Breast cancer stage 5

Breast cancer has become a disease with an increasingly high incidence in today's society. Many women have lost their health or even their precious lives because of breast cancer. Breast cancer is graded into certain levels. If breast cancer has reached level five, then the disease is already in the late stage and requires surgery to be completely cured. Here we will introduce to you the surgical treatment methods for breast cancer!

1. Radical mastectomy for breast cancer

In 1894, Halsted and Meger published the surgical principles of radical mastectomy: ① The primary lesion and regional lymph nodes should be removed in one piece; ② The entire breast and pectoralis major and minor muscles should be removed; ③ The axillary lymph nodes should be completely removed in one piece. Haagensen improved the radical mastectomy and emphasized that the surgical operation should be particularly thorough, mainly including ① Carefully peel off the skin flap; ② After the skin flap is completely separated, the pectoralis major and minor muscles are cut off from the chest wall and turned outward; ③ The axilla is dissected, and the long thoracic nerve should be retained. If there is no obvious enlarged lymph node in the axilla, the dorsal thoracic nerve can also be retained; ④ Chest wall defects are all given skin grafting.

Common complications during surgery include: ① Axillary vein injury: This is mostly caused by unclear dissection of the fat and lymphatic tissue around the axillary vein, or by cutting the axillary vein branches too close to the axillary vein trunk. Therefore, it is very important to clearly expose and retain a few branch ends. ② Pneumothorax: When cutting the rib ends of the pectoralis major and pectoralis minor muscles, sometimes the clamps are clamped too deep into the small blood vessels of the chest wall, which may rupture the intercostal muscles and pleura, causing tension pneumothorax.

Postoperative complications include: ① Subcutaneous effusion: mostly caused by poor fixation of the skin graft or poor drainage, which can be prevented by multiple sutures between the subcutaneous and chest wall tissues and continuous negative pressure drainage; ② Skin graft necrosis: too tight skin sutures and too thin skin grafts can be the causes. When there are many skin defects, skin grafting is appropriate; ③ Edema of the affected upper limb and limited lifting of the affected upper limb: mainly due to reduced postoperative activity and traction of the subcutaneous scar. Therefore, functional training is required as soon as possible after surgery. Generally, the patient should be able to lift the upper limb freely about one month after surgery.

2. Extended radical mastectomy for breast cancer

Extended radical mastectomy includes radical mastectomy and internal mammary lymph node dissection, which is to remove the 1st to 4th intercostal lymph nodes. The second, third and fourth costal cartilages need to be removed. The surgical methods include intrapleural and extrapleural. The former is more traumatic and has more complications, so the latter is more often used.

3. Imitation radical surgery (modified radical surgery)

It is mainly used for non-invasive cancer or stage I invasive cancer. It can also be used for patients in stage II with no obvious clinical axillary lymph node enlargement.

(1) Type I: The pectoralis major and minor muscles are preserved. The principles of skin incision and flap separation are the same as those of radical surgery. First, the entire breast is removed (the surgical fascia of the pectoralis major is also removed). The entire breast is dissected to the axilla. Then, the axillary lymph nodes are removed. The removal range is basically the same as that of radical surgery. The anterior chest nerve should be preserved. Finally, the entire breast and axillary lymph tissue are removed in one piece.

(2) Type II: The pectoralis major is retained, the pectoralis minor is removed, and the skin incision steps are the same as before. After the breast is dissected to the outer edge of the pectoralis major, the attachment points of the pectoralis major at the 4th, 5th, and 6th ribs are cut and turned upward to expand the surgical field. The attachment point of the pectoralis minor is cut at the coracoid process of the scapula. The following steps are the same as radical surgery, but care must be taken to retain the anterior pectoral nerves and accompanying blood vessels. Finally, the entire breast, pectoralis minor, and axillary lymphatic tissue are removed in one piece.