grandmother was diagnosed with breast cancer. Almost all relatives on my mother's side had this disease.

After my mother fell ill, I was told to take an analysis for tumor markers every six months. But for people like me, this is not really an option. Because many factors affect the result of the analysis: physical state at a particular moment, overwork, etc. I understood that I needed to solve the problem in a different way.

A year and a half ago, I thought about breast reduction. I had a size D, and it started to get in the way: my neck hurt, I stooped and could not pick up underwear. In the fall of 2017, for the first time, I met with the doctor advised by my mother, Sergey Nikolaevich Voronov from the Center for Plastic Surgery of the Russian Railways Departmental Hospital in Ivanovo.

I was sure that I would persuade him to do the operation. She arrived, told about her mother (she passed away a year ago), the doctor examined her breasts and noted that there was already ptosis (that is, stretching of the tissues), and he was not against reduction. Sergey Nikolayevich also clarified when I last checked my breasts, that is, I did an ultrasound and was at the appointment with a mammologist, but I never did this: I thought that this should be done after 35 years. Although the annual medical examinations took place always.

Then the doctor painted the examination scheme before the operation: consultation with a mammologist, ultrasound, x-ray, blood test for BRCA gene mutations - it is he who reveals a predisposition to cancer. There are several types of analysis, but BRCA1 shows the likelihood of breast and ovarian cancer. Sergey Nikolaevich explained that if mutations are found, then it makes sense to immediately preventive mastectomy with a one-time reconstruction. I knew about this operation and even understood that I might do it in the future, but I did not expect it to happen so early.

Difficulties arose already at the stage of going to the radiologist. As a rule, X-rays in such situations are not done until the age of 35, considering this an unnecessary measure, but I was able to agree. An ultrasound found a mass in right chest and advised to return in a month - while it was harmless.

Then I explained to the mammologist that I came to him from the surgeon and I was preparing for the operation. He said that she was useless now and sent her for a consultation to the Herzen Cancer Institute in Moscow. They also explained that the formation should be monitored, it is unlikely that it is malignant, but an x-ray can be done in a month. When I told about my situation, I received a sea of ​​negative comments in the style of “you are still young, you don’t have children, why cut out a healthy organ.” At that time, I already had the results of the BRCA analysis: 85-90% chance of developing breast cancer, 45% ovarian cancer and 15% bowel cancer. Knowing the unpredictability of this disease from my mother's experience, I had already made up my mind not to play with fire. I understand that it is important to breastfeed a child, but it is much more important to have a healthy mother next to him.

With this attitude, I returned to the Center for Plastic Surgery in Ivanovo, where, after a long consultation of three doctors (besides Sergey Nikolayevich, there were surgeon Natalya Sergeevna Voronova and mammologist-surgeon Maxim Valeryevich Venediktov), ​​it was decided to do a mastectomy with preservation of my nipples. They called me two weeks later and scheduled the day of the operation.

Separately, I will say that there are no quotas in our country for such an operation, it is paid. Yes, women do a standard mastectomy in the presence of tumors, but few doctors undertake such an operation. After all, before that I was in one of the largest oncological centers in Moscow, and with a 90% chance of breast cancer, the doctor did not even consider this option. That is why I strongly advise people to do a BRCA blood test - it is very affordable, but for some reason not everyone is told about it.

Operation

Two weeks before the operation, I began to panic, because I only in theory understood what was waiting for me. On the net I found a couple of photos of women who did something similar and talked about it in in social networks. There is a lot of information on the topic of cancer, but there is nothing here, both in Russian and in English.

The operation lasted a little over four hours. The mastectomy was done under general anesthesia, I woke up only the next day and was leaving for a very long time. It seemed to be conscious, but I do not remember many things.

After the operation, I spent a week in the hospital under the supervision of doctors. severe pain not during rehabilitation. I know that girls who enlarge their breasts complain of pain, but this is not the case: in the hospital I was injected with painkillers 5-6 times a day, and I slept almost all the time, didn’t move, I couldn’t even wash my hair myself - I did it my boyfriend. By the way, he was immediately in favor of the removal of the mammary glands and helped me a lot along the way, like all my relatives - such a support group!

Rehabilitation

Already in the hospital, a problem arose: the left nipple was recovering well, but the right one remained dark. Nevertheless, I was discharged home, and then the most unpredictable thing happened: I started to panic! The hospital in Ivanovo is located 400 km from home, I’m far away, despite the fact that I keep in constant contact with the doctor, an allergy appeared on my body (it turned out that this is an allergy to Levomekol, which needs to be smeared on the nipples), and in my head I thought: “What if Am I repulsed?"

I was afraid to move, did not use ointment, everything began to heal, but the problem with the right nipple remained, it became darker.

Three weeks after the operation, I came for the first examination, and the doctors said that the right nipple had not healed. He was immediately removed, the operation took no more than five minutes. Then, of course, I was in shock, and it was not so much the absence of a nipple that frightened me, but the presence open wound. The doctor explained that she needs to be treated three times a day so that there is no infection.

At home, I had no idea how to make a dressing, but in the end I gathered myself, took off the bandage, stood in front of the mirror and gave myself time to get used to it. Once a week I came to the doctor (he examined the wound) and at the same time studied options for restoring the nipple. The first is to make it out of skin (the darker scar tissue on the wound has already given the effect of an areola). The second is to make a prosthesis. It is waterproof, attached to a special glue and lasts for three months. To begin with, I decided to wait for a full recovery, and then make a decision.

Now, three months after the operation, I have almost recovered. And in this regard, the question arose: is it necessary to do something at all? From an aesthetic point of view, the areola looks natural. But if I decide to restore, then both nipples, my own and restored, will look different. So I gave myself a summer to think, to see how comfortable I am in this state.

In general, rehabilitation would have been faster if not for this problem. A month and a half later, everything looked good. Now there is only slight redness in the area of ​​​​the seams and swelling, but this is also normal.

How to live after surgery

Three months after the operation, doctors do not allow to remove the bra at all (but not with bones - they put pressure on the seams). I save myself with sports ones because they are lighter. Two months later, I started doing yoga without a lot of stress on my hands.

Implants come with a lifetime warranty. If earlier they were silicone, and could really burst, now they are made of biomaterial (even if something happens to the implant, the liquid in it will not harm the body).

Now my breast size is C. That is, in fact, it has decreased by only one size. But outwardly the difference is very big. She became more toned due to an anatomical rather than a round implant. I think that over time it will be even less.

There are no restrictions after the operation. After recovery, you can, for example, plan a pregnancy. This is one of the differences between a mastectomy and a breast reduction operation, when you have to wait a year and a half so that the shape does not deform during pregnancy.

As for the likelihood of cancer, then you will have to monitor the situation in any case. It is not necessary to exclude ovarian and intestinal cancer, the predisposition to which the analysis revealed. I have already said that tumor markers are not the most informative thing (the results can help if there are additional tests). Therefore, I will regularly do uzi. I do not rule out that in the future it will be necessary to remove the ovaries, but for now I prefer not to think about it - after all, this is a more age-related disease, unlike breast cancer.

The only side effect after the operation is depression. I had mild form depression immediately after discharge. In life, I am not an alarmist, I can pull myself together, make balanced decisions, but in the first weeks after the operation there were breakdowns and tears. From this situation I made one conclusion: the main thing is to control yourself! Because now I know for sure that I made the right decision. I am not promoting the operation, but people should be aware of this possibility. When you already have malignancy, surgery and recovery are much more difficult.

In addition, I want to believe that my story will help someone or even save a life. People are already interested in what tests and where I passed. The next good thing is my collaboration with Anna Pisman's jewelry brand Moonka Studio. In the summer we will make a collection of jewelry, part of the sales of which will go to the Cancer Foundation!

Similar materials from the rubric

The removal of the mammary gland is called a mastectomy, and the removal of the breast can be complete or partial. According to indications, the pectoral muscle and lymph nodes in the armpit can be removed. The main indication for this surgical intervention is breast cancer (BC). Amputation of the breast can be a solution to the problem of oncology or a way to prolong life in case of a disease. Breast cancer is currently the leader among all forms of oncology in women, and if the removal of the breast is proposed, it is necessary to agree without hesitation.

Removal of the mammary gland is called a mastectomy, the removal of the breast can be complete or partial.

Predisposing factors are:

• heredity;
• hormonal imbalance;
• microtrauma of the mammary gland;
• degeneration of fibroadenoma (benign process), existing cysts;
• stagnation of milk with HB.

Prevention as such does not exist, there are many factors, it is impossible to single out one main one separately. All that remains is a regular examination by a mammologist.

Prevention as such does not exist, there are many factors, it is impossible to single out one main one separately

Amputation of the mammary gland can be performed according to the following indications:

• the size of the tumor exceeds 1 quadrant;
• conducted radiation or chemotherapy were unsuccessful;
• the tumor is larger than 5 cm;
• after the resection of the breast, the affected area was not completely removed, therefore, a complete amputation is required;
• contraindications to radiation therapy;
• extensive phlegmon of the mammary gland;
• mastopathy with multiple lesions of the gland with cysts or nodes.

Removing a breast on one side reduces the risk of cancer, but does not guarantee that it will not appear on the other.

Removal of mammary glands (video)

Analyzes and preparation for surgery

Diagnostics includes:

• blood and urine tests;
• Ultrasound of the gland;
• blood test with the determination of coagulability;
• biopsy;
• mammography.

For the upcoming operation, you should:

• 2 weeks before it, stop taking anticoagulants;
• antibiotics are administered preventively on the evening before the operation;
• 12 hours before surgery, the patient should not eat;
• cleanse the intestines with an enema.

Operation types

The following types of surgical intervention can be distinguished:

1. Total breast removal surgery - a complete amputation is performed, including the nipple and areola. The pectoral muscles are left. If the tumor size does not exceed 2 cm, then the nipple and areola are not removed.
2. Subcutaneous - in this case, the tumor should be next to the areola no further than 2 cm; the gland with lymph nodes is removed, but the nipple and areola remain. An incision is made around the areola. After radiation therapy is required.
3. Partial (lumpectomy) - remove only the damaged area and part of the healthy tissue around. With stage 1 and 2 cancer, lymph nodes are also removed, long-term results are good.
4. Halsted radical mastectomy - it is performed with extensive lesions: the gland is removed, both pectoral muscles and axillary lymph nodes, fatty tissue from the armpit, under the collarbone and shoulder blade. The operation is radical, but more traumatic. Today, this method is rarely used, only in the later stages of cancer, when the tumor grows into the pectoralis major muscle, infiltrates it and causes swelling. The incision is closed with the remaining skin. The scar after the operation is 15-20 cm. There are many complications after such an operation.
5. Radical improved - amputation of the mammary gland is performed: everything is removed, even small blood vessels lymph nodes, but the incision is made as an incision around the areola. Through it, and remove the tissue of the gland. The scar remains transverse.
6. Radical extended - to the removed gland, pectoralis major muscle, lymph nodes, the removal of the pectoralis minor muscle and resection of the chest wall, where the tumor has sprouted, is added.
7. Quadrantectomy - it is performed if the tumor occupies the quadrant of the breast. Then a separate incision is made through which the axillary lymph nodes are removed.
8. Modified radical mastectomy according to Paty - 2 semi-oval incisions are made around the gland, from the parasternal to the mid-axillary line (axillary lines). The gland with the fascia of the pectoralis major muscle is removed from this incision, the muscle itself is not touched; the pectoralis minor is removed or pulled to the side to open access to the lymph nodes in the armpit; and then the gland and nodes are removed in a single block. A drain is inserted and the wound is sutured. The pectoralis major muscle is preserved, so the operation is not so traumatic, the functions and cosmetic appearance of the remaining muscles are better preserved. Currently, it is this operation model that is most often performed, which has become the gold standard for surgical treatment breast cancer.
9. Extended radical mastectomy according to Urban - the technique is similar to Halsted, but parasternal lymph nodes are additionally removed here. For this, 2-3 costal cartilages are removed along the parasternal line. This method has no advantages over the Halsted method. It is also rarely used, only if there are metastases in the indicated lymph nodes.

All operations are performed under anesthesia. Depending on the amount of removal, the procedure can take from 1 to 3 hours or more. Guarantees complete cure the operation does not. It all depends on the type and size of the tumor, its stage, etc. Often, after surgery, chemotherapy or radiation therapy may be prescribed to consolidate the results, according to indications. Removal of the mammary glands in women can, according to indications, be carried out bilaterally, when both are removed at once.

Metastases in the lymph nodes during any operation reduce the 5-year postoperative survival, so they are trying to be removed.

When mutating genes are detected, women are under the dynamic supervision of doctors to identify early stage cancer

Prophylactic mastectomy

The hereditary nature of breast cancer implies a mutation of the BRCA1 and BRCA2 genes. This discovery led to the emergence of preventive removal of the mammary glands. In the United States, Angelina Jolie set an example in 2013, who removed the mammary glands bilaterally, when it turned out that 80% of her risk of breast cancer was due to heredity. Preventive removal is not practiced in Russia. When mutating genes are detected, women are under the dynamic supervision of doctors to detect an early stage of cancer. Proactive removal mammary glands possible only when there is a risk of developing cancer with possible complication.

Breast surgery (video)

Postoperative period

After 1.5 days, it is allowed to walk, but in the first days there is a pronounced pain syndrome. Patients should not make sudden movements, raise their hands up. You can not force physical activity.

After removal of the drainage tubes, fluid may accumulate at the surgical site, usually it resolves itself. In other cases, the fluid is removed by the doctor during the dressing by puncture. A tight bandage is applied around the chest, which must be worn for a month. The bandage forces the skin to adhere tightly to the site of the operation to the muscles so that lymph does not collect here. But it happens that the lymph is still collected, in such cases, a puncture is periodically performed at the surgeon at the place of residence. At obese women lymph is collected longer. The stitches are removed 2 weeks after the operation. If there are no complications, the woman returns to her rhythm of life in 1.5-2 months. At the same time, you can resume sexual life.

Consequences of a mastectomy

In the first days after the operation, there is a feeling of discomfort in the neck and back, numbness of the arms, shoulders, chest and armpits; at the site of the operation, the skin is stretched and coarsened. Arms and shoulders may temporarily weaken. These sensations remain irreversible in rare cases. In connection with these phenomena, a few days after the operation, they begin to do special therapeutic exercises.

Removal of lymph nodes under the armpits often leads to the fact that the outflow of lymph slows down and edema develops - lymphedema. Sometimes this is irreversible. This complication may appear immediately or after several months.

The arm on the operated side must be protected from injury at all times. Many women are interested in restoring the shape of their breasts. Such reconstructions can be performed during surgery or 9-12 months after surgery using a silicone implant or using own tissue from another part of the body: skin, fat and muscle can be taken from the abdomen, buttocks or back. Options and expected results are discussed with the plastic surgeon. A reconstructed breast, even if visually similar to a healthy one, will still differ in sensitivity and touch.

Removal of mammary glands in men

Mastectomy can also be performed on men. They can also develop oncology of the mammary glands (carcinoma), although it is extremely rare. They may also have gynecomastia, which is treated with hormones. If there is no effect, the breast is also removed. With obesity, the breast is not removed, only liposuction is performed.

Complications after mastectomy

In the form of complications can be observed:

1. Hematomas and postoperative bleeding.
2. Suppuration of the wound.
3. Erysipelas is the most common and dangerous complication of lymphedema. In this case, it develops bacterial infection skin and subcutaneous tissue, which in turn causes thrombophlebitis, abscesses. Erysipelas can be treated well with timely treatment.
4. Painful scars and welts.
5. Neuropathic pain syndrome in the form of tingling, numbness and stabbing pains in chest wall, armpit, hand.
6. After 4-6 weeks, lymphostasis may develop.
7. Frozen shoulder syndrome - arm movements in shoulder joint limited and painful. This can develop several months after surgery and is due to nerve damage during surgery.

Contraindications after surgery

It is strictly forbidden to take a shower and wash until the stitches are removed. Need to exclude physical exercise, you can not sunbathe and overheat (forever), it is forbidden to swim in the pool for 2 months. You can not sleep on your side from the side of the operation, you need to regularly massage your hands - stroking from the fingers to the shoulders. After removing the stitches, you need to start doing gymnastics: raising your arms to the sides and up; placing a hand on the affected side behind the head; bend your elbows and raise your elbows.

Can lymph nodes be removed? This is ruled out because the risk of the cancer returning increases.

Do I need to visit an oncologist after surgery? A visit to the doctor is mandatory, once every 3 months. If there are no complications, then later visits with a regularity of 1 time in six months. A visit to the doctor is especially important for women with venous insufficiency because they often develop lymphedema.

It becomes urgent to visit a doctor if:

• pallor and cyanosis of the hand appeared;
• the arm became edematous, tight and tight, cold;
• There was pain and it became difficult to move the arm.

With swelling of the hand, treatment is prescribed:

• benzopyrones and nicotinic acid to relieve swelling, inflammation and improve blood circulation;
• olive, jojoba oils are used to nourish and moisturize the skin of the hand;
• to normalize the outflow of lymph, you must wear a special elastic sleeve (sold in a pharmacy);
• protect your hand from injuries: you can’t even measure blood pressure on it, give injections, droppers, take tests, allow mosquito bites, bruises;
• exclude any physical work.

As soon as the lymph stops accumulating, you can go in for sports, do your usual work at home. Young women can give birth, but after consulting a doctor.

After the operation, the elderly are recommended to purchase special underwear with a removable prosthesis to balance the load on the spine. A woman after a mastectomy is given a lifelong disability group 3. After surgery, adjuvant or preventive therapy, which complements beam method and operation. This is done to prevent micrometastases that breast cancer gives. This includes hormones, chemotherapy, targeted therapy with special drugs for targeted targeted effects only on cancer cells. Thus, mastectomy is today the only way to help women solve their problem or prolong life.

The indications for removal of the mammary gland accepted in clinical mammology are mainly associated with malignant neoplasms. Most doctors insist on a mastectomy if:

• the woman has tumors in more than one quadrant of the breast;
• radiation therapy of the affected mammary gland has already been carried out;
• the tumor is larger than 5 cm in diameter and has not shrunk after neoadjuvant chemotherapy;
• biopsy showed that the initial segmental resection of the tumor did not remove all of the cancerous tissue;
• The patient has connective tissue diseases such as systemic lupus or scleroderma, in which there are very severe side effects of radiation therapy;
• the tumor is accompanied by inflammation;
• the woman is pregnant, but radiation therapy is not possible due to the risk of damage to the fetus.

This method is recognized as the main way to prevent the recurrence of breast cancer, especially when a mutation in the BRCA genes is detected. At the same time, the world's leading specialists in the field of mammology note that the complete removal of a cancerous breast reduces the risk of tumor recurrence in the same breast, but does not exclude the possibility of cancer in the other breast.

Preparation for breast removal

The operation is prescribed when the patient is diagnosed, that is, a mammogram was performed and a biopsy of the tumor tissue was performed. Therefore, preparing for a mastectomy is reduced to general analysis blood, repeated fluoroscopy of the chest and chest, as well as the removal of an electrocardiogram (ECG).

When referring a woman to an operation, the doctor must make sure that a few days before the scheduled operation (and preferably a couple of weeks before it), the patient did not take drugs that thin the blood (aspirin, warfarin, phenylin, etc.). Also, the surgeon and anesthesiologist should be informed about the patient's use of any drugs based on medicinal plants or herbal decoctions. For example, stinging nettle, water pepper herb, yarrow, ginkgo biloba leaves may increase the risk of bleeding and therefore should not be used at least two weeks before any surgical procedure.

A dose of antibiotics may be given to prevent inflammation. 8-10 hours before the operation, the patient should stop eating.

Surgery to remove the mammary gland

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

Removal of breast cancer, primarily large tumors in the later stages of the disease, or when tumors may occupy a significant area within the contours of the breast, can be done with a simple or total mastectomy. That is, the surgeon removes the entire breast tissue and the skin ellipse (including the skin of the nipple), but does not remove the muscle tissue under the breast. In this type of operation, a biopsy of the nearest (control or sentinel) lymph node is mandatory. The postoperative scar is usually transverse.

A skin-sparing approach to the removal of the breast (subcutaneous mastectomy) is practiced, in which the tumor, all breast tissue, nipple and areola are removed, but almost 90% of the skin of the breast is preserved, the incision and, accordingly, the scars are smaller. However, if the breast is large, then a downward incision is made, and then the scars after the removal of the mammary gland will be larger.

The gland is also resected with the preservation of the nipple and areola, but this is possible only when the tumor is at a considerable distance from the nipple zone. In this case, an incision is made on the outer side of the breast or along the edge of the areola and all tissues are removed through it. IN modern clinics this method includes either simultaneous reconstruction of the gland, or placement of a special expander tissue expander in place of its removed structures for breast reconstruction in the future.

With a radical resection of a common malignant neoplasm, it is necessary to remove not only all the structural parts of the gland, but also the underlying muscles of the chest, fiber from the armpits, axillary The lymph nodes and often deeper tissues. If the mammary gland is removed along with the internal mammary lymph node, then an extended radical mastectomy is performed.

All these operations have a clear methodology, and specialists know what is at stake when a Halstead, Paty, or Madden mastectomy is necessary.

When forming in the area armpit such an anomaly as an additional mammary gland, the removal of an additional mammary gland is performed. Usually glandular and adipose tissues predominate in the structure of the superfluous organ; they are cut out, the muscle tissues are sutured, and a suture is placed on top, which is removed after about a week. With a significant size of the accessory gland, fat can be removed by pumping it out.

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

Removal of two mammary glands

The above surgical methods also carry out the removal of two mammary glands - a double or bilateral mastectomy. The need for such an operation may be due to the presence of a tumor in one breast and the woman's fear about the risk of developing cancer in the other, contralateral breast. Most often, such fears haunt women who have a tendency to oncopathologies of the gynecological sphere in their family.

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

Even with a full double mastectomy, not all breast tissue that may be at risk of becoming cancerous in the future can be removed, according to the National Cancer Institute. In addition, during such an operation, the surgeon cannot remove the tissues of the chest wall and supraclavicular region, but they may contain breast stroma cells.

Sectoral removal of the mammary gland

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

By resection of the mammary gland, it is possible to remove the focus of chronic purulent mastopathy, as well as a large hormone-dependent benign education cystic or fibrotic. However, only phyllodes fibroadenoma of any size that threatens malignancy and significant fibrocystic neoplasia prone to degeneration are subject to mandatory resection. Although fibrosis of the breast tissue in almost 15 cases out of 100 reappear.

In other cases, enucleation (husking) or laser therapy is performed, and the removal of a breast cyst can be performed without excision: by sclerotherapy of its cavity by aspiration.

Removal of mammary glands in men

In the case of oncological diseases of the mammary glands, the removal of the mammary glands in men is performed. Regardless of age, a mastectomy is considered a medical necessity when there is concern that a male's breast augmentation may be breast carcinoma. It is natural that final decision the need for surgical intervention is accepted only after a comprehensive examination - with mammography and biopsy.

Pathologically enlarged glandular tissues are also removed for gynecomastia in men over 18 years of age with the ineffectiveness of testosterone hormone therapy.

IN adolescence- on the background hormonal imbalance mastectomy is not performed during puberty, since this pathology can spontaneously regress over time. In addition, mastectomy before puberty is complete can cause recurrence of gynecomastia.

With elementary obesity in adult men, which is often manifested by excessive deposition of adipose tissue in the area of ​​​​the mammary glands, liposuction can be applied.

Consequences of breast removal

A natural consequence is pain after removal of the mammary gland, for the removal of which painkillers are taken (primarily NSAIDs). Also, this operation is characterized by the release and accumulation of significant volumes of serous fluid in the wound cavity and under the skin. To remove it, the wound must be drained for at least seven days. In addition, a fairly tight bandage is applied around the chest with an elastic bandage, and it must be worn for at least a month.

Experts note such main complications after removal of the mammary gland, such as:

• postoperative bleeding and hematomas;
• temperature associated with suppuration of a postoperative wound or necrosis of tissues poorly supplied with blood at the incision site;
• defeat skin chest with beta-hemolytic streptococcus, which develops erysipelas;
• due to scarring of the dissected tissues, scars form, often this process causes discomfort and is painful;
• development of a longer neuropathic pain syndrome, which appears stabbing pain, numbness and tingling in the chest wall, armpit, or arm;
• depressed mood, feeling of inferiority.

Almost always, after a month and a half, a violation of the natural outflow of interstitial fluid is manifested and lymphostasis develops. This violation is especially pronounced due to the cessation of normal lymph flow when the axillary lymph nodes are removed. Lymphostasis leads to the fact that from the side of the removed organ, not only swelling of the hand appears, but also numbness of the skin on the inner surface of the hand is felt. Frozen shoulder syndrome is also noted - a short-term or longer-term limitation of the range of motion of the arm in the shoulder joint. This syndrome can manifest itself within a few months after the operation, and its cause lies in the damage to the nerve endings located in the surgical area.

Recovery after breast removal

Already 1.5 days after the operation, you can get up and walk, but speed up recovery motor activity not recommended: it should go gradually, as the stitches are removed after about 1-2 weeks from the day of the operation.

In most patients, recovery after breast removal lasts for 4-6 weeks, but it may take longer (this largely depends on the complexity of the operation and general condition health).

The list of what is impossible after a mastectomy includes prohibitions on:

• showering (and bathing) before stitches are removed;
• physical activity, heavy lifting and vigorous movement;
• exposure to heat and UV radiation;
• any injections into the arm from the side of the removed breast;
• swimming in reservoirs and pools (at least two months);
• sexual contacts (within 1-1.5 months).

In connection with lymphostasis, breast surgeons give their patients the following recommendations after removal of the mammary gland:

• observe personal hygiene and clean hands;
• avoid damaging the integrity of the skin injuries of the hands, and in the case of the slightest scratch, use antiseptics;
• do not sleep on the side of the operated gland;
• wear a special elastic bandage (providing soft compression to improve lymph flow and reduce swelling);
• massage regularly: in the form of upward strokes of the arm in the direction from the fingers to the shoulder joint.

After removing the sutures, it is necessary to purposefully develop the arm. Gymnastics consists of the following exercises:

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

Nutrition should include enough calories, but be light, that is, fatty and spicy consumption is not recommended, as well as sweets. It is useful to eat more often, but in smaller portions, the diet should include ordinary foods (cereals, meat, fish, dairy products, vegetables and fruits). Animal fats should be replaced with vegetable fats, salt and sugar consumption should be reduced.

Treatment after breast removal

Cancer patients are treated after removal of the mammary gland - adjuvant therapy. At any stage of cancer, after complete or partial removal of the breast, in order to destroy the remaining atypical cells and avoid relapse, chemotherapy is prescribed (Cyclophosphamide, Fluorouracil, Mafosfamide, Doxorubicin, Xeloda, etc.) and a course of radiation therapy.

If the tumor is a hormone-dependent neoplasm, apply hormonal preparations. Tablet antiestrogen Tamoxifen (other trade names: Zitazonium, Nolvadex, Tamoplex, Cytofen, Zemid, etc.) are taken 1-2 times a day for 20-40 mg.

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

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

The anti-cancer effect of drugs for targeted therapy is achieved by acting precisely on molecules cancer cells that promote tumor development. Thus, drugs of this group are able to stabilize the pathological process and prevent the recurrence of the disease. The targeted drugs Bevacizumab (Avastin), Trastuzumab (Herceptin) are given intravenously every two or three weeks; Lapatinib (Tyverb) tablets (1000-1250 mg orally per day).

Life after breast removal

The main thing to remember is that life continues after the removal of the mammary gland, although for all women who have undergone such an operation, this is already a slightly different life ...

First, a woman gets a disability after a mastectomy. Specifically: according to the Order of the Ministry of Health of Ukraine (No. 561 dated September 5, 2011) “Instructions on the establishment of disability groups”, a unilateral mastectomy suffered by a woman due to a malignant neoplasm is an indisputable basis for III disability groups - for life (that is, without the need for periodic re-examination).

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

You can pick up or order breast pads, as well as a removable prosthesis - textile or silicone.

To date, the so-called exoprostheses for women who have lost their breasts are produced by many companies in a large assortment: these are tissue prostheses for the first time, and silicone prostheses for permanent use, of various sizes and modifications.

There is also a large selection of orthopedic underwear, as you will need a bra - to fix the breast prosthesis. These are quite elegant and at the same time functional and comfortable bras with "pockets" into which the prosthesis is inserted, and wide straps. Special swimsuits are also on sale.

themselves plastic surgeons argue that plastic after a mastectomy is a complex and rather expensive operation. This can be a plastic surgery to install a silicone implant or mammoplasty using own tissues taken from other parts of the body (skin, subcutaneous tissue, muscles). But in any case, a woman has a mammary gland that is very similar to a natural organ, which, of course, has a positive effect on the general emotional and psychological state of patients who have undergone breast removal.