Mastectomy according to Pirogov. Planned and preventive mastectomy: what it is, indications and treatment results, reconstructive plastic surgery after surgery

(Breast cancer) women of any kind are susceptible age group, however, this disease is more often registered in those who have crossed the 40-year mark. There is also genetic predisposition to breast cancer: such patients account for approximately 10% of total number accurately established diagnoses. At the same time, patients who have altered BRCA1 and BRCA2 genes, as well as those who have a history of family cases Breast cancer or ovarian cancer, bilateral prophylactic mastectomy is recommended as the only effective remedy preventing the development of the disease.

In what cases is prophylactic mastectomy necessary?

Currently, doctors know more than 15 genes, changes in which significantly increase the risk of developing breast cancer. The most well studied mutations of the BRCA1 and BRCA2 genes, which are inherited (familial forms of breast cancer) and in 87% of cases cause malignant processes in the mammary glands and ovaries. Women with a family history of breast cancer should undergo regular preventive examinations:

• In the period from 25 years to 50 years – 2 times a year ultrasound of the mammary glands or once a year MRI of the breast;
• After 50 years - mammography screening at least once a year.

The defective BRCA1 gene generally triggers breast cancer around the age of 35, while carriers of the mutated BRCA2 gene develop the disease primarily after the age of 40. Moreover, even if a unilateral breast resection has been performed in the past, the risk of tumor formation in the second gland remains extremely high. To prevent the development of breast cancer, women at risk are recommended to have a bilateral prophylactic mastectomy, which reduces the likelihood of developing the disease in 89-100% of cases.

In order to prevent unnecessary removal of mammary glands, all patients must undergo DNA testing, after which a geneticist can assess the risk of developing breast cancer. Next, possible tactics of action are discussed with the woman:

• Monitoring the state over time.
• Prescription of drug therapy.
• Removal of both ovaries for preventive purposes.
• Prophylactic bilateral mastectomy.

In cases where a woman chooses the latter option, additional consultation with a breast surgeon, and, if necessary, with a specialist in plastic surgery to discuss the issue of subsequent breast reconstruction.

Before and after

Methodology for prophylactic mastectomy

• Bilateral prophylactic mastectomy with simultaneous breast reconstruction, the patient is 33 years old.

The essence of the operation and the recovery period

Bilateral prophylactic mastectomy is performed under general anesthesia, in this case only breast tissue is subject to removal. The axillary and intrathoracic lymph nodes remain.

Tissue incisions are made in a semi-oval shape under the breasts or through the areola (depending on the chosen technique):

1. Subcutaneous resection is performed in such a way that the integrity of the areola and nipple is preserved, and in the future it is possible to perform breast reconstruction.
2. The skin-preserving technique involves the removal of the nipple-areolar complex, however, the necessary conditions for further breast reconstruction.

At the last stage of the operation, after all the glandular tissue has been excised and the bleeding has stopped, the wound is sutured layer by layer and drainage is inserted into it for 3-14 days to drain the secreted fluid.

Considering that bilateral prophylactic mastectomy is performed not to treat an existing disease, but to prevent it, there is no need for additional therapeutic measures (radiation or chemotherapy, hormone therapy).

Bilateral prophylactic mastectomy (removal of the mammary glands) can be performed either with or without immediate reconstruction. In the first case, it is possible to perform both a skin-sparing mastectomy (the nipple-areolar complex is removed) and a subcutaneous mastectomy (that is, with preservation of the areola and nipple). Due to compelling evidence high efficiency prophylactic mastectomy, this type operations is included in a number of national and international recommendations, including recommendations:

• Association of Oncologists of Russia,
• European Society of Mastologists,
• National Comprehensive Cancer Society (USA).

Today we have extensive experience in performing such operations, which reduce the risk of developing breast cancer by 90%. The first such operation in Russia was performed by our specialists on January 23, 2007.

Rehabilitation

The patient’s rehabilitation after surgery proceeds quite quickly:

• In the evening of the same day you can get up and move around within the ward. The next day, at feeling good and you can go home. In the future, visits for dressings 2-3 times a week and physical therapy classes.
• On days 3-14, the drainage tubes are removed, and on days 10-20 the sutures are removed. 2-3 weeks after the operation, the woman can return to her usual life.
• After 2-3 months, it is possible to visit saunas, steam baths, swimming pools, solariums, as well as perform any physical activity.

In the case of one-stage reconstruction of the mammary glands, additional manipulations are possible, depending on the type of reconstruction (ligations on the abdomen and wearing a bandage during reconstruction with tissues displaced from the abdomen; inflating the expander, if it was used for reconstruction, etc.) Equally important throughout recovery period wear compression stockings, which help improve fast healing wounds, improves blood circulation in chest and protects the seams from possible damage.

The fundamental features of our technology are:

1. Total removal of breast tissue, including tissue behind the areola.
2. Skin incisions and intradermal sutures to achieve maximum aesthetics.
3. Careful histological examination breast tissue (undiagnosed tumors may be hidden there).

Mastectomy is the removal mammary glands when the risk of developing cancer reaches 51% or more. The operation to remove the mammary gland differs in its characteristics and age category.

Types of gland removal operations

A Madden mastectomy is the removal of the mammary gland along with the lymph nodes of the armpit. After removal, rehabilitation is prescribed. The breasts need to be reconstructed to recreate the shape and volume.

Patey's mastectomy is the removal of the mammary gland, tissue in armpit and parts of the pectoral muscle.

Subcutaneous mastectomy- This is the removal of glandular tissue by scraping through a small incision. At the end of the operation, a prosthesis is inserted into the skin and sewn inside. Subcutaneous mastectomy is convenient for women in terms of the possibility of restoring the shape of the breast. This allows them to maintain volume and make discreet incisions, similar to plastic surgery. Subcutaneous mastectomy can be done bilaterally, depending on the extent of the breast involvement. Subcutaneous mastectomy is also performed for sarcoma, breast cancer, and purulent inflammation.

After a double mastectomy (bilateral), a woman does not have a single breast left, but there is the possibility of plastic surgery.

Mastectomy according to Pirogov is the removal of the mammary gland due to lymphocele, when cancer is detected at stages 1-2. After surgery, lymphostasis of the arm or upper and lower limb. After removing the pier. zhel. The swelling of the arm may go away, but it is reversible, that is, it may go away in a year and a half.

Radical mastectomy- This is the Halsted method, which involves the removal of all muscle groups of the mammary cavity, axillary lymph nodes, fiber and the breast itself. Radical mastectomy can be performed according to different methods, it all depends on the degree of complexity of the operation. Radical mastectomy is done only after discovering an abscess the size of the entire pier. zhel.

Indications for types of operations

By absolutely different indications surgery may be prescribed depending on the course of the disease, the structure of the cancer, tumor, state of health, etc. The table clearly shows which mastectomy is prescribed when, why, and what happens after removal of the mammary gland.

There is a separate type of preventive mastectomy, which is performed to exclude possible complication current risk of developing cancer. Operations are performed when there is a high probability (from 70%) of development cancerous tumor. To prevent complications from appearing, such removal of the thoracic part is performed.

Postoperative period

The period after completion of the operation may be accompanied by such consequences as:

At the end of the surgery, reconstructive plastic manipulations are also performed in order to return the shape to its previous appearance. During the first three months, everything hurts—headache, joint pain, back pain. The heart also hurts due to the stress on the body. The joint hurts and radiates to the nerve endings. You should follow massage, recommendations, treatment, diets. For a speedy recovery, treatment involves a bandage, underwear and exoprostheses, exercises and much more.

Today, Anita underwear, exoprostheses and prostheses are produced for women, which have a special sleeve for comfortable wearing. There are:

The bandage may have a sleeve that is worn on one side. The bandage does not include a sleeve for both sides. The sleeve is only on the side where exoprostheses are not inserted.

Exoprostheses are inserted into swimsuits, bras, and clothing for any occasion. Swimsuits and their structure include sleeves, fasteners and support in the form of a belt. Swimsuits also have sleeves and cups.

The texture hides breast problems and the sleeve complements the fabric perfectly. This structure allows you to hide the stitches left due to the mastectomy. Swimsuits must be worn, these are the recommendations of doctors. This way a woman will be able to influence men and regain her mental health.

Swimwear is an open piece of clothing that allows a woman, despite the circumstances, to show herself in all her glory. While following recommendations, nutrition, and doctor’s orders, do not forget about femininity. Swimwear can be ordered in a store for relaxation at the sea, pool, lake, but continue to treat your “life”. The main thing is to treat yourself from the inside, and think about how wonderful life is.

Many ladies are afraid of losing men with their transformations. Men have no understanding of what life a woman had. Because of this, men experience rejection, many men have families destroyed, because the appearance of a woman has been changed. Wives and young girls are afraid that men will lose the desire to be close, and only men can do this if they put everything into a woman to return her smile. Men have no questions about how nutrition should be done, why the body hurts and radiates to the back. After all, no one knows how long a person lives or how long a person has left. Appreciate life, give support.

Attention! The following video presents video clips of microsurgical operations.
Viewing of these videos is strongly discouraged for persons under 16 years of age, pregnant women, and persons with an unbalanced psyche.

Term "mastectomy" for more than 100 years, translated from ancient Greek it means: “mastos” - breast, “ek tome” - remove. That is, a mastectomy is the removal of the mammary gland. “Radix” is Latin for a root; the operation proposed by W.S. Halsted claimed radicalism, the removal of a tumor with “roots”. To do this, the pectoralis major and minor muscles and lymph nodes of 3 levels were removed along with the mammary gland. This volume of operation corresponds to the name "radical mastectomy". Currently used rarely, it is indicated for ingrowth of a breast tumor into a large pectoral muscle or when metastases located in level 2 lymph nodes grow into the pectoralis major muscle; or when performing palliative operations. Accompanied by deformation of the anterior chest wall due to tissue deficiency in the subclavian region.

Types of mastectomy surgery

1. Patey & Dyson modified radical mastectomy. The modification involves reducing the volume of surgery compared to radical mastectomy by preserving the pectoralis major muscle. That is, with a modified radical mastectomy according to Patey & Dyson, the mammary gland, pectoralis minor muscle, and 3 levels of lymph nodes are removed. This surgical technique is used when it is necessary to remove the entire mammary gland and there are multiple metastases in the lymph nodes of levels 1-3. Does not lead to such pronounced deformation of the chest wall as with radical mastectomy according to W.S. Halsted, however, when removing the pectoralis minor muscle, small nerve branches innervating outer part the pectoralis major muscle, which leads to atrophy of the latter.
2. Madden modified radical mastectomy. The modification involves reducing the volume of surgery compared to radical mastectomy by preserving the pectoralis major and minor muscles and preserving lymph nodes 3 levels. That is, with a modified radical mastectomy according to Madden, the mammary gland and lymph nodes of 1-2 levels are removed. The most commonly used option for surgery for breast cancer is currently in Russia.
3. Modified radical mastectomy according to Auchincloss H. The modification implies a reduction in the volume of surgery compared to radical mastectomy due to the preservation of the pectoralis major and minor muscles, and the preservation of lymph nodes of 2-3 levels. That is, with a modified radical mastectomy according to Auchincloss, the mammary gland and level 1 lymph nodes are removed.
4. Radical mastectomy with preservation of the pectoral muscles. The operation involves removal of the mammary gland and lymph nodes of levels 1-3. Both pectoral muscles are preserved. Allows removal of all 3 levels of lymph nodes when necessary, preserving both pectoral muscles and the innervation of the outer part of the pectoralis major muscle.

With all types of radical mastectomy, it is possible to develop swelling of the arm due to impaired lymph outflow (lymphostasis). The probability of developing lymphostasis is 10-40%. If the operation was on the side of the working hand (for right-handers - on the right, for left-handers - on the left) and if radiation therapy was carried out on the areas where the lymph nodes are located, the probability increases.

Mastectomy, the removal of only the breast, is one of the earliest operations in breast surgery.

Depending on the volume of skin removed, any mastectomy can be performed in different ways, which changes its name:

• subcutaneous (preserving the nipple and areola);
• skin-preserving (along with the breast tissue, the nipple-areolar complex and the skin over the tumor are usually removed);
• with standard skin removal (usually 4-5 cm from the palpable edge of the tumor with excision of the nipple-areolar complex);
• with total removal of the skin (with an edematous-infiltrative form of cancer or a nodular form with secondary edema of the skin).

At the same time or some time after any type of mastectomy, reconstruction (restoration) of the mammary gland can be performed. The main three reconstruction methods are:

1. transverse rectoabdominal(transversal recto-abdominal muscle *, TRAM) flap;
2. thoracodorsal flap(flap based on the latissimus dorsi muscle) in combination with an implant;
3. two-step method, in which in the first stage an expander (a silicone reservoir that can be gradually inflated with the introduction of fluid) is installed to stretch the tissue, in the second stage the expander is removed and a permanent implant is installed.

The first method is more traumatic, but has its undeniable advantages: the TRAM flap consists only of the woman’s own tissue, it is well tolerated radiation therapy.

* - that is, a transverse flap based on the rectus abdominis muscle.

Advantages of the technology used at the Frau Klinik

• Widespread use of preoperative drug treatment for stage II-III cancer (this improves treatment results, reduces the volume of surgery, reduces the risk of implant rejection, and increases the likelihood of preserving axillary lymph nodes when using sentinel lymph node biopsy technology).
• The volume and technique of performing operations combine maximum radicalism and the minimum possible injury.
• The scope of the operation, timing and reconstruction options are selected in discussion with the patient.

Subcutaneous mastectomy‏‎ - this surgery for the removal of fatty and glandular tissue of the mammary gland. In this case, only 90% of the tissue is removed while preserving the nipple-areolar complex. This feature distinguishes the procedure from subcutaneous dissection, an operation in which only up to 5% of the glandular tissue remains.

Subcutaneous mastectomy is performed for therapeutic purposes to prevent the development of cancer.

Indications for surgery

The following medical indications exist for the operation:

• the tumor should be localized at a distance of no more than two centimeters from the nipple-areolar zone;
• the size of the tumor should not exceed two centimeters;
• the tumor is located far from the surface;
• the oncological formation is located deep in the mammary gland.

Features of the operation

Subcutaneous mastectomy can be performed by several different ways, differing in the type of cut. The surgeon must choose the optimal method based on physiological characteristics patient. The incision should be of such a size as to make it possible to remove the cancerous formation along with the surrounding layer of fatty tissue and lymph nodes.

When performing a subcutaneous mastectomy, a woman can simultaneously undergo breast correction through high-quality healing of the surgical incision. It should be noted that during the procedure, complete excision of glandular tissues located in the axillary, subclavian and subscapular areas occurs. The nipple and areola remain intact. This eliminates the possibility of cancer recurrence.
Another important feature This operation involves a mandatory course of radiation therapy. This course allows you to completely remove cancer cells that could remain after the operation. Radiation therapy begins immediately after the incision heals and continues for one and a half months, several sessions per week.
To return the breast to its previous volume, the surrounding muscles are used, which can be moved without fear of circulatory problems. In cases where muscle volume is insufficient, silicone prostheses can be used. As you can see, surgery can solve two problems at once: therapeutic and cosmetic.

Contraindications to subcutaneous mastectomy

Efficiency of the procedure

The effect of the operation was studied in 1999. Based on the results of the studies, it was found that the risk of tumor formation decreases depending on the number of glandular tissues removed. Patients with high risk development of cancer reduce the likelihood of cancer by ninety percent after a mastectomy.

Operation methodology

Subcutaneous mastectomy is usually performed in two traditional ways:

1. making a long transverse incision for a complete anatomical view of the subcutaneous structures;
2. resection in the areas of the nipple and areola.

It is impossible to say for sure which of these methods is more effective.

The standard operation is performed by making an incision around the areola to create an internal view of the tissue and inclusions being removed. At a certain breast size, the incision may increase in a literal direction. For more effective excision, glandular tissue is treated with a tumescent solution. This reduces the risk of bleeding during surgery. After treatment with saline, the breast tissue is removed while maintaining the blood supply. During the operation, precautions are taken to prevent necrosis in the nipple area. To prevent bleeding, large veins are recommended to be ligated rather than coagulated.

Removal of the breast (mammary glands), an operation that causes fear in women diagnosed with breast cancer.

What is important to know about this operation, and in what cases will it help eliminate the inevitability of developing breast cancer? When is breast removal performed?

Reasons for breast removal (mastectomy)

The first reconstructive surgeries after mastectomy were undertaken in the late 19th century. But a large number of complications made these operations unpopular until 1963, when a mastectomy was successfully performed, followed by breast reconstruction with silicone endoprostheses.

Over the next decades, plastic surgeons have been improving breast reconstructive technology. Today, a more popular operation is one-stage organ reconstruction after mastectomy.

Mastectomy, types and methods

A mastectomy is the radical removal of the breast and some adjacent tissue by surgical intervention. According to the degree of spread of cancer in the mammary gland and metastasis, the following types operations:

1. Patey method, which allows you to radically remove a mammary gland affected by cancer. In this case, not only glandular tissue is removed, but also axillary nodes and pectoralis minor (pectoralis minor muscle). This operation is indicated for a confirmed cancer diagnosis with the presence of metastases. Most mastectomies are performed using this method.
2. Halstead method- Same radical surgery, with excision of not only the gland, but also axillary lymph nodes, and pectoral muscles with fatty tissue. The pectoral nerve is left. This method is indicated for severe stages of cancer, with deep metastases to the muscles adjacent to the mammary gland.
3. Madden method, a less radical operation, since only the mammary gland is removed. Nearby muscles and lymph nodes are left. This operation is prescribed for women diagnosed with ductal carcinoma. The Madden method is also used in preventive surgeries for patients with genetic indications.

Today, the newest technique is skin-preserving breast removal.

Plastic surgeon Heather Richardson

Today, there is more than one criterion for the volume of operations. This can be a lumpectomy (partial or segmental mastectomy).

It is defined as complete surgical resection of the primary tumor to achieve significant negative margins (ideally 1 cm).

This can be done using specific palpation guidelines or imaging guidelines and is applicable for most patients with invasive carcinomas stages I or II.

There are relative contraindications, which are presented below.

CONTRAINDICATIONS

1. small breast size;
2. large tumor size (> 5 cm);
3. collagen vascular disease.

Absolute contraindications include the following situations.

CONTRAINDICATIONS

1. multifocal disease;
2. history of previous radiation therapy in the treatment area;
3. inability to undergo radiation therapy for invasive disease;
4. first or second trimester of pregnancy;
5. constant positive histological tests for the presence of tumor cells after attempts to preserve the organ.

You can have a mastectomy about six months after you have completely stopped breastfeeding.

Plastic surgeon Daniel Barrett

Breast reconstruction options after a partial mastectomy include the following:

1. Fasciocutaneous flaps for local tissue improvement.
2. Breast parenchyma flaps.
3. Myocutaneous flap from the latissimus dorsi muscle.

A total mastectomy for cancer includes complete removal all breast tissue.

Studies were conducted (in 2017) that showed that the risk of cancer recurrence after total breast removal and surgery with preservation of tissue, nipple, and areola is almost the same. That is why more and more surgeons are leaning towards the second option.

Plastic surgeon Kenneth Francis

The following options are available:

1. A modified radical mastectomy is a mastectomy with axillary lymph node dissection (ALND).
2. Radical mastectomy – mastectomy plus en-block resection of the pectoral muscle with ALND.
3. Extended radical mastectomy – radical mastectomy with resection of the internal lymph nodes of the mammary gland.
4. Skin-sparing total mastectomy (SSM).
5. Areola-sparing mastectomy (NSM). During surgery, all breast tissue is removed, but the nipple remains in place.

Indications

The main indication for breast removal is a confirmed diagnosis of breast cancer. In addition, mastectomy is indicated if the BRCA1 gene is detected in the patient.

Today, preventive mastectomies are increasingly being performed on patients who have the BRCA1 gene in their body, which gives virtually no chance of avoiding the development of breast cancer.

How is breast removal surgery performed (step by step)?

To perform this surgical intervention, it is used. The duration of the operation is about 3-4 hours.

If lymph nodes are also removed, then the surgeon will need more time to work.

Initially, the doctor cuts the skin and eliminates the affected tissue.

These are complex manipulations that require highly qualified doctors. Finally, the surgeon sutures using absorbable sutures or staples.

To be able to pump out accumulated fluid, reduce swelling, and speed up recovery, a drainage is used that is placed in the chest.

There are different situations, so the nipple can be left or also removed. After some time, the patient may be referred for a biopsy. It will help check the operated area for the presence of cancer cells.

After surgical intervention the woman will need to be in inpatient conditions a few days.

Recovery after surgery

After the breast tumor has been removed, the woman needs to recover. At first, the patient will feel pain. After breast removal surgery, it is necessary not to move sharply, not to carry heavy things, or to raise your arms up.

If a woman is tormented by strong painful sensations, then the doctor will prescribe painkillers.

Quite often, the doctor prescribes chemotherapy in conjunction with surgery. Radiation therapy may also be needed.

When drainage tubes are removed, a small amount of fluid may accumulate. But there were times when it was necessary health care. In such a situation, the doctor drains the excess “water” using a needle.

After surgery, you risk bleeding, infection, pain, swelling in the area upper limbs, hardness in the scar area, hematomas, numbness (this happens when lymph nodes are removed).

Plastic surgeon Barbara Persons

In most cases, a woman after breast removal is in depressed state. Depression can last a long time and sometimes requires psychological treatment.

People in such a situation need to understand that life is not over, but they are given a chance to become healthy.

You need to try not to start developing complexes and withdrawing into yourself, but to find a way to hide your shortcomings. In addition, there is reconstructive surgery that will help create new breasts that are close to real ones.

A return to your previous life is possible after 6-8 weeks of recovery, if no complications arise. It is worth having sexual intercourse after 1.5-2 months.

If the breast is to be completely removed, the patient may be offered reconstruction. But not everyone agrees to it. In addition, some people do not have the opportunity to conduct it, because it is not cheap.

In this case, you can use prosthetics. What it is? Today, bras are produced that create the appearance of normal natural breasts.

To ensure a quick recovery without complications, you cannot:

• take a shower before;
• load your body, carry weights;
• go for any injection into the affected area;
• swim in a pool, river, or sea for about 2 months after surgery;
• engage in sexual intercourse for about 1.5-2 months.

Hand development after suture removal

When a woman's stitches are removed, she should start working on her arms. To do this, you need to perform certain exercises:

• raise your arms up and in different directions (you can be in a standing or sitting position), throw them behind your head;
• stand up, bend your elbows, place them in front of your sternum, then move them apart;
• try to clasp your hands behind your back.

All these exercises can be performed only after approval by the doctor.

Question answer

If you are concerned, then you should speak with a breast surgeon to review your risks, and if they are high, you should review surgical options.

Unfortunately, loss of nerve sensation is common after mastectomy and lymph node dissection. Only time will tell - nerves can take up to 2 years to fully return, so you need to be patient. If the situation does not improve in two years, most likely things will remain that way.

Most of the time, itching can be controlled with topical or oral steroids, cold compresses, or antihistamines after surgery. In more significant cases, neurologically active drugs such as Neurontin may be used.

Preventive mastectomy

Many women learned about the possibility of preventing the development of breast cancer from media reports. Hollywood celebrity Angelina Jolie, in order to avoid the risk of developing breast cancer, had a mastectomy (after which she had it inserted).

Others followed suit famous women. Now not only doctors know about preventive mastectomy.

To decide whether a preventive mastectomy is necessary, it is worth learning about its indications and all possible postoperative complications.

Indications for preventive mastectomy

In our country, preventive mastectomy began to be carried out officially in 2010. The basis for its implementation is the presence in the body of a diagnosed breast cancer mutagen (BRCA1 and BRCA2), or malignant tumor one of the mammary glands.

Also justified indications for preventive mastectomy are a family history of cancer, confirmed by genetic testing. The operation is indicated if there are signs of precancerous pathology of the organ.

In private clinics, such an operation can be performed even without a confirmed diagnosis, only guided by the wishes of the patient. In such cases, she is required to provide legal confirmation of her refusal to make further claims regarding the outcome of the operation.

Contraindications for preventive mastectomy

Breast removal is not performed for preventive purposes if the patient has certain contraindications.

CONTRAINDICATIONS

1. Mature age (over 65 years);
2. Lipomatosis 2-3 degrees;
3. Arterial hypertension;
4. Diabetes;
5. Cardiovascular pathologies;
6. Bronchial asthma;
7. Psychiatric diagnosis.

The decision to perform a preventive mastectomy on a patient is made collectively by several specialists. She gives written consent to the operation, which is legally certified.

Carrying out the operation

Simultaneous organ reconstruction after mastectomy is carried out in stages:

• Direct mastectomy - removal of glandular tissue without skin;
• Reconstruction of an organ is the transfer of a graft from its own tissues, or an implant, with the further formation of the contours of the gland.

Breast reconstruction methods

Restoring the mammary gland using tissue from the patient’s body, according to plastic surgeons, is the most relevant. During breast reconstruction, tissue flaps (skin, muscle, subcutaneous tissue) are used different zones body: abdomen, thighs, buttocks.

They are transplanted to the site of the removed glandular tissue. And although from a technical point of view, this type of reconstruction is a more complex procedure, it is considered more reliable in terms of graft survival.

However, in 9 out of 10 cases, another reconstruction method is chosen - using implants. The fact is that when reconstructing with your own tissues, you have to carry out additional operations to correct the breast, since its aesthetics cannot be achieved immediately.

In my practice, the vast majority of women are inclined towards the method of reconstruction using implants (up to 80%).

Plastic surgeon Michael Zenn

Restoring breast shape using implants. To do this, first prepare a so-called “pocket” for the endoprosthesis, which consists of the pectoralis major muscle and an area of ​​skin stretched with an expander. There are other technologies that allow the use of artificial fabrics if there is a lack of skin.

The second reconstruction method, although less traumatic, also has disadvantages. This is a development after implantation of capsular contracture.

Which operation option gives a better result? A more reliable result and long-term effect is provided by the option of carrying out reconstruction with authentic body tissues. But technically this technique is more complex and requires high professionalism of a plastic surgeon.

As practice and research from 2014 show, most women do not undergo reconstruction after the intervention. This is 59% of patients in urban areas and 71% in villages.

Plastic surgeon Dallas Buchanan

Rehabilitation

A patient's recovery from mastectomy and breast reconstruction may vary in length.

This depends on factors such as the technique used for reconstruction surgery, individual characteristics female patients, professional skills of a plastic surgeon.

Lasts longer postoperative period due to restoration by own tissues.

It takes place in several stages, since after the primary plastic surgery, after 3-5 months the patient requires correction of the volume and shape of the breast. Additional operations are also performed to create a new areola and nipple from your own tissue.

Complications

The most commonly observed complications after mastectomy include the following:

• Temporary swelling of the tissues located near the site of the removed organ;
• Postoperative wound pain;
• Infection of the wound cavity;
• Bleeding;
• Permanent swelling of the arm from the surgical intervention as a result of lymphostasis;
• Severe swelling of the arm due to surgery;
• Phantom pain in the area of ​​the removed breast;
• Seroma is an accumulation of serous tissue fluid in the postoperative cavity.

Complications after reconstructive surgery more often occur when implants are installed. Suppuration of the wound cavity and implant rejection are possible. More severe complications observed in the form of skin necrosis and contractures.

Cost of preventive mastectomy

The average cost of preventive radical mastectomy in Moscow is from 80,000 to 110,000 rubles. Modified version – 160,000 rubles. Surgery with endoprosthetics – RUB 31,790.