Sectoral resection of breast cancer: preparation and in the postoperative period
Sectoral resection of the breast is a term that refers to the operation, during which removes the sector on where the tumor (usually benign) cyst or an area of suppuration. Under the «sector» understand the area of triangular shape, occupying 1/8 to 1/6 of the entire gland, as its sharp end directed to the nipple. Thus between the edge of the tumor or cyst and the line of resection should be healthy tissue, as visually defined and effective limits of education may vary.
In some cases this operation is carried out in the initial stages diagnosed with breast cancer. According to the latest data, this does not affect the prognosis of the disease, but improves the quality of life of women, as less changes its character.
Run sectoral resection can both under General and under local anesthesia. The greatest effect can be achieved by conducting a thorough preliminary markup of the mammary gland under the control of ultrasound mammography.
Indications for intervention
Sectoral resection is assigned when:
- nodal mastopathy;
- vnutriportovaya papilloma;
- the suspicion of cancer as the primary diagnosis;
- the fibroadenoma of the breast;
- the lipoma is one or more, provided that they are localized in one sector of the breast;
- granulomas in the breast tissue;
- the initial stage of cancer;
- chronic purulent process in the body, when due to bacterial melting the fabric was lost and restore it.
Sectoral resection of breast cancer is also carried out, but it is possible in the following cases:
- if a cancerous tumor is located in the upper outer quadrant;
- the size of the tumor is not more than 3 cm;
- the size of the breast will remove the tumor and a large area around;
- no metastases in regional lymph nodes;
- after the surgery will have to performed radiotherapy.
Sectoral lymph node resection is good because it:
- retains the previous appearance of the breast;
- removes only the affected area;
- if when carrying out histological studies of the tumor during surgery, it turns out that it’s malignant, the scope of the intervention can be expanded by removing more tissue.
Contraindications to sector resection
The operation cannot be conducted when:
- pregnancy and lactation;
- the presence of a malignant tumor of any localization;
- systemic and rheumatoid diseases, if we are not talking about the treatment of breast cancer;
- infectious diseases;
- venereal disease.
Sectoral lymph node resection for different pathologies
If the fibroadenoma
Fibroadenoma is a hormone-dependent tumor localized in the breast. It is in 95% of cases are benign in nature, but it still can degenerate into a malignant form, fibroadenoma. That is exactly what this tumor is judged on the basis of ultrasound or x-ray mammography. This diagnosis will also show the shape of the tumor.
Removal of fibroadenomas often is the method of a sectoral resection of a mammary gland. Perform this operation when:
- tumor larger than 2 cm and there is a tendency to its further growth;
- there is a suspicion (fuzzy boundaries, randomly arranged vessels) that this tumor is malignant;
- leaf-type tumors;
- woman plans pregnancy and breast-feeding. Since fibroadenoma can hinder lactation, and also to suppurate when milk production of dairy glands, it is necessary to resect.
During the procedure, the tumor is sent for histological examination. It will show if there are cancer cells or not. Fibroadenoma without treatment alone does not resolve.
In breast cancer
Resection of cancer of the prostate is the preferred method of treatment, while chemotherapy and radiation therapy – only subsidiary. It can be of several types, depending on:
- stage of cancer;
- growth of tumors;
- penetration of the tumor into the surrounding tissue;
- condition hormonal women;
- the health status of women.
Extended sectoral resection with lymph node dissection can be performed only in the initial stages of the cancer with a small cancerous lesion (3 cm) and slow its growth, and in the absence in the lymph nodes of cancer cells. To do this, remove usually the middle of them – «watchdog», determined by radioisotope method or with the dye.
In this case, will be removed not only the tumor, but surrounding tissue; the area of the pectoral muscles, on which rests the mammary gland; lymph nodes that collect lymph from this Department; the fatty tissue, «inverting» the lymph nodes and connecting vessels.
Preparation of sectoral resection of the mammary gland covers the passing of a rigorous examination of the woman, when tests on:
- prothrombin index, INR, fibrinogen, the level of free heparin;
- the level of thyroid hormones;
- prolactin, testosterone, estradiol;
- blood urea, bilirubin, AST, glucose, ALT;
- microscopy of urine sediment;
- determination of blood group and Rh-factor.
When you reject the above tests from the norm will need to consult with a physician or specified practitioner specialist. They will tell what actions are necessary to produce to normalize the function of an organ, which was rejected. In this case, rehabilitation after resection of the sector must pass without complications.
In addition, preoperative preparation includes blood tests for the presence of antibodies to the HIV virus, hepatitis B, RW. In case of positive results of at least one analysis, the intervention will have to wait and conduct the appropriate treatment in infectious diseases (with detection of hepatitis B or HIV) or venereal diseases (in case of positive RW-test).
Before surgery be sure to pass laboratory tests:
- chest x-rays;
- Ultrasound of the thyroid gland;
- mammography – ultrasound (up to 45) or radiological (after 45 years).
If sectoral resection will be carried out for cancer using imaging – CT or MRI – are excluded distant metastases, suggests it absolutely other operation. Also, in preparation for intervention may be treated with radiation.
Action before surgery
The woman before the operation to do the following:
- to exclude the contraceptive pill (in consultation with the operating surgeon and gynecologist who ordered the drug);
- stop taking vitamin E for 5 days before the intervention;
- after consulting with the therapist or cardiologist, at least 3-4 days before surgery to cancel Aspirin, Warfarin, Chimes, Pentoxifylline or other krovanistaya drugs. Otherwise, sectoral resection may be complicated by severe bleeding;
- to stop drinking alcohol or Smoking, as this leads to a decrease in blood supply to the tissues. The healing period in this case will be longer.
If the plan is to perform surgery under General anesthesia, the last intake of food should be 6-8 hours before him, and water for 4 hours. This is important because the introduction of anaesthesia may be complicated by the emergence of vomiting, and on a full stomach it’s dangerous.
When planning sectoral resection under local anesthesia need to stop eating and drinking 4 hours prior to surgery.
How is sectoral resection
The technique of operation next is performed in several stages:
- Marking of the surgical field.
- Introduction of local anesthetic into the tissue or introduction of anesthesia.
- Sections semi-oval shape along the planned lines. They are directed from the periphery of the gland toward the nipple and are held at 3 cm from the edge of the tumor. If resection was carried out in connection with purulent process, are much smaller margins within healthy tissue.
- Blunt instrument are separated by tissue from the fascia (film), inverting pectoralis muscle, the entire depth of the chest. The surgeon secures the tumor with your fingers, so that it is not shifted.
- The separated tissue is removed.
- Stops bleeding from injured blood vessels.
- Inserted in the wound drainage.
- If there is a need for histological examination, the wound is covered and not temporarily sutured. The results of the examination of the histologist surgeons decide to take the wound or remove the entire gland and the lymph nodes.
- Sutured wound with a sterile dressing is served.
If using a sectoral resection was removed intraductal papilloma, the border of the excision of the tissue is determined by the introduction of colorant (it is injected under ultrasound) in the duct. Then make a cut along the edge of the areola, beside him painted duct, which is ligated near the nipple, and then recovered to its Foundation and there is also suture. Between these two threads together with duct papilloma removed.
The duration of the intervention – about 30 minutes. Upon its completion, the patient is taken to the house where she must spend 2 to 3 days.
Because the operation is traumatic, postoperative period lasts more than 2 weeks, but the patient usually feels only the first 8-10 days. They have the following features:
- Drainage can remove on the second day on it if there is no outflow (i.e. in the container attached to it, nothing accumulates). When the intervention was carried out for cancer of the prostate, drainage removed on day 3, before discharge.
- The first three days will feel the pain that is eliminated by the introduction of a muscle pain medication. After discharge it is recommended to take these drugs in pill form, on demand, and do not exceed the recommended dosage.
- In the first two days, the temperature can increase. This is a normal reaction to operational stress.
- Daily changing sterile dressings on the wound. After discharge you will have to come to clinic.
- To 7 days you need to take antibiotics. Most likely, it will be the drugs that need to be administered intramuscularly.
- Sutures are removed in 7-10 days.
Operating doctor may give the following recommendations after a sectoral resection of a mammary gland:
- To include in the diet a sufficient amount of animal protein in the form of boiled or baked lean meat, poultry or fish, and eggs. Fried, salty and smoked foods you have to exclude.
- Also in the diet should be sufficient amount of ascorbic acid. For this you need to drink a decoction of rose hips, eat fresh or frozen black currants, green peas, sweet peppers, melons, greens, tomatoes, sweet potatoes, turnips and squash.
- Knitwear should not put pressure on the surgical wound. The best option is a sports bra made of natural fabrics that will not put pressure or bring other discomfort.
- You need more rest.
- To monitor their weight. Weight more than 3 kg should serve as a basis for consultation, as this may be the swelling inside the operated gland.
- To bathe under a shower the next day after removing the stitches. Around the seam, wash the skin with soft gauze cloth and soaped baby soap. After bathing the surgical area is necessary to DAB with a dry clean gauze, and then treated with alcohol. Away from seam chest lubricate the baby cream.
- The hair from the axillary fossa with the operated side to remove the shaver, to avoid damage to the skin.
- After removing the stitches, you can begin performing exercises that will help to quickly restore arm muscles from the operated side, to normalize its own state. This «doctoring» of her arm, clenching in her hand a rubber ball or a carpal expander, frequent fastening-unfastening of a bra, a towel movements resembling a wipe of the back.
After operation it is impossible to heat the wound, treating it with milk, urine or tea.
You need to go to a operating doctor if:
- after sectoral resection of the breast tissue appeared seal;
- the wound became stronger than the ache or pain has no tendency to diminish troubling with the same intensity;
- the temperature is kept on the third day or later;
- the temperature rose again after a period when it was normal;
- from the wound pus;
- swollen arm or shoulder on the operated side.
What can be complicated operation
After sectoral resection of the mammary gland may develop these complications:
This accumulation of fluid in the operated gland due to damage to lymphatic capillaries. It requires repeated puncture with a fence of serous fluid.
The festering wounds
It is manifested by the increased pain of the wound, separation from the wound pus. Temperature can increase, violated the General condition (weakness, fatigue, loss of appetite).
Accumulation of blood
Hematoma after sectoral resection of the mammary gland usually appears in the case when he was not seen and was sutured with a container, or the fabric is so swollen that the thread is bad resist on it. Then the vessel is leaking blood, which accumulates in the breast. In this case, requires re-intervention in the body to remove accumulated blood and the bleeding stops.
Reasons for the formation of seals after conducting sectoral resection of the mammary gland varied. It could be internal scarring, resulting from the suturing of tissues. Then they are not painful and will eventually diminish. As the seal is also described and seroma, and recurrence of the tumor. So if it was not, and then it appeared, be sure to consult a doctor.
Lymphoedema of the hands
This complication develops due to the fact that removed lymph nodes through which was carried the flow of lymph not only from the breast, but also on the hands. This condition is treated for a long time, and it would be better if the woman will turn as soon as you notice an increase in hand volume.
In the treatment of complications used a special kind of gymnastics and physiotherapy. The woman also issued a number of recommendations which would prevent the growth or recurrence of the lymph oedema. They are as follows:
- do not wear tight jewelry on the affected hand;
- do not allow to be taken from a vein in her blood, only in extreme cases;
- to measure this arm blood pressure;
- after bathing, thoroughly wipe the entire hand, including between your toes;
- not to raise this hand of gravity, do not perform counter manipulation;
- to avoid damage to the patient’s hands;
- to exclude the execution of the manicure on this extremity;
- keep your hand out of a hot bath;
- not to visit the sauna;
- to protect your hand from sun rays;
- very carefully carry out the manicure on this extremity;
- when you travel to wear the arm compression sleeve, and to drink fluids in sufficient quantity.
When You have the indications for sectoral resections of the breast, try less to worry about. If it fails to pass all the tests, to fully compensate for their condition before the intervention and after it implement all the recommendations, the likelihood of any complications is minimal.