What Happens in a Mastectomy Procedure?

Mastectomy is a surgical procedure used to treat chronic cystic mastopathy, breast tuberculosis and other diseases. Postoperative incision flap necrosis, wound subcutaneous hemorrhage, or fluid accumulation may occur.

Total mastectomy

Mastectomy is a surgical procedure used to treat chronic cystic mastopathy, breast tuberculosis and other diseases. Postoperative incision flap necrosis, wound subcutaneous hemorrhage, or fluid accumulation may occur.

Chinese name

Total mastectomy

Alias

Simple mastectomy

Surgery classification

General Surgery / Breast Surgery

ICD encoding

85.4601

Total mastectomy

Simple mastectomy

General Surgery / Breast Surgery

85.4601

The breast is made up of glands, fat and fibrous tissue. The mammary glands are derived from the epidermis and are located in the reticular fascial tissue. The nipple is a local hyperplasia of the spinous layer of the epidermis. The physiological activity of the breast is restricted by various hormones, such as anterior pituitary hormone, adrenocortical hormone, and sex hormone, and produces corresponding changes in tissue structure. Adult female breasts are located in the sac composed of superficial fascia, with 4-5 intercostal spaces above and below, and the upper boundary is generally at the level of the second rib. Axillary midline on both sides. The upper part of the gland protrudes into the axillary cavity into the tail lobes of the breast.

The center of the mammary gland is the nipple, and the ring isola is around. The cyst of the breast is the superficial thoracic fascia, which extends deep into the breast and divides the mammary gland into about 20 lobes arranged radially, with cell-like adipose tissue between the lobes. Each mammary lobe has a corresponding lactiferous duct that opens into the nipple. The enlargement of the ducts near the nipple is called the ductus sinus. Cooper ligaments are connected to the skin and pectoralis major fascia.

The lymphatic vessels of the breast are very abundant, and the main returning channels are the axillary lymph nodes and internal mammary lymph nodes.

Axillary lymph nodes can be divided into 5 groups: outer, anterior, posterior, internal and central. The lateral group is around the axillary arteries and veins; the anterior group is located on the superficial surface of the anterior serratus, the lower edge of the pectoralis minor muscle, and the lateral thoracic artery. Breast cancer metastasis first invades this group of lymph nodes; the posterior group is located on the posterior side of the axillary arm, along the subscapular vessels Distribution; the central group is in the center of the axillary base, in the loose adipose connective tissue on the deep side of the axillary fascia, and the lymph nodes of each group meet here; the inner group is located on the deep side above the pectoralis minor muscle, and its output tube collection is the subclavian trunk and the lateral neck The lymph nodes are in communication, the subclavian lymphatic stem is injected into the chest duct on the left and the right lymph duct is injected on the right.

Parasternal lymph nodes are arranged along the blood vessels in the thorax. The superficial and deep lymphatic vessels of the medial breast and anterior thoracic wall merge into this group of lymph nodes, and then the intercostal lymph vessels enter the mediastinal or supraclavicular lymph nodes.

Lymphatic vessels on the underside of the breast pass through the anterior abdominal wall and into the hepatic lymphatic vessels in the subcondylar space. Lymph vessels on the deep side of the breast pass through the pectoral muscles into the subclavian lymph nodes. Superficial breast lymphatics have extensive connections with cutaneous lymphatics. Cancer can thus spread to the contralateral breasts and armpits.

The blood supply to the breast is mainly from the lateral thoracic artery, the intercostal branch of the internal thoracic artery, and the lateral branch of the intercostal artery.

The superficial veins of the breast are the subcutaneous veins, and the deep veins accompany the arteries of the same name, merge into the internal thoracic veins, axillary veins, odd veins, or semi-odd veins, and eventually flow into the pulmonary vascular network.

The innervation of the breast is mainly the lateral cutaneous branches and anterior branches of the 2nd to 6th intercostal nerves, and the supraclavicular and anterior thoracic nerves.

Mastectomy is suitable for:

1. Large intrapapillary papilloma or older patients with bleeding.

2. Chronic cystic breast disease with extensive lesions. Those with suspected precancerous lesions have relative indications for total breast resection of the diseased side.

3. Breast tuberculosis, due to chronic inflammation with extensive scars, sinus tracts, lesions that destroy most breast tissues, and those who do not heal after long-term anti-diarrheal or non-surgical treatment.

4. Breast sarcoma, advanced breast cancer as palliative surgery.

5. Breast carcinoma in situ or micro carcinoma, eczema-like cancer lesions are mainly in the nipple area.

6. Male hyperplasia of the breast, one side of the breast is significantly larger than the contralateral non-surgical treatment ineffective.

The scope of the surgical field preparation was ipsilateral chest and supraclavicular area and axilla. Shave your armpit hair.

Tuberculous lesions should be treated with anti-TB before surgery.

Patients with smaller breasts or frail, elderly people can be supplemented with local anesthesia on the basis of intercostal nerve blocks.

Breast hypertrophy surgery with larger wounds should use general or epidural anesthesia.

1. The upper limb is abducted 90 °, and the incision is designed according to the size of the breast. The chest is wide and those with full breasts can make longitudinal spindle incisions in the 2nd to 6th intercostal space. For patients with thin and narrow breasts, lateral spindle incisions can be made as appropriate. If the tumor is in situ or early cancer, the margin should be 5 cm away from the tumor.

2. Cut the cortex and subcutaneous tissue, and dissect the skin flaps on both sides of the fat layer sharply, from the inner edge to the sternum margin and the outer edge to the lateral edge of the pectoralis major muscle. Note that the anterior axillary paramammary glands should be included in the resection.

3. Separate the breast tissue along the surface of the pectoralis major fascia, and remove the breast tissue from the upper and lower sides of the anterior axillary line as appropriate.

4. In case of vascular perforation of the chest wall, careful hemostasis is required. The intercostal and internal thoracic arteries should be sutured to stop bleeding. Covering wounds with more bleeding should be covered with hot and humid gauze to help stop bleeding. If the suture tension in the middle of the incision is large, it can be used for stealth separation.

5. After the breast tissue is removed, clean the wound to remove the remaining blood clots, shed fat and connective tissue, and place a drainage tube or rubber roll with a side hole at the lowest position of the incision or the outside of the incision hole to fix it to the skin Fix it on the drainage with a safety pin to avoid dislocation. Negative pressure drainage tube should be used in the large residual cavity, and the drainage effect is better.

6. The subcutaneous tissue and skin are sutured in layers. If the patient has a scar, the incision can be slightly Z-shaped, and the healing is better. Gauze pads for incisions were appropriately pressure bandaged. After 24 ~ 48h, take out the drainage tube.

After total mastectomy, do the following:

1. Patients with chronic infection may use antibiotics as appropriate.

2. Drainage was removed 2 to 3 days after operation and pressure bandaging was performed for 3 to 5 days.

3. The suture was removed 7 days after the operation.

4. For cancer, systemic chemotherapy or local radiation therapy should be considered after surgery.

1. Incision flap necrosis is one of the common complications. Often due to excessive skin resection, the skin margin is tensioned when sutured, or the suture incorrectly angles the edge of the flap, local blood circulation disorders, affecting incision healing.

2. When the wound surface is large and the flap edges are difficult to align, the adipose tissue under the free flap should be sneaked as appropriate until the skin tension in the middle of the incision is not great. The slit edge of the incision should not be too tight, so as to avoid ischemia and infection at the thread foot.

3. Subcutaneous hemostasis or effusion, mostly due to large wounds, did not completely stop bleeding during surgery, and under the skin flap was caused by extensive lymphatic exudate from capillaries. Such complications can also result from improperly placed drainage tubes during surgery or failure to properly pressurize the wound after suture.

The treatment method is to check the wound 24h after surgery, and those with hemorrhage should improve the drainage. After 48 hours, the blood and fluid are still accumulated, and local puncture should be performed. The pooled serum should be sucked out or a small incision beside the local incision should be placed in a silicone tube for negative pressure suction. In a few cases, 1 or 2 stitches of suture can be removed through the original incision to discharge blood and fluid, and then press and bandage.