Surgical treatment of breast cancer remains the major means of surgical treatment of a variety of its options are still lacking a unified opinion, the general trend is to minimize the surgical damage to the device under the right conditions allow try to breast-conserving therapy in patients with early breast cancer appearance . No matter what kind of surgical use must be strictly controlled in order to cure the main function and appearance retention, supplemented by principle.
(A) The first surgical indications Halsted radical mastectomy for breast cancer surgery is reasonable, effective clear, the past century become the treatment of breast cancer, followed by the standard way to nearly half a century, breast cancer surgery and conducted a number of exploratory changes, the overall Trends nothing more than conservative and expansion of both is still debated. Partial breast resection and mastectomy is the representation of conservative surgical procedure. Postoperative radiotherapy doses of radiation need to vary, usually 30 ~ 70Gy, the limitations of the strict selection of early cancer can receive a better effect. But whether as a routine treatment for early breast cancer, and how to choose the accuracy of such early cancer, it’s harder to a conclusion.
(B) surgical contraindications
1. Systemic contraindications: â‘ tumor distant metastasis â‘¡ elderly and the infirm who can not tolerate surgery. â‘¢ generally poor, showing cachexia â‘£ important organ dysfunction who can not tolerate surgery.
2. Localized lesions contraindications: Ⅲ patients with one of the following conditions: ①the breast skin, orange peel-like swelling of more than half of the breast area; ② the breast skin and the advent of satellite-like nodules; ③ breast violation of the chest wall; ④ clinical examination sternum lymph node enlargement and confirmed to be transferred; ⑤ ipsilateral upper extremity edema; ⑥ supraclavicular lymph nodes confirmed by pathology for the transfer; ⑦ inflammatory breast cancer are two of the following five conditions: ①tumor ulceration; ② orange peel-like skin, breast edema of the entire breast area is l / 3 or less; ② carcinoma with pectoralis major fixed; ④ maximum length axillary lymph node diameter of more than 2.5cm; ⑤ adhesion to each other or with axillary lymph node skin, deep tissue adhesion.
(C) surgical method
1. Radical mastectomy: in 1894, and Meger, respectively Halsted radical mastectomy operation method on the surgical principles: â‘ the primary tumor and regional lymph nodes should be en bloc resection; â‘¡ removed all the breast and chest size of the muscle; â‘¢ axillary lymph node for en bloc complete resection. Haagensen improved radical surgery of breast cancer, emphasizing the surgical operation should be particularly thorough and meticulous dissection flap mainly â‘ ; â‘¡ flap completely separated from the chest wall chest will be large and small muscles reveal cut out; â‘¢ axillary dissection, thoracic Long Path of God should be retained, such as the axillary lymph nodes had no significant while those thoracodorsal nerve can also be retained; â‘£ chest wall defect to be skin grafting in all common complications are: â‘ axillary vein injury: multi-axillary vein due to the anatomy of the surrounding fat and lymphoid tissue, the anatomy is unclear, or because when you cut off a branch too close to the axillary vein axillary vein due. Therefore, a clear exposure and to retain the branch stump is important. â‘¡ pneumothorax: In the cut pectoralis major, pectoralis minor muscle in the ribs sometimes only the end result of clamping the chest wall of the small blood vessels penetrating branches, the next clamp too deep an extent which rendered touch-breaking intercostal muscle and pleura caused by tension pneumothorax. Postoperative complications included: â‘ subcutaneous fluid: Multi-skin graft fixation because of poor or poor drainage due. The skin and chest wall can be used multiple suture between the organization and sustained negative pressure drainage and prevention of skin graft necrosis â‘¡: skin suture too tight and the skin thinner and so can their causes. Large skin defect, the appropriate use of skin grafting â‘¢ ipsilateral upper extremity edema. Ipsilateral upper extremity flattering limited: mainly postoperative reduction in activity, skin scarring caused by traction, therefore, requested an early postoperative functional exercise should normally be about a month after the operation can be achieved flattering comfortable with the basic level of 2. Breast cancer, extended radical surgery : breast cancer, including breast cancer, extended radical mastectomy radical mastectomy or radical mastectomy and internal mammary lymph node dissection that is cleared 1-4 intercostal lymph nodes, the time required to remove the second, three or four costal cartilage. Surgical methods are within the law and pleural pleural outside France, the former major complications of multiple trauma, and they tend to use the latter.
3. Imitation radical mastectomy (modified radical mastectomy): mainly used for non-invasive cancer or invasive cancer, Phase I Phase â…¡ clinical trial no significant axillary lymph nodes who may choose to apply.
(1) â… Type: Retention pectoralis major pectoralis minor muscle. Principle of separation of the skin incision and skin flap with radical mastectomy. Do first mastectomy (surgical fascia together with removal of pectoralis major) to the whole breast to the axillary dissection side, and then OK axillary lymph node dissection, removing the scope of the basic tracks with radical mastectomy chest God should be retained. Finally, the whole milk and axillary lymph tissue en bloc resection (2) â…¡ type: Retention pectoralis major pectoralis minor muscle resection. Steps such as the skin incision with the former, the outer edge of the breast after dissociation to cut off the pectoralis major pectoralis major rib attachment points for the first 4,5,6, and turned to expand the surgical field to the top of the coracoid in the shoulder blades off the Department of pectoralis minor muscle attachment point, the following steps with the radical surgery, but reservations should be noted that the chest nerve and accompanying vessels Finally, the entire breast, chest muscles and underarm lymph tissue of small en bloc resection.
4. Breast surgery alone: As an old-style operation which had been replaced by radical mastectomy of breast cancer biology in recent years with the development of the mastectomy renewed attention. Its indications: First, non-invasive or axillary lymph node metastasis of early cases of postoperative radiotherapy could not. 2 is a partial view of breast cancer with late postoperative radiotherapy alone. From the ever-growing beauty school and asked to see mastectomy breast reconstruction is still required complex surgery. Would be unsuitable for young women in the early disease. The main indications so it should be limited to old and feeble person or some only palliative resection of advanced cases of 5. Less than the whole milk surgical excision: In recent years due to advances in radiotherapy equipment and found that the lesions than in the past early and the patient’s quality of life after surgery has higher expectations and therefore reported that there were a lot less than full mastectomy operation of conservative surgical approach from the partial removal of up to l / 4 mastectomy and postoperative radiotherapy for some applications.
Breast-conserving surgery is not suitable for all breast cancer cases and could not replace all of the radical operation, but an improved breast cancer treatment method should be taken to avoid recurrence of their indications as follows: ①tumors less suitable for clinical T1 and some of the T2 (less than 4 cm) following lesions; ② around the tumor, located in often inappropriate for those under the areola; ③ solitary lesion; ④ well-demarcated tumor, such as the naked eye or under a microscope, the borders are often not see clearly inappropriate for ; ⑤ axillary lymph node metastasis with no clearly defined. The effects of treatment with the following factors: ①tumor resection margin must have a normal border, if there is sufficient margin of normal organizers a better prognosis; ② primary tumor size and histological grade; ③ after postoperative radiotherapy, such as no radiation therapy, local recurrence is higher.
