Recovery after a mastectomy. Mastectomy - indications for breast removal, preparation, technique of the operation and the rehabilitation period Suture after surgery to remove the breast

Theoretically, it was possible to remove the tumor sectorally, but the doctors decided to play it safe and remove it completely. They explained this by the fact that at a young age, cancer develops much more aggressively and faster, besides, then, well, I lost a lot of weight and my breasts became small. In general, in order not to risk my life, as I said, the doctors decided to remove the left breast completely. I have always been incredibly proud of my breasts, they were so beautiful! Before the operation, to be honest, I even tried to convince myself that I would not wake up ... but when they took me out from under anesthesia, I was still glad that I was alive.

How to live after breast removal?

I did the operation in Moscow. The surgeons and anesthesiologists were all men, and I read in their eyes a clear sympathy for my person. While I was in intensive care (almost 2 days), they constantly supported me, for which I am very grateful to them. And several times in conversations they told me that plastic surgeons do miracles and my beautiful breasts can then be restored. This thought was very encouraging to me. Well, thank God, my husband was very supportive.

The operation was followed by treatment - 4 courses of chemotherapy, without radiation. Then there was a period that I called "not before plastic surgery", because I was very nauseous during chemistry, my hair fell out and I wore a wig, well, and all the other delights of this period.

Reconstruction after mastectomy

In general, doctors say that plastic surgery can already be done 2 months after removal, if there was only chemotherapy and not earlier than a year after radiation therapy. But for some unknown reason, the suture did not heal for a very long time after mastectomy. More than a year. After he finally healed, I began to study information about breast reconstruction methods, doctors, clinics, etc. In general, as the doctors told me, only a small part of women after mastectomy go for reconstruction surgery. Perhaps because of fear, or maybe because of age, it is simply not interesting for someone. But, since, as I said, at the time of the removal of the mammary gland I was only 27 years old, the issue of reconstruction was vital for me. I hope that what I write next will be useful to someone.

So what are the ways to repair the breast after a mastectomy?

Method one - with an expander

Its essence is that during the operation a special expander is inserted under the skin in a deflated state. Then, with certain intervals of time (according to different versions, these intervals can be up to several months) it is pumped up, increasing in size. The expander is stretched and the skin on the chest is gradually stretched along with it. It is important that it be gradual, then there will be no stretch marks, breaks and any other "amenities". Further, when the expander together with the skin grow to the required size, a second operation is performed, during which the expander is replaced with an implant. A few months later, a third nipple shaping operation is performed. This stage, in my opinion, from the point of view of aesthetics, is the most difficult to accomplish, but more on that later.

And yet, I initially wanted to operate exactly according to the first method, because after it there are fewer scars, but I was thin at that time and the layer of skin was too thin, in general, skin and bones. The surgeons said the skin would tear. In general, this option is not for everyone.

Method two - transplantation of one's own skin with muscle tissue (autotransplantation)

There are variations here too. Either a flap of tissue with muscles is taken from the area of \u200b\u200bthe shoulder blades, or from the abdomen. Further, without cutting off the artery, the doctor must carefully turn this flap and "embed" it into the place on the chest where the mammary gland will form. An incision is made along the suture left after the removal of the mammary gland, the implant is installed and immediately closed with its own flap. This concludes the operation. Only after complete healing and after the implant is in place, it will be possible to talk about the second stage of breast reconstruction - the formation of the nipple.

The third method of breast reconstruction known to me after mastectomy is transplantation of own tissues and, most importantly, fat, without the use of a silicone implant.

This method was advised to me by one of the doctors in Moscow; I did not come across a description of this method on the Internet. It seems to me - this method is not very popular ... well, right. Now I already thank God that I was smart enough not to use this method. Since at that time the only place on my body where one could find even a little bit of fat was my butt, the Moscow doctor suggested that I cut off a piece of skin and pump out the fat from the butt and sew it onto my chest. Without an implant! As another surgeon later explained to me, after a short period of time, the breast will lose its shape and will hang in a bag. In addition, deep scars and a failure will remain on the priest, that is, you will not show your priest or your chest to anyone.

As you can imagine, I refused the third method, and the first did not suit me because of the lack of subcutaneous fat on the chest. Remained option number 2 and find a good surgeon.

I began my search with the recommendations of oncologists. Despite the abundance of plastic surgeons in Moscow, the choice, as it turned out, was not at all great. Somehow we have few doctors specializing in breast reconstruction after its removal. I read a lot of reviews on the Internet, shoveled an incredible amount of information ... and realized that in Moscow, and in Russia in general, I do not want to be operated on. In order not to bore you with the details, how I went to the Swiss medical center and their plastic surgeon, I will say briefly, it was through the acquaintances of my distant acquaintances. The recommendations were solid from people I could trust.

Is it true that everything is too expensive in Switzerland?

Well, of course Switzerland is more expensive than some other countries, but the quality of their services is worth it! Definitely! Moreover, in my case it was about my health and beauty. Not just about some banal Botox injection, but about complex operation, with the results of which I will live my whole life. I don't think it's worth saving on such things.

I wanted to have this operation so badly! After all, almost 2 years after the removal of the mammary gland, I could not even completely undress with my husband, I could not overcome the psychological barrier. So, in anticipation of positive changes in my life, I came to Geneva to the very medical center that my friends had advised me. They arranged for me a meeting with 3 plastic surgeons (in their private offices) so that I could choose a doctor, feel which of them I trust more, see photographs of their work, ask about the details of the operation. By the way, I don't speak French, and my English was definitely not enough, so the medical center provided me with a medical translator (they also found a hotel for me).

I liked all three doctors. But one of them is bigger than the rest. He is not just an ordinary surgeon, but the president of some serious association of plastic surgeons. A kind of workaholic who adores his job. I love such enthusiastic people. By the way, he received me in his office on Saturday !!! In Europe, this is generally not accepted. The weekend is sacred, everyone is resting. And it works! And of course the photographs of his work impressed me a lot! So, I chose a doctor, we set the day of the operation. Since this doctor's schedule is busy for several months in advance, my operation was scheduled in 2 months, and the doctor's secretary said that I was lucky.

Questions: 107

Hello Dmitry Andreevich! I am 68 years old, weight 80 kg., Height 160 cm. 12/19/18 I had an operation - left-sided mastectomy according to Madden, 13 lymph nodes were removed (hyperplasia according to histological examination). Diagnosis after immunohistological examination: Lev invasive ductal carcinoma. breast, non-specific type. Luminal type A. T2N0M0. Today it is already 7 weeks after the operation, the drainage is still installed, and a lot of lymph is separated through it: 90 ml per day, then 50-60 ml for two days, then again 90 ml. Tell me, do I need to remove the drainage now and switch to lymph puncture, or keep it until the lymph volume decreases to 30 ml? Maybe this drainage provokes lymph flow? Will the course be able to heal on its own after removing the drainage, or has the tissue around the drainage already healed and formed a "tunnel, fistula" and the surgeon will have to suture this passage?

The question is answered: Krasnozhon Dmitry Andreevich

Hello, Natalia. In principle, there is nothing wrong with this situation. Lymphorea can persist for a long time. I usually remove the drainage when I release 50 ml or less of fluid per day. Drainage by itself does not induce fluid accumulation. To reduce lymphorrhea for my patients, I usually suture the cavity after mastectomy, though it's too late to talk about it. The tunnel where the drainage is located will close itself, there should be problems with this. If for some time liquid is released through it, then nothing terrible will happen. We must be patient.

Good day. Tell me, please, after mastectomy and radiation, it has already been half a year. The seam in one place is hyperimia and constantly sore, after a while the sore disappears and appears again. There is no suppuration or pain. The surgeon says that this is a small seroma. That there was a strong tension on the fabrics and in one place the seam parted. No fistula. I used levomekol, baneocin, solcoseryl. Complete healing does not occur. Did ultrasound and PET. They do not find anything wrong under the seam. So why is an area in one place hyperemic and a permanently non-healing dry sore? Is it worth worrying? Thank.

The question is answered: Krasnozhon Dmitry Andreevich

Hello Yana. Obviously, we are talking about skin deficiency and trophic disorders. If the ulcer persists for a long time, then I usually perform its excision. You have to watch you to speak definitely. If there are trophic disorders after radiation therapy, then I often propose to perform lipofilling - the introduction of autologous fat in the area of \u200b\u200bsurgery. Come to us for breast reconstruction, there are quotas for your region. In any case, you need to be guided by the opinion of the attending physician.

Hello, my grandmother 1944 (73g) in November 2017 was diagnosed with NET of breast cancer T4n2mo. was carried out: 1) preoperative chemistry therapy according to the Xelox scheme 4 courses 2) Octreocid was prescribed for a year from 11.2017-12.2018 3) radical mestectomy in February 2018 4) after radiation surgery 5) after surgery femara for life After surgery 7 months have passed, all this time She goes to pump lymph 2-3 times a week. Everything went to the best, and from 250ml it went to 90-150. But when her doctor at the place of residence was on vacation, she went to pump out to another doctor for two weeks, after these two weeks, when she returned to her doctor after vacation, she developed a hematoma and fluids were pumped out 350 ml with blood, after this incident , lymph comes with blood, this happens from July 2018 to the present day, travels twice a week, pumped out 250 ml, most likely a blood vessel is damaged, ultrasound does not show any lymphocyst. Hemoglobin drops, already 90, was 140. The attending surgeon suggested only dressing, pumping and drinking iron. At the place of residence, the doctor without ultrasound says that an operation is needed, that it is a lymphakist. What is done in such cases if the vessel is damaged and the person loses blood?

The question is answered: Krasnozhon Dmitry Andreevich

Hello Evgenia. Most likely damage occurred during one of the punctures blood vessel and apparently a lot of blood has poured into the wound, judging by the level of hemoglobin. I don't think this is about ongoing bleeding. In principle, in this case, I would suggest re-draining - placing a drain in the wound or performing an open drain - an opening in the skin through which lymphatic fluid would drain out. Iron supplementation is indeed advisable. In any case, you need to be guided by the opinion of the attending physician.

Hello, in June 2018 was held radical mastectomy to remove the left breast. Almost 4 months have passed, but the hand does not rise up to the maximum. Did gymnastics. But there is no effect. What to do and where to go.?

The question is answered: Krasnozhon Dmitry Andreevich

Hello Veronica. It is necessary to contact the attending physician for examination, then it makes sense to contact the instructor in remedial gymnastics. In such a time frame, the hand should move in full. In any case, you need to be guided by the opinion of the attending physician.

Hello dear doctor my mother had surgery on August 30, 2018. on the left breast, a lymph node was removed on the left side, a drain was installed and it is still standing. The lymph is drained 2 times a day, a daily amount of 150 mg. Could this be normal? Can this drain stand for so long?

The question is answered: Krasnozhon Dmitry Andreevich

Hello Victoria. Yes, long-term lymphorrhea is nothing special. To reduce it, I usually suture the skin flaps to chest wall or I perform axillary surgery using a pectoralis minor flap. The drainage can be left on for longer periods. In any case, you need to be guided by the opinion of the attending physician.

Good evening, Dmitry Andreevich! Mom had an operation (radical mastectomy) in June 2018. Two months they pumped out the lymph, then a lump appeared just below the suture, the doctor made an incision, inserted a drainage, pus collected there. They injected an antibiotic, gave a severe allergy. Now the wound is washed with peroxide, saline and an antibiotic was injected there. Now, due to allergies, the antibiotic is not administered and we do not drink anything. Pus, not much, but still remains on the bandage. The temperature jumps 37-37.5. Can an allergy give a temperature or is it still pus gives a temperature? I am very afraid, Mom 79 years. Thanks in advance for your reply.

The question is answered: Krasnozhon Dmitry Andreevich

Hello Sabina. Allergic reactions from the side of the skin, usually the temperature does not rise. I do not think that in your case we are now talking about suppuration, most likely a fistula has formed, which causes an increase in body temperature. It is necessary to look at the patient in order to speak definitely. In any case, you need to be guided by the opinion of the attending physician.

Hello, Doctor. My mom underwent surgery on July 18, 2018 to remove her breast (grade 2 cancer). Today is September 10th. Until now, liquid flows about 50 ml per day. We got 2 chemistry. Why is the liquid still running out? It happens?

The question is answered: Krasnozhon Dmitry Andreevich

Hello Laura. If the mammary gland was large, then, as a rule, the accumulation of fluid occurs for a long time. We must be patient and continue the puncture. Although, with the accumulation of fluid less than 50 ml per day, punctures can be done less often.

Hello! Mom had an operation to remove her breasts. The lymph was pumped out for 3 weeks. Now, under the seam in the place where the lymph is removed, the seal is like a brick. What could it be?

The question is answered: Krasnozhon Dmitry Andreevich

Hello Valentine. It is possible that a seroma has formed - an accumulation of fluid in the wound. In such a case, I would recommend contacting the doctor who operated on you, would perform a puncture, if it is found during examination or ultrasound. The second possible option is that skin flaps began to grow in the chest wall and a skin deficit has formed, which you can feel as a thickening. In any case, you need to be guided by the opinion of the attending physician.

Good evening, Dmitry Andreevich! 06/27/18 my mother (79 years old) underwent a radical mastectomy. Everything would be fine, but for the third month now we have been going to pump out lymph. After the last pumping, she developed a lump under the skin, and the skin turned red. The lump is quite impressive, like a quail's egg. Could a relapse start so early? Or just an infection in the hospital. I also wanted to know if mom needs radiation therapy because of her age, she has triple-negative cancer pT2N1aM0, KI67 - 60% Thank you in advance for your answer!

A mastectomy is a surgical procedure that removes part or all of the breast tissue affected by cancer. The patient needs a long recovery period after such an intervention. It usually lasts about two months for physical recovery and six months for psychological recovery.

Postoperative rehabilitation

If no complications have arisen during the day after the mastectomy, the patient is admitted to the intensive care unit. Already the day following the operation, you can and should get up. The earlier a woman begins to perform rehabilitation measures, the lower the risk of developing complications such as lymphostasis, erysipelas, and the recovery will be faster. If rehabilitation is started late, then this process will stretch in time and will be more painful.

Those who have undergone surgery almost immediately experience intense pain in the chest area. To reduce them, the attending physician must prescribe pain relievers. It is recommended to use them in moderation, preferably only in case of acute pain. Before that, a history is compiled with information about allergies and drug reactions. It is forbidden to drink alcohol and drive a vehicle at this time. Laryngeal pain after general anesthesia may be present.

At first, there may also be fever and a slight increase in body temperature, but such a reaction should not cause concern, this is quite normal during surgery, unless, of course, negative symptoms worsen and such serious develop side effects, such as erysipelas, lymphostasis, etc.

Temporary side effects when removing the mammary gland are edema and hematomas; to eliminate them, it is advised to use ice warmers in the armpits and areas of lymph node dissection. The incisions are sewn up with special material, and they are covered with sterile bandages on top, so it is forbidden to correct and remove them yourself. The bandage is removed after a week, and the sutures - after two weeks, if they have not resolved by that time.

A special drainage is installed for the woman to drain excess fluid, it is made of a plastic tube inserted subcutaneously on one side, and a bag for taking it on the other. A day after removing the drainage, the patient is allowed to take a shower. Care should be taken when wiping the suture area; they should be gently patted down with a towel, avoiding moving the sterile dressings.

Often, patients are worried about how many days they need to stay in the clinic after a mastectomy. As a rule, the operation and several days after it proceed without complications, and on the third day the patient is discharged from the hospital home without removing the drainage tubes. Health workers should be trained on how to properly handle the drainage system. In the case of subcutaneous mastectomy with breast reconstruction, the hospital stay is increased to six days to avoid implant rejection and erysipelas.

The pain begins to subside after the third day. A woman should get out of bed calmly, without sudden movements, avoid carrying heavy loads and not raising her arms above her head. For about four weeks, you will need to visit the clinic, make dressings and remove the serous fluid that forms after removing the drainage under the skin. Further, based on the testimony of analyzes and examinations, the doctor prescribes further treatment. This could be:

All procedures are carried out only with the consent of the patient, no one can force him to take chemotherapy or be irradiated. The return to the previous way of life occurs in about two months, if there are no complications.

Postoperative complications are determined by the volume of surgical intervention and are post-traumatic. The most typical are displacement of blood clotting indices, erysipelas, lymphostasis. Phantom pain and asthenia are also characteristic. Since the patient has postoperative stress, wound healing may deteriorate and the period of lymphorrhea and scar formation may increase.

When diagnosing, the doctor relies on the patient's complaints, the nature of the pain and the test indications, as well as his own examination. The table below shows rehabilitation measures for various complications.

Table 1 - Complications and rehabilitation measures after mastectomy

So, let's designate the difficulties that patients face after surgery to remove the mammary gland, as well as during and after treatment:

• The most common problem is depression, which makes it difficult to recover from cancer. It aggravates the patient's condition, increasing fatigue and reducing the body's defenses. We need the support of relatives and communication with those who have already gone through these procedures and returned to a full life. In severe cases, it is recommended to contact psychotherapists so as not to delay the period of psychological adaptation.
• After a mastectomy, it is imperative to purchase a good exoprosthesis, choose the right underwear, so that the woman does not suffer from complexes due to the lack of a breast.
• The patient needs to learn how to self-care the scar in order to avoid inflammation. Be careful with lifting weights, do not lift things over 1 kilogram for three years. Limit housework, especially if it involves an inclined position. This is very important if there is lymph congestion in the hand from the side of the operation.
• Be careful when working in the garden, do everything in seals to avoid introducing microbes into small wounds. In connection with the deterioration of the outflow of lymph, there is a threat of erysipelas. All cuts and scrapes should be treated with antiseptics!
• When removing breast cancer, it is not recommended to become pregnant, as the hormonal jump can provoke a recurrence of the disease. Proper nutrition plays a large role in recovery. The diet is simple and effective. It is better to exclude smoked meats and canned food completely. It is recommended to limit sweets with this diet. In the diet, as much as possible, you need to increase the amount of vitamins, and reduce fats. Naturally, you cannot smoke and drink alcohol. Main principles:
• Also helps to recover special exercises... They must be done even while in the hospital. Developing the arm with gymnastics and massage to prevent lymphedema should be started as early as possible, gradually increasing the load. In this you need to be careful and do the exercises regularly. It is also important to monitor your posture because the load on the spine changes.
• Swimming and exercise have a beneficial effect on the recovering body. And it is more rational to replace taking a bath with shower procedures. It is useful to swim in the sea, but it is forbidden to stay in the sun. It is also important to know that a change in the climatic zone is unfavorable, as it can provoke a recurrence of breast cancer.
• Constant observation by a doctor during the first year every 3 months, in the next five years - every six months. It is necessary to consult with an oncologist when prescribing treatment by other doctors, be it immunotherapy or physiotherapy.
• 
  Partial unemployment or disability. Immediately after the operation, a ten-day sick leave is discharged with an extension, if necessary, for another month. If there are complications, then it is drawn up for the entire period of treatment. But this period of time should not exceed 4 months. Some time after the mastectomy, the woman undergoes a medical commission, which issues a conclusion on the need to prolong the sick leave, or MSU, which assigns the patient a disability group. The mere fact of removal of the mammary gland is not a reason for disability in Russian Federation... It can be given temporarily to continue treatment, or permanently in case of a threat of metastases. In any case, the issue of granting a disability group is decided by a medical and social examination, to which the attending physician directs.

In general, the prognosis after mastectomy is quite favorable, especially in cases of early detection and competent treatment of breast cancer. The survival rate in the first stage of the disease is slightly less than 100%, in the second - up to 80%. This is also influenced by the type of malignancy of the neoplasm. The appearance of serious complications (erysipelas, lymphostasis) causes more negative prognosis.

Timely removal of the tumor and the course of subsequent therapy can keep the patient's normal life for a long time. Without treatment, the disease progresses extremely rapidly and leads to disability and death. Breast cancer today is one of the most positive in terms of survival prognosis. It is important to remember that life goes on after a mastectomy. A woman should tune in to a good outcome, this helps a lot in the fight against the disease.

08.12.2017

QUESTION: Doctor, my mother's hemoglobin dropped sharply after a mastectomy. What do you recommend? How to raise it? And what caused it? Thank.

ANSWER: Hello! How long have you had an operation? If your mother has recently had an operation, most likely, there is a hematoma after lymph puncture! Contact the surgeon who performed the operation! Has hemoglobin dropped a lot? He shouldn't fall like that!

09.12.2017

QUESTION: Vitaly Alexandrovich, I asked you a question about a mother whose hemoglobin dropped after a mastectomy. 12 days have passed since the operation, hemoglobin 80. Thank you.

ANSWER: Hello! Most likely, your mom was bleeding! But 80 is not enough, you must definitely raise it!

16.12.2017

QUESTION: Vitaly Alexandrovich, are the patient's emotional needs taken into account when deciding to remove the breast?

ANSWER: Hello! Many factors are taken into account: from the type of tumor, from the person and his adequate response to the situation, from the future lifestyle! Everything counts! How can we go without it?

26.12.2017

QUESTION: Vitaly Aleksandrovich, does preventive mastectomy - breast removal - increase survival? If it does, then for which molecular subtypes of cancer?

ANSWER: Hello! Of course, one can argue that there is no gland and no cancer, increasing survival! Usually prophylactic mastekiomy is done with Brca1,2,3,4 mutations! But in our country, prophylactic mastectomy is still not widely used!

14.01.2018

QUESTION: Vitaly Alexandrovich, how many lymph nodes are removed during mastectomy?

ANSWER: Hello! In a standard Madden and Peyty operation, 3 levels of lymph nodes in the armpit are removed - for some it may be 10 lymph nodes, and for others 20 or more.

16.01.2018

QUESTION: Vitaly Alexandrovich, when can I take the first shower after a mastectomy?

ANSWER: Hello! The answer is when the doctor permits, usually after removing the drain!

18.01.2018

QUESTION: Vitaly Aleksandrovich, how long should dressings be done after mastectomy?

ANSWER: Hello! This period is different for everyone, as long as lymphorrhea lasts, with a mastectomy this is normal. On average, 1.5-2 months.

31.01.2018

QUESTION: Hello, Vitaly Alexandrovich! My question is, 2 months after the mastectomy, my seam thickened and reddened. Very dense in some areas. There used to be a thin seam. What can it be and what to do?

ANSWER: Hello! More often than not, this is such a healing process! Until 6 months, it becomes more dense, and then vice versa. Red because now it is sprouting with blood vessels and this is like a reaction! Sometimes there is inflammation after 2 months, but usually it goes away after local dressings!

11.02.2018

QUESTION: Vitaly Aleksandrovich, almost 6 months have passed since the mastectomy and my hand is still limited in mobility. What will you advice me?

ANSWER: There can be many reasons for this. Are you doing exercises and exercises for recovery? You need to be watched, come for a consultation, and we will resolve this issue! I think it will be useful for you to read my article on how to live after a mastectomy.

11.02.2018

QUESTION: Doctor, my mother has had 4 months after masteetomy, but she still feels pain in the operated area. How normal is this? And how long the recovery process takes. Thank.

ANSWER: Hello! This is normal and natural, you can read in detail on my website information about recovery and pain! We are all different and everyone's pains do not last the same! I hope that soon everything will go away with your mother. On average, pains can last 6 months!

11.02.2018

QUESTION: Vitaly Alexandrovich, is it possible to wear jewelry on the operated side after mastectomy. I mean wrist bracelets or finger rings. Or better not to. Thank.

ANSWER: Hello! Of course you can wear jewelry. If you have symptoms of lymphadenitis, then you will not be able to wear the ring, and if you do not have signs of swelling of your hand, then wear it without problems!

25.02.2018

QUESTION: Vitaly Alexandrovich, is there always lymphorrhea after mastectomy? Is this considered the norm? And how long can it last? Thank.

ANSWER: Hello, this is the norm and natural! It lasts for everyone in different ways - from a month to 3-4 months!

Today

QUESTION: Vitaly Alexandrovich, 3 months have passed since the mastectomy and the stitch still hurts. Is this a variant of the norm? And this place is still numb.

ANSWER: Hello! This is the norm in your case! This is all related to the operation and soon all symptoms should disappear!

05.03.2018

QUESTION: Vitaly Alexandrovich, I'm worried about edema after mastectomy. The operation was 2 months ago. Do I have a reason to worry? Thank you so much.

ANSWER: Hello, you have no reason to worry, this is a natural normal process after a mastectomy.

12.03.2018

QUESTION: Vitaly Alexandrovich, are there any ways to reduce lymphorrhea after mastectomy? Thank.

ANSWER: Hello! For many years, surgeons have tried to deal with this problem and, unfortunately, nothing has been invented, only punctures! This process usually takes place later!

12.03.2018

QUESTION: Vitaly Aleksandrovich, what will happen if the liquid that forms during lymphorrhea is not pumped out? Thank.

ANSWER: Hello, the liquid will accumulate under the skin and this will cause discomfort, and worst of all, inflammation and suppuration of the wound can occur!

17.03.2018

QUESTION: Vitaly Alexandrovich, more than two months have passed since the mastectomy, but I am still worried about pain in my arm. How to reduce this arm pain after mastectomy? Thank.

ANSWER: Hello! Pain is a natural condition in this case, it can be reduced by taking painkillers! Soon this pain will be less!

29.03.2018

QUESTION: Vitaly Aleksandrovich, for how long do they give a sick leave after mastectomy? Thank. ANSWER: Hello! Usually the sick leave is given by the attending physician in the hospital and in the polyclinic at the place of residence, and it is given for the period that is necessary, this period is unlimited!

03.04.2018

QUESTION: Vitaly Alexandrovich, what is a Madden mastectomy?

ANSWER: Hello, this is the removal of a breast with lymph nodes of all levels in the armpit for breast cancer!

04.04.2018

QUESTION: Vitaly Alexandrovich, how long after a mastectomy should you start wearing compression sleeve? Thank.

ANSWER: Hello! It is not necessary to wear the sleeve after a mastectomy, it is necessary to wear it only if there are any complications, such as lymphedema, for example!

09.04.2018

QUESTION: Does the body need to be prepared for chemotherapy, when to start and how?

ANSWER: Hello, there is no such need, since our body is ready for anything!

10.04.2018

QUESTION: Vitaly Alexandrovich, are there any ways to somehow reduce the release of serous and lymphatic fluid after mastectomy? And what is this process called? The drainage costs the seventh day and there is still a lot of fluid accumulating - sometimes less, sometimes more!

ANSWER: Hello! Honestly, I will tell you that this problem is hanging in the air and no one knows how to solve it !!! There are many methods for stopping lymphorrhea - this is the name of this process, but they are all ineffective and lymph still continues to accumulate in the axillary region, but only time stops this process, which on average lasts about 1-2 months! Some surgeons suture skin flaps to chest in the armpit, someone injects solutions into this area, but I repeat that this is all pointless! Do not trust someone who promises otherwise! Everything will go away for you soon, be patient!

ANSWER: Hello! Fundamentally different !! Histology is the structure of the tumor, what type of cancer and the damage to the lymph nodes is assessed. Immunohistochemistry is an analysis of the same tumor that tells how to treat this tumor! Is it the study of tumor cell receptors? These are short in words for an ordinary non-medical person!

Mastectomy is a method of treating breast cancer by surgically removing all or part of the breast. Scars are the result of this procedure.

The incision and surgical approach depend on the volume of the breast to be removed and the woman's desire to undergo reconstruction after a mastectomy.

1. Certain surgical approaches, such as nipple-sparing surgery, can improve the appearance of scars.
2. The surgeon's actions during the mastectomy process depend on the size and depth of the tumor.
3. A woman's desire for breast reconstruction also determines the type of surgery.

How is a mastectomy performed?

The appearance of mastectomy scars depends on the type of surgery that was performed

Often, the appearance of the scars that remain after a mastectomy depends on the incision and the technique the surgeon uses.

At the beginning of the operation, the surgeon will make an incision in the skin of the chest to open inner part breasts.

As soon as the surgeon has removed the breast tissue as well as the muscles and if necessary the lymph nodes, he will immediately suture the skin where he made the incision.

When the tissue damage heals, scars will appear on the skin of the breast. Despite the different surgical approaches described in the current material, most mastectomy scars form a horizontal line through the ribcage, and sometimes these scars are crescent-shaped. Quite often, the type of incision performed by the surgeon and subsequent scars depend on where the cancer first affected the breast.

Over the decades, the methods used by surgeons during breast surgery have undergone significant changes. Currently, there are a large number of different procedures that are becoming more accessible for women every year. Of course, before the operation, the patient should ask her surgeon what method of surgical intervention he intends to use and what results can be expected.

What Types of Mastectomies Lead to Scars?

Any type of mastectomy leads to scars of varying severity. However, there are a number of approaches that a surgeon can use.

Partial mastectomy or lumpectomy

Partial mastectomy involves some area of \u200b\u200bbreast tissue. Sometimes the surgeon also removes the layer of tissue that covers the chest muscles.

A lumpectomy usually leaves a straight scar on the skin of the breast. Sometimes the surgeon will have the opportunity to make an incision in the crease of the breast or around the nipple to try and hide the scar.

As a result of a partial mastectomy, most of the breast is usually left intact, and therefore breast reconstruction is usually not required. Women who have undergone a lumpectomy often need follow-up radiation therapy.

Skin-sparing mastectomy

This surgical method is usually performed if the woman intends to undergo breast reconstruction immediately after the main procedure. A skin-sparing mastectomy involves the removal of the breast, areola, nipple, lymph node, or nodes. But the surgeon leaves the skin of the breast.

The preservation of most of the breast skin allows immediate reconstruction using either implants or the woman's own tissue. After a skin-sparing mastectomy, there is usually a visible medium to large scar on the front of the breast. However, the surgeon can hide this scar by making an incision in a less obvious location.

Nipple-Sparing Mastectomy

Women who are undergoing prophylactic or preventive mastectomy, as well as those with early stage breast cancer, may be candidates for a nipple-sparing mastectomy (nipple-sparing mastectomy). This procedure also involves preserving the skin of the breast and areola.

Typically, this surgical approach is suggested for women with small breasts and leaves a scar on the side of the breast. However, the surgeon can make an incision in the crease of the breast, that is, on the bra line, and thus make the scar invisible.

Simple mastectomy

This type of surgical approach involves removing the breast, areola and nipple, and sometimes lymph nodes and some area of \u200b\u200bthe breast skin, the area of \u200b\u200bwhich depends on the woman's plans for reconstruction. The chest wall and lymph nodes located far from the operated breast, for example, in the armpit, are preserved.

Typically, the surgeon makes an oval incision that goes around the nipple across the entire width of the breast. This incision leaves behind a significant and visible scar.

Modified radical mastectomy

This method consists in the fact that the surgeon removes all breast tissue, as well as lymphatic vessels in the chest and armpits. The chest wall usually remains intact. Modified radical mastectomy leaves behind a large and visible scar on the chest.

What additional treatment is required after a mastectomy?

The main goal of a mastectomy or any other oncological surgery is to remove the amount of tissue that is the minimum required for cancer treatment.

The surgeon and oncologist will discuss all possible options for helping the woman and make the best decision for her. After the operation, the woman will probably need drainage tubes along with several weeks of rehabilitation.

Certain types of breast surgery, such as lumpectomy, do not always require the patient to stay in the hospital overnight, but mastectomy does.

The duration of the procedure is determined by the type of mastectomy that is performed on the woman, as well as the type of reconstruction.

Recovery after a mastectomy takes several weeks. In addition, chemotherapy may be required after surgery.

The woman should be on the lookout for signs of infection, such as a local increase in body temperature, redness or discharge at the incision site, and fever, which may indicate a systemic infection in the body.

How is breast reconstruction performed after mastectomy?

Reconstruction is a surgical procedure performed after a mastectomy to improve the appearance of one or both breasts. It can be performed either at the same time as the mastectomy, or over a period of time.

For reconstruction, the surgeon may take tissue from another area of \u200b\u200bthe woman's body, use implants, or use a combination technique.

Tissue expansion and implants

If a woman decides to reconstruct her breasts with implants, the doctor will have to place a device called a tissue expander under the muscles of the chest or under the skin of the breast.

This procedure can also be performed either during a mastectomy (immediate reconstruction) or later (delayed reconstruction). The woman will need to visit the doctor several times to fill the implant with saline expansion solution.

Once the chest skin has stretched and healed after surgery, the surgeon can prepare permanent implants. This time usually occurs approximately 2-6 months after the mastectomy.

However, for some women, permanent implants are installed directly during the mastectomy.

Reconstruction using autologous tissues

Another popular breast reconstruction method is reconstruction using autologous or native tissue. During this procedure, the doctor removes tissue from abdominal, back or buttocks of a woman and uses it for reconstruction along with the area of \u200b\u200bthe breast skin that was preserved during the mastectomy.

This type of procedure is more difficult because the surgeon sometimes has to restore blood circulation to the breast tissue.

This type of reconstruction can also be performed either directly during the mastectomy, or after a while.

What if a woman doesn't want to have breast reconstruction?

Although breast reconstruction after mastectomy is very popular, some women refuse this procedure.

According to the BreastCancer.org website, about 44% of women undergoing mastectomy do not express a desire for further reconstruction.

Women choose to abandon reconstruction for a number of different reasons. This range includes:

• health problems that could make future surgery dangerous or unreasonable;
• the desire to quickly restore the usual daily activity;
• fear of using tissue from other parts of your body or implants for reconstruction;
• high cost of reconstruction.

Sometimes women who do not want to have their breasts restored decide to use prostheses (artificial breasts) that can fit in a bra. These women also have access to a sticky pear-shaped device that attaches to the body.

Many women do not use reconstruction or prostheses and refuse to explain their decision.

How to improve the condition of sutures after mastectomy without reconstruction?

If the woman decides not to undergo reconstruction, she should talk to her doctor about surgical techniques, with the help of which you can maximize the condition of the stitches left on the skin after a mastectomy.

For example, the surgeon may take steps to flatten the stitches against the surface of the skin, making the chest smoother. Otherwise, the woman may be left with rough scars on the chest, which creates a bumpy appearance of this part of the body.

Despite the fact that it does not cause any physical discomfort, women do not like the way such scars look.

Sometimes the surgeon can make what is called a Y-shaped incision, that is, make two small incisions in addition to the main one. This technique can slightly reduce the protrusion of the skin.

Tattoos after mastectomy

In February 2017, the Journal of the American Medical Association published an article entitled "The Healing Role of Tattoos After Mastectomy." In this article, the details of the work of a tattoo specialist who often has to apply drawings over mastectomy scars were revealed.

This is a new approach for women who decide to opt out of breast reconstruction.

Some women who have undergone breast reconstruction come to tattoo parlors to get nipple tattoos. These tattoos give the nipples an extra three-dimensional effect. There are masters who specialize in working in this direction.

Conclusion

The decision about breast reconstruction, concealing mastectomy scars or even refusing to wear prostheses is entirely up to the woman. However, you should talk to your surgeon about all the options available.

If a woman feels that the doctor does not respect her desire for reconstruction or refusal, she can consult with another specialist.

Sometimes wives wish to delay making a decision about reconstruction until they have had a mastectomy.