The classic radical mastectomy for breast cancer is thin skin flap, excision of the whole breast and superficial skin, pectoralis major muscle, pectoralis minor muscle and intermuscular lymph nodes, all fat and lymphoid tissue in the armpit. Thorough dissection of local cancer tissue and axillary lymph nodes with cancer metastasis can basically achieve the purpose of local cure, and the postoperative local recurrence rate is low, and it is mainly used for clinical stage II and III patients.
There are two types: radical mastectomy type I with preservation of pectoralis major and minor muscles and modified radical mastectomy type II with only pectoralis major muscle excision of pectoralis minor muscle. Postoperative edema of the upper limbs is reduced, good function can be maintained, and it provides conditions for postoperative breast reconstruction. It is mainly suitable for clinical stage I and II patients, and the most ideal indication is microcarcinoma. For patients with microcarcinoma, the 10-year survival rate is 95%. However, it is generally not used for patients with significantly enlarged axillary lymph nodes and adhesions.
Extended radical surgery is to remove the lymph nodes in the 1st to 4th intercostal internal mammary region during radical surgery. There are two types of surgery: extrapleural method and intrapleural method. The advantage of this procedure is that the lymph nodes in the internal mammary region are removed, and all the first-level lymphoid tissues of the breast are completely removed. Compared with the classical radical mastectomy, the local recurrence rate is reduced. But its complications are more than other surgical methods. It is mainly used in stage II and III cases, especially in patients with cancer lesions located in the medial and center of the breast.
Breast cancer mastectomy alone is a reduction surgery that involves only a mastectomy and removal of the pectoralis major fascia. This procedure is between modified surgery and partial excision. It has little advantages and is generally not used.
There are four types of surgery: (1) lumpectomy; (2) tumor and surrounding breast tissue removal; (3) wedge resection; and (4) quadrantectomy.
This type of surgery is widely used in Europe and the United States. Its main advantages are that it is less traumatic, can preserve the breast shape, and is supplemented by postoperative chemotherapy. The curative effect is similar to that of modified radical mastectomy, but the local recurrence rate is high. Those who wish to preserve the shape of their breasts. However, to ensure the success of the operation, it is necessary to strictly grasp the surgical indications, be familiar with the surgical methods, work closely with the pathologist, and strive to ensure that there is no tumor at the edge of the specimen. Breast local radiotherapy is also required after surgery to remove residual tumor inside and outside the breast and to ensure the appearance of the breast. In order to cooperate with comprehensive treatment in a timely manner, firstly, a transverse diamond-shaped incision should be used to reduce tension; attention should be paid to protecting the pectoralis major nerve during operation to avoid damage; the free flap is moderate. Avoid wound necrosis caused by electrosurgical burns on the skin; complete hemostasis, smooth drainage, and rationally bandage the wound to prevent subcutaneous fluid accumulation and secondary infection.