How to be monitored after breast cancer surgery. Postoperative period for breast cancer

Mastectomy and other breast surgeries

Radical mastectomy My plan for breast cancer is to completely remove it along with the skin, pectoralis major muscle, tissue and lymph nodes of the axillary and subclavian areas. It is not easy to prepare psychologically for such an operation, but the patient must understand the full extent of the risk and the need for decisive measures to fight for her health in general. Women are well aware of how plastic medicine is developed now; normal practice is to reconstruct the breast after a mastectomy, so the need for surgery must first of all be taken into account the important indications of the course of the disease.

A common complication after surgery is swelling of the upper limb and stiffness of the shoulder joint on the corresponding side, which often develops shortly after surgery.

Increasing edema of the upper limb is a consequence of lymphostasis in it due to disruption of the network of lymphatic vessels in the axillary region. Stiffness in the shoulder joint occurs as a result of deformation of the joint capsule by scarring processes in this area.

Pain appears when trying to abduct and raise the arm. A sharp restriction of movements in the joint contributes to an increase in stiffness. Patients try to limit movement in the joint due to pain; they hang their arm on a scarf, which contributes to an increase in stiffness.

Therefore, the best method of combating joint stiffness and increasing swelling of the limb is therapeutic exercises. It should begin from the first days after discharge from the hospital, first in special rooms under the guidance of an instructor, and then independently.

The patient and her relatives must understand the importance of therapeutic exercises and carry them out, guided by special guidelines.

Instead of resting the hand of the operated side, movements with this hand are necessary: at first careful, until pain appears, and then increasingly increasing in amplitude. Rocking movements in the shoulder and elbow joints, abduction and elevation of the arm are initially performed by the patient herself with the help of her healthy arm, and then independently, without support. It is necessary to accustom the patient to combing her hair with a sore hand, rubbing her back with a towel, doing exercises with a gymnastic stick, etc.

Swelling due to lymphostasis develops shortly after surgery (weeks, months) and can be easily treated: longitudinal massages, elevated position of the limb. Restoration of impaired lymph flow occurs due to newly formed lymphatic vessels or the appearance of collateral pathways.

In contrast to the mild swelling that accompanies surgery itself, often after 6-12 months. after surgery, late dense swelling of the limb appears. They occur more often in people who have undergone combination treatment, when areas of possible metastasis were irradiated before or after surgery.

Late dense swelling of the limb may be a consequence of the scarring process in these areas, preventing the restoration of lymphatic drainage pathways. But they can also be the first sign of an incipient relapse. Therefore, every case of late edema of the limb requires examination by an oncologist.

If the patient complains about the appearance of late edema of the limb, it is necessary to contact an oncologist, regardless of the timing of the scheduled examination. If the oncologist removes the suspicion of a relapse, measures to eliminate or reduce swelling will begin. They require the time and patience of the patient and close relatives to carry out a set of prescriptions from the oncologist: massage, self-massage, elastic bandaging, a set of therapeutic exercises, an elevated position at night and a number of preventive measures to prevent suppuration, erysipelas, and the appearance of cracks.

How to help yourself?

Psychologists have developed several methods for relaxing and overcoming stress caused by a serious illness.

Mental pictures

We all know how to fantasize: we remember various situations from the past and wonder what we would do in a given situation. In our thoughts we change events for the better. Or indulge in pleasant memories. We want to relive everything again.

The ability to fantasize can be used to relax before unpleasant procedures or medical examinations, or if you are suffering from insomnia or pain.

Start by relaxing. Choose the position that is most comfortable for you. Turn off the lights, turn on your favorite music. There is also special music written for maximum relaxation: it includes the sound of the sea and the singing of birds. Close your eyes and focus all your attention on your breathing. Breathe as deeply as possible, stretching the inhalation and exhalation for as long as possible. Inhale the vitality of nature, the joy of life and exhale everything that annoys you: pain, anger, fatigue, fear. With each inhalation and exhalation, you will gain strength and get rid of what bothers you.

Then switch your attention to your toes, feel the lightness of your limbs, “raise” this comfortable feeling higher and higher. Feel how your body is resting, how the wrinkles around your eyes are smoothing out.

Imagine your favorite place on earth - a forest meadow, a mountainside, a seashore. Remember the smallest details of this place: colors, smells, sounds. Is it cold or warm around you? Can you touch something by reaching out your hand? Is there someone near you? Feel how good you feel! Let joy, life, the power of nature fill you. When the time comes to leave the virtual paradise you've created, don't be sad. After all, you can always return there!

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Questions and answers on: after breast cancer surgery

2013-12-16 17:06:47

Marina asks:

Hello, please tell me what is the probability of surviving after surgery for stage 3 breast cancer? What are the prognoses?

Answers Medical consultant of the website portal:

Hello, Marina! To determine the prognosis for survival, it is not enough to know the stage of breast cancer; additional information is needed - the histological structure of the tumor, the degree of differentiation, the sensitivity of the tumor tissue to hormones, the woman’s age, concomitant diseases, response to therapy, etc. The attending physician has all this information - it is with him that all questions regarding the prognosis of the disease should be discussed. Take care of your health!

2013-12-10 17:52:14

Armine asks:

Hello, my aunt has breast cancer. with minor elements of fibrosis...after the operation she passed all the tests - the window - there are no markers... now I have a question... is there a need for chemotherapy and therapy with Herceptin???

Answers Filonenko Andrey Grigorievich:

Good afternoon, Armine.
You don’t write, but one must think that before the operation the type of tumor, its hormonal status, and the presence of HER2-new receptors were known. You also have to think that HER2-new was positive before the operation. In this case, we are talking about a very good tumor response to chemotherapy.
Your question is clear, but the answer is not so simple. In the presence of HER2-new, significantly better treatment results are obtained with Herceptin. It would be very disappointing to fail to meet the standard and have a relapse after some time.
The tumor in the mammary gland died. However, the presence of HER2-new is a poor prognostic sign. You cannot be completely sure that ALL the tumor tissue in your aunt’s body has died.
Of course, meeting the standard does not protect you 100% from relapse, but then at least you won’t have anything to reproach yourself for.
So my advice is: do Herceptin.

2013-07-30 04:43:36

Ivan asks:

Hello! My mother underwent surgery after test results showed the presence of a malignant tumor in her left breast. The breast was not completely removed. She was discharged on the 10th day after the operation. left breast cancer pT2H0M0 2A stage 3 cl.gr. P.50. 4. G3 May I know what these numbers mean and what is your forecast?

Answers Kirsenko Oleg Vladimirovich:

Ivan, stage 2 breast cancer. The prognosis, in general, is not bad. But you need to know how old the tumor is and what the hormonal sensitivity is, because additional treatment is required.

2010-11-01 23:37:24

Irina asks:

Is it possible to give birth after a diagnosis of breast cancer (breast removed) st ll T2N0M0 cl.gr.lll After 4.5 years, the tests were good during all this time. After the operation I underwent chemotherapy and radiation therapy. Thank you in advance.

Answers Bondaruk Olga Sergeevna:

Good afternoon. According to international standards, it is believed that a few years after breast cancer is cured, it is possible to become pregnant and give birth.
If hormone therapy was not performed because the tumor was non-hormone sensitive, then the risk of relapse is lower. However, before conception, it is necessary to undergo a complete examination - CT scan of the lungs and abdominal cavity,
Ultrasound of the pelvic organs, osteoscintigraphy. During pregnancy you will definitely need to undergo
medical and genetic counseling.

2015-09-12 09:04:00

Elena asks:

Good afternoon I have patency of one fallopian tube, but in 2007 I was diagnosed with breast cancer - treatment and surgery were performed to remove the mammary glands. For the first five years after the operation, doctors forbade getting pregnant, but now we have been trying to get pregnant for the fourth year - and it doesn’t work (we did everything!). The next step is IVF. Can I count on a free IVF program? Thank you.

Answers Palyga Igor Evgenievich:

Hello, Elena! If one of your fallopian tubes is patent, then you cannot count on a free IVF program. IVF for budget funds is carried out with complete confirmed obstruction of the fallopian tubes.

2015-02-27 09:36:38

Galina asks:

Hello, I have oncology - breast cancer, first I had chemotherapy, then radiation therapy, then surgery. After radiation therapy there was a burn to the skin and larynx, everything went away on the skin, but the pain in the larynx remained, it hurt not only to swallow food, but also to simply swallow. Nothing has happened for about a year now. The doctors shrug, according to all indications, everything is normal, although the ENT diagnosis is chronic laryngitis, but the pills she prescribes do not help at all. My question is, is there a remedy that will help me?

Answers Molotov Alexander Viktorovich:

Good afternoon. Contact the Oncology Institute to clarify the diagnosis and treatment. Get well. ENT doctor Ph.D. n. MOLOTOV A.V.

2014-10-15 17:17:06

Anya asks:

Good evening. Mom has breast cancer. After the operation, radiation therapy was prescribed for 21 days. Mom has bronchial asthma. During radiation therapy, on the 10th day the temperature rose, which has persisted for a month. Mom is worried about severe weakness, cough, wheezing, and insomnia. Please help me with an answer. How to help the body recover and overcome complications? Thank you.

Answers Filonenko Andrey Grigorievich:

Good afternoon, Anya. Your questions are understandable, but without examination and examination it is difficult to answer them. Your mother's complaints may have different explanations. Unfortunately, I cannot exclude in absentia even the continuation of a tumor disease as the cause of such complaints. I recommend that you and your mother communicate with your doctor. I'm sure he can answer all your questions.

2014-06-03 09:47:51

Olga asks:

Hello! I am 33 years old. In 2012, my uterus, appendages and cervix were removed. This is associated with breast cancer. I already regretted having this operation. After all this, I was prescribed Tamoxifen, which I take. The hot flashes are too frequent and I no longer know what to do. I'm just exhausted. Constant weakness, depression. I look at the kids and tears roll down that I can’t have any more children myself. Doctors prescribed Cyclim and Climoxan for hot flashes, but to no avail. Tamoxifen itself causes hot flashes. Please advise what I should do and whether it was possible to do without this operation. There would be an opportunity to change everything and return everything to revenge.
Thank you in advance!!!

Answers Wild Nadezhda Ivanovna:

Depression must be fought. You need to communicate with people, you need to take care of yourself: swimming, walking, gymnastics. If you can’t have your own children, help orphans, other people’s, sick children, help women with the same pathology as you: advice, just help bring medications, .... If you feel very hot, then buy a fan, swimming will ease hot flashes and problems with the back and joints. You cannot undergo hormone replacement therapy, but you can use homeopathy: abufen. Tamoxifen is prescribed and discontinued only by an oncologist. Check the level of calcium, phosphorus, vitamin D in the blood - you may need multivitamins or calcium supplements. Take care of your appearance, perhaps you will be interested in cosmetics... Move, move... movement is life, and the Lord God gave us life - which means we must do something in this life.... Not into the past look back - it has already come true and gone, you need to move forward, and when you want to cry - smile, even if the tears are rolling. Fight. Don’t be angry that I’m writing this, but this is the only way to fight depression and other negativity. Remember that depression is an obstacle to treatment and negative energy that pulls you down. Ah, life is struggle, movement, love.

2014-02-16 09:30:12

Victoria asks:

Hello, please help me with advice! After an ultrasound examination, my mother-in-law was diagnosed with breast cancer. I don’t have the card in my hands, I live far from them. So far they have only given me a statement: Diagnosis of SA in the left breast, yellow. ST-3b, T4N1M0, class gr.2.
Recommendations: Chemistry 1 course according to the scheme: ENDOXAN 1000 mg + epirugicin 140 mg + 5 fluorouracil-100 mg. IV drip for 1 day. Already instilled. It is recommended to wait 3 weeks and re-evaluate changes in dynamics and the possibility of surgery. I am alarmed by the fact that a CT scan was neither recommended nor performed and treatment was prescribed. Please tell me an alternative - is radiation therapy indicated instead of a second course of chemotherapy (the drugs are sold directly in the department, we later found out that we overpaid by 2 times). Thank you very much in advance, with best regards.

Answers Kirsenko Oleg Vladimirovich:

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Indications for intervention

Sectoral resection is prescribed for:

suspicion of cancer - as a primary diagnosis;
breast fibroadenoma;
– one or more, provided that they are localized in one sector of the mammary gland;
granulomas in gland tissue;
early stage of cancer;
a chronic purulent process in an organ, when, due to bacterial melting, the tissue has died and cannot be restored.

Sectoral resection for breast cancer is also performed, but this is possible in the following cases:

if the cancer is in the upper outer quadrant;
tumor size – no more than 3 cm;
the size of the mammary gland will allow removal of the tumor and a large area around the perimeter;
no metastases to regional lymph nodes;
After surgery, radiation therapy will be required.

Advantages

Sectoral mammary resection is good because it:

safe;
maintains the same appearance of the mammary gland;
Only the affected area is removed;
If a histological examination of the tumor during surgery reveals that it is malignant, the scope of the intervention can be expanded by removing more tissue.

Contraindications to sectoral resection

The operation cannot be performed if:

pregnancy and lactation;
the presence of a malignant tumor of any location;
systemic and rheumatoid diseases, unless we are talking about the treatment of breast cancer;
diabetes mellitus;
infectious diseases;
venereal disease.

Mammary sectoral resection for various pathologies

For fibroadenoma

is a hormone-dependent tumor localized in the mammary gland. In 95% of cases it is benign, but it can still degenerate into a malignant form, fibroadenosarcoma. The fact that it is this particular tumor is judged on the basis of ultrasound or x-ray mammography. Such a diagnosis will also show the shape of the tumor.

Removal of fibroadenoma is often performed using sectoral resection of the mammary gland. This operation is performed when:

the neoplasm exceeds 2 cm in size and there is a tendency for its further growth;
there is a suspicion (fuzzy boundaries, randomly located vessels) that this tumor is malignant;
leaf-shaped type of neoplasm;
woman plans pregnancy and breastfeeding. Since fibroadenoma can interfere with lactation and also fester when the mammary glands produce milk, it must be resected.

During the intervention, the tumor is sent for histological examination. It will show whether there were malignant cells in it or not. Fibroadenoma does not resolve on its own without treatment.

For breast cancer

Resection of a cancerous tumor of the gland is the main method of treatment, while chemotherapy and radiation therapy are only auxiliary. It can be performed in several types, which depends on:

stages of oncopathology;
tumor growth rate;
penetration of the tumor into neighboring tissues;
the state of a woman’s hormonal levels;
woman's health status.

Extended sectoral resection with lymph node dissection can be performed only in the initial stages of cancer with a small size of the cancerous tumor (no more than 3 cm) and its slow growth, as well as in the absence of cancer cells in the lymph nodes. To do this, the closest one is usually removed - the “sentinel” one, which is determined by the radioisotope method or using a dye.

In this case, not only the tumor will be removed, but also: adjacent tissues; the area of the pectoral muscles on which the mammary gland rests; lymph nodes that collect lymph from this section; fatty tissue that “wraps” the lymph nodes and the vessels connecting them.

Preparation

Preparation for sectoral resection of the mammary gland includes undergoing a thorough examination of the woman, when tests are taken for:

prothrombin index, INR, fibrinogen, free heparin level;
thyroid hormone levels;
prolactin, testosterone, estradiol;
blood levels of urea, bilirubin, AST, glucose, ALT;
microscopy of urine sediment;
determination of blood group and Rh factor.

If the above tests deviate from the norm, you will need to consult with a physician or a specialist specified by the physician. They will tell you what actions need to be taken to normalize the function of an organ whose indicator has deviated. In this case, rehabilitation after resection of the sector should proceed without complications.

In addition, preoperative preparation includes a blood test for the presence of antibodies to the HIV virus, hepatitis B virus, and RW. If the results of at least one test are positive, the intervention will have to be postponed and appropriate treatment will be carried out by an infectious disease specialist (if hepatitis B or HIV is detected) or a venereologist (in the case of a positive RW test).

Before the operation, it is necessary to undergo laboratory tests:

fluorography;
Ultrasound of the thyroid gland;
– ultrasound (up to 45 years) or x-ray (after 45 years).

If a sectoral resection is performed for cancer, distant metastases are excluded using tomography - computed tomography or magnetic resonance imaging - because this involves a completely different operation. Also, as preparation for the intervention, radiation therapy can be performed.

Actions before surgery

Before surgery, a woman must do the following:

exclude taking birth control pills (in consultation with the operating surgeon and gynecologist who prescribed the drug);
stop taking vitamin E 5 days before the intervention;
After consulting with a therapist or cardiologist, at least 3-4 days before surgery, discontinue Aspirin, Warfarin, Curantil, Pentoxifylline or other blood-thinning drugs. Otherwise, sectoral resection may be complicated by severe bleeding;
stop drinking alcohol or smoking, as this leads to a decrease in blood supply to tissues. The healing period in this case will be longer.

If an intervention is to be performed under general anesthesia, the last meal should be consumed 6-8 hours before, and water 4 hours before. This is important, since the introduction of anesthesia can be complicated by vomiting, and it is dangerous on a full stomach.

When planning a sectoral resection under local anesthesia, you should stop eating and drinking 4 hours before surgery.

How is sectoral resection performed?

The operation technique is as follows, performed in several stages:

Marking the surgical field.
Injection of local anesthetic into tissue or induction of anesthesia.
Semi-oval cuts along the marked lines. They are directed from the periphery of the gland towards the nipple and extend 3 cm from the edge of the neoplasm. If resection was carried out in connection with a purulent process, much smaller indentations are made within healthy tissue.
Using a blunt instrument, tissue is separated from the fascia (film) that wraps the pectoralis major muscle to the entire depth of the chest. In this case, the surgeon fixes the tumor with his fingers so that it does not move.
The separated tissues are removed.
Stops bleeding from injured vessels.
A drain is inserted into the wound.
If there is a need for histological examination, the wound is temporarily covered and not sutured. Based on the results of the histologist's examination, surgeons decide whether to suture the wound or remove the entire gland and lymph nodes.
The sutured wound is covered with a sterile bandage.

If an intraductal papilloma was removed using sectoral resection, the boundary of tissue excision is determined by the introduction of a dye (it is injected under ultrasound guidance) into the duct. Then an incision is made along the edge of the isola, a colored duct is found near it, which is tied up near the nipple, and then isolated to its base and a suture is placed there too. Between these two threads, the duct along with the papilloma is removed.

The duration of the intervention is about 30 minutes. Upon completion, the patient is taken to the ward, where she must spend 2 to 3 days.

Rehabilitation

Since the operation is traumatic, the postoperative period lasts more than 2 weeks, but the patient usually only feels the first 8-10 days. They have the following features:

The drainage can be removed on the second day if there is no outflow through it (that is, nothing accumulates in the container attached to it). When the intervention was performed for gland cancer, the drainage is removed on the 3rd day, before discharge.
For the first three days, pain will be felt, which is eliminated by injecting painkillers into the muscle. After discharge, it is recommended to take such medications in tablet form, as required, and not exceeding the recommended dosage.
In the first two days, the temperature may rise. This is a normal reaction of the body to operational stress.
Sterile dressings on the wound are changed daily. After discharge you will have to come to the clinic for this.
You need to take antibiotics for up to 7 days. Most likely, these will be drugs that need to be administered intramuscularly.
The sutures are removed within 7-10 days.

Include a sufficient amount of animal protein in your diet in the form of boiled or baked lean meat, poultry or fish, as well as eggs. Fried, salty and smoked foods will have to be excluded.
Also in the diet there should be a sufficient amount of ascorbic acid. To do this, you need to drink rosehip decoction, eat fresh or frozen black currants, green peas, sweet peppers, melons, herbs, tomatoes, sweet potatoes, turnips and pumpkin.
Knitwear should not put pressure on the postoperative wound. The best option is a sports bra made of natural fabric that will not press or cause other discomfort.
Need more rest.
Watch your weight. Weight gain of more than 3 kg should serve as a basis for consulting a specialist, as this may be swelling inside the operated gland.
You can only take a shower the next day after the stitches are removed. Wash the skin around the seam with a soft gauze cloth soaped with baby soap. After bathing, the seam area should be blotted with dry, clean gauze and then treated with alcohol. At a distance from the seam, lubricate the breasts with baby cream.
Remove hair from the armpit on the operated side with an electric razor to avoid skin damage.
After the sutures are removed, you can begin performing exercises that will help quickly restore the muscles of the arm on the operated side and normalize your own condition. This is “combing” the sore hand, squeezing a rubber ball or wrist expander in the palm of the hand, frequently fastening and unfastening the bra, and performing movements with a towel that are reminiscent of wiping the back.

After surgery, you should not heat the wound or treat it with milk, urine or tea.

You need to urgently contact the operating doctor if:

after sectoral resection, a compaction appeared in the breast tissue;
the wound has become more painful or the pain does not tend to decrease, disturbing with the same intensity;
the temperature persists for the third day or later;
the temperature has risen again after a period when it was normal;
pus is released from the wound;
the arm or shoulder on the operated side is swollen.

How can the operation be complicated?

After sectoral resection of the mammary gland, the following complications may develop:

Seroma

This is an accumulation of fluid in the operated gland due to damage to the lymphatic capillaries. It requires repeated punctures with the collection of serous fluid.

Wound suppuration

It is manifested by increased pain in the wound and discharge of pus from the wound. The temperature may rise and the general condition may be disrupted (weakness, fatigue, loss of appetite).

Blood accumulation

A hematoma after sectoral resection of the mammary gland usually appears in the case when some vessel was not noticed and not sutured, or the tissue is so swollen that the thread does not hold well on it. Then blood “leaks” from the vessel, which accumulates in the mammary gland. In this case, repeated intervention in the organ is required to remove accumulated blood and stop bleeding.

Seal

The reasons for the formation of a lump after sectoral resection of the mammary gland are varied. These may be internal scars formed as a result of tissue suturing. Then they are less painful and decrease over time. Seroma and tumor recurrence can also be described as compaction. Therefore, if it was not there, and then it appeared, be sure to consult a doctor.

Lymphedema of the arm

This complication develops due to the fact that the lymph nodes through which lymph drained not only from the chest, but also from the arm, were removed. This condition takes a long time to treat, and it will be better if a woman contacts her as soon as she notices an increase in the volume of her arm.

In the treatment of such complications, a special type of gymnastics and physiotherapy is used. The woman is also given a number of recommendations, the implementation of which will prevent the increase or recurrence of lymphedema. They are as follows:

do not wear tight jewelry on the sore hand;
do not allow blood to be taken from her veins, only as a last resort;
do not measure blood pressure on this arm;
after bathing, thoroughly dry the entire hand, including the spaces between the fingers;
do not lift weights with this hand, do not perform counteracting manipulations;
avoid damaging the sore arm;
exclude manicure on this limb;
keep your hand out of the hot bath;
do not visit the sauna;
protect your hand from sunlight;
perform a manicure on this limb very carefully;
When traveling by air, wear a compression sleeve on your arm and drink plenty of fluids.

When you have indications for sectoral resection of the mammary gland, try to worry less about it. If you take all tests in a timely manner, fully compensate for your condition before the intervention, and follow all recommendations after it, the likelihood of any complications is minimal.

Very often, surgery for the treatment of breast cancer is performed as a complete mastectomy. Surgical intervention includes complete removal of the mammary gland, regional lymph nodes and complete or partial excision of the pectoralis major muscle.

After breast cancer surgery Patients are strongly recommended to undergo routine examinations once every 3-4 months (the first 5 years after mastectomy). After the five-year period, the number of visits to the gynecologist should be once a year. During a routine examination, the doctor finds out whether the patient has complaints and prescribes additional examination methods. Studies such as ultrasound diagnostics, mammography and cytological analysis can determine the presence of relapse of the disease.

Leading clinics abroad

Possible complications after breast cancer surgery

After excluding recurrence of the disease, a set of therapeutic measures is carried out, including: self-massage, bandaging with an elastic bandage, physical therapy, elevated position of the lower extremities at night and prevention of skin inflammatory processes.

Rachiocampsis:

The complication occurs due to a decrease in the load on the spinal system on the side of the removed gland.

Pathology of the immune system:

Immune system deficiency develops due to the loss of regional lymph nodes in which immune cells (lymphocytes) accumulate.

Pathology of the pulmonary system:

Radiation therapy for breast cancer sometimes causes pathological dilatation of the bronchial tract. Treatment of the complication involves the use of aerosol therapy, which involves exposing the alveoli and bronchi to particles of the drug. The therapeutic drug is injected into the lung tissue using moist inhalation.

Introduction

Anatomy of the breast.

The mammary gland is located on the anterior surface of the chest from the 3rd to the 7th ribs. This is a complex tubular-alveolar gland (derived from the epidermis, it is classified as a gland of the skin). The development of the gland and its functional activity depend on reproductive hormones. During puberty, excretory ducts are formed, and secretory sections - during pregnancy. The parenchyma of the gland consists of 15-20 individual complex tubulo-alveolar glands (lobes, or segments), opening by the excretory duct at the apex of the nipple. The lobes (segments) are represented by 20-40 lobules, consisting of 10-100 alveoli each.

Blood supply.

Arterial blood enters the mammary gland from the internal mammary artery (60%), external mammary artery (30%) and branches of the intercostal arteries (10%).

Venous drainage occurs through the intercostal and internal mammary veins.

Lymphatic system. Lymph from the outer quadrants of the mammary gland flows to a group of axillary lymph nodes. The axillary lymph nodes are divided into nodes of 3 levels (depending on their relationship with the pectoralis minor muscle). Lymphatic drainage occurs from the inner quadrants of the mammary gland to the parasternal lymph nodes.

Innervation: phrenic, intercostal, vagus and sympathetic nerves.

Types of breast surgery

Surgical interventions on the mammary gland can be divided into three groups:

Surgeries for inflammatory diseases (acute and chronic mastitis). These include, first of all, opening and draining the abscess. It is extremely rare for mastitis to remove the mammary gland (for gangrene of the mammary gland).

Surgeries for benign and malignant neoplasms (fibroadenoma, breast cancer, fibroadenomatosis). These include - enucleation of a breast tumor - sectoral resection of the mammary gland - radical resection of the mammary gland - mastectomy (removal of the mammary gland) - axillary lymphadenectomy - biopsy of axillary lymph nodes

Plastic surgeries include: - endoprosthetics (breast augmentation with a silicone prosthesis) - reduction mammoplasty (breast reduction) - mastopexy (breast lift) - breast reconstruction

Sectoral breast resection

The essence of the operation is the removal of a section of breast tissue suspected of cancer or a benign breast tumor.

Indications

Suspicion of breast cancer. For the purpose of establishing a diagnosis.

For benign diseases for therapeutic purposes (fibroadenomas, lipomas, granulomas, chronic mastitis, etc.).

Breast cancer (when sectoral resection is part of breast-conserving surgery).

Anesthesia

Local anesthesia with a solution of novocaine or, if the latter is intolerant, with another anesthetic (for example, lidocaine). General anesthesia is used for non-palpable formations, when the tumor is determined only by mammography and ultrasound, but cannot be detected during examination. Also, general anesthesia can be used for polyvalent allergies (intolerance to all drugs for local anesthesia). General anesthesia is also performed if sectoral resection is part of an organ-sparing operation.

Surgery

The surgeon marks the incision lines for sectoral resection and radical mastectomy using a stick with cotton wool and brilliant green. Using two semi-oval incisions running in a radial direction relative to the nipple, the gland tissue is dissected with an arcuate incision. Having retreated 3 cm from the edge of the tumor through the entire thickness of the gland to the fascia of the pectoralis major muscle under the control of the hand fixing the tumor node, the surgeon makes an incision on the other side. The sector (area) with the tumor is removed. Stop the bleeding. Then the wound is sutured with separate sutures, capturing the bottom so that cavities do not form. If necessary, sutures are placed on the subcutaneous tissue. Separate interrupted sutures or a cosmetic suture are applied to the skin. The removed sector of the mammary gland is sent for urgent histological examination (lasts 20-30 minutes). If cancer is detected, it is necessary to expand the scope of the operation, which depends on specific conditions (tumor size, mammography and palpation data before surgery).

The scope of sectoral resection may be reduced if it is known that the tumor is benign.

Complications

Wound suppuration due to infection during or after surgery.

Accumulation of blood (hematoma) as a result of careless control of bleeding or any violations of the blood coagulation system.

results

The sutures are removed within 7-10 days. The cosmetic defect depends on the individual characteristics of the body and the execution of a simple or cosmetic suture. With the latter, the results are usually better.

Any operation is stressful for the patient, so sedatives are usually prescribed the day before. During surgery, do not worry, listen to your doctor. If you feel pain, it is best to say: “It hurts.” The doctor will definitely administer an additional painkiller.

After surgery, the dressings should be changed by a nurse or doctor. If early discharge from hospital or outpatient surgery is necessary. It is necessary to carry out dressings correctly yourself:

Wash your hands thoroughly with soap and water

Treat them with a swab dipped in a solution of alcohol or vodka

Carefully remove the bandage

Gently wipe the surface of the wound with a swab soaked in a solution of alcohol or vodka. Place a bandage folded 2-3 times on the wound and secure it with a plaster.

If you have the slightest doubt, you should consult a doctor. You should also consult a doctor if:

Temperature above 39 degrees two days after surgery

Severe pain in the area of surgery

During bandaging, pus discharge was discovered