Simplified radical mastectomy for breast cancer

Simplified radical mastectomy for breast cancer is to remove breast skin, subcutaneous fat tissue, breast, and clear axillary adipose tissue and lymph nodes. This kind of operation is relatively simple, retaining the pectoralis major and the pectoralis minor muscles. The upper extremity edema rarely occurs after surgery, and the arm activity is better. If radiotherapy and chemotherapy are added after surgery, the 5-year survival rate is not lower than that of radical mastectomy. This procedure is applicable to stage I and II breast cancer. Treatment of diseases: breast cancer sarcoma breast cancer Indication Suitable for stage I and II breast cancer. Contraindications One of the following conditions is not suitable for surgery: 1. There is extensive edema in the breast and its surrounding skin, and its range is more than half of the breast area. 2. The mass is fixed with the chest wall. 3. The axillary lymph nodes are significantly enlarged and have been closely adhered to the deep tissues, or the upper limbs have edema or shoulder pain. 4. There are satellite nodules in the breast and its surrounding skin. 5. Metastasis of the supraclavicular lymph nodes. 6, inflammatory breast cancer. 7, there has been a distant transfer. Preoperative preparation The scope of surgical field preparation is the ipsilateral chest and supraclavicular region and armpit. Shave the mane. For tuberculous lesions, anti-tuberculosis treatment should be performed before surgery. Surgical procedure The surgical incision and flap free range are the same as radical mastectomy. From the top of the breast to the sternum, the upper end of the rectus abdominis, the outer edge of the breast is treated with an electric knife along the pectoralis major fascia, and the whole breast and adipose tissue are removed. Large blood vessels were ligated to stop bleeding, and small bleeding points were treated with electrocoagulation to stop bleeding. Then cut the tendon fascia and separate the pectoralis major muscle to the top of the iliac crest, and pull the pectoralis major and pectoralis minor muscles inward and upward. Expose the axilla, use sharp scissors to start from the top of the sac, and carefully separate the adipose tissue and lymph nodes down the iliac vein. Take care to protect the iliac vein, the thoracic nerve, and the thoracodorsal nerve Finally, the central lymph nodes, the medial lymph nodes of the pectoralis major and the subscapular lymph nodes were removed. If you touch the suspicious metastatic lymph nodes under the clavicle, you should cut off the large and small muscles at the same time, so that they turn down, carefully separate the subclavian lymph nodes and adipose tissue, the operation is the same as radical mastectomy. Then rinse and anastomize the pectoralis major. There is no need to match the pectoralis minor muscles. Place the drainage and compress the wound. If there is no suspicious metastatic lymph node under the lock muscle, do not need to cut the chest and small muscles. complication 1. Pneumothorax: Caused by the hemostasis of the hemostatic forceps when the intercostal artery is worn through the pleura. Pneumothorax is often unilateral. After diagnosis, if the lung atrophy is more, it can be used for thoracic puncture and pumping. A small amount of pneumothorax can absorb it by itself. 2. Infection: After radical mastectomy, once infected, it is often more serious. This is because the operation time is long, the flap is thin, the blood supply is poor, and the axillary lymph nodes are removed. Therefore, antibiotics should be routinely added after surgery. If the flap is found to be necrotic, it should be removed early and skin grafted if necessary. 3. Axillary contracture: infection, incision rupture and unreasonable incision can cause axillary skin contracture. When the contraction is light, the flap can be repaired by "Z" shape; when it is heavy, the scar can be removed and repaired as a medium-thickness skin patch. 4. Limited upper arm activity: Excision of the pectoralis major and pectoralis minor muscles will affect the upper arm activity, but if the exercise starts on the 5th postoperative day, it can prevent the upper arm from being restricted. The method is as follows: 1 The upper arm moves forward and backward, and is raised a little and reaches the head. 2 Gradually increase the upward arc of the temple. If you insist on activities like this, you can basically comb your hair and lift your arms up and down before you leave the hospital. 5. Upper extremity edema treatment: upper extremity edema on the disease side is a common complication, and obese women are more common. (1) Type: Temporary edema, often caused by surgery to destroy large pieces of soft tissue. Bandages can be worn or enhanced with elastic bandages. Persistent (secondary) edema, the incidence of 10%, can last for months or years, such as intraoperative findings of axillary lymph node metastasis or postoperative radiotherapy, it is more likely to occur. The reason is that thrombic phlebitis can be treated with prophylactic anticoagulant therapy on the 3rd postoperative day. One is that venous reflux is blocked, the pressure is increased, and raising the affected limb can alleviate the symptoms. One is that the obstruction of lymphatic reflux is related to surgical anatomy, infection, axillary effusion, and radiotherapy response, which is more difficult to handle. (2) Prevention: Carefully dissect the axillary fossa during surgery, protect the skin, prevent infection of the incision, avoid axillary effusion, prevent dermatitis during radiation therapy, and prohibit blood transfusion, infusion, and appropriate exercise after the upper limb. It is important to prevent infection of the incision. (3) Treatment: Light-weight patients, feasible centripetal massage, 1 to 2 hours a day. In severe patients, the subcutaneous fat tissue of the upper limbs can be removed in large amounts, and then elastic bandage is used to compress the bandage, but this method is more destructive. Obese patients can use low-salt foods and take appropriate diuretics. Various physiotherapy effects are not ideal.