1. Radical mastectomy
Halsted's operation modified by Han Gensen was adopted, that is, thin skin peeling was used to remove all the fat and lymphoid tissues of breast and superficial skin, pectoralis major, pectoralis minor and intermuscular lymph nodes, and armpit. This kind of operation is still widely used in China. Its advantage is that it can thoroughly clean the local cancer tissue and axillary lymph nodes with cancer metastasis, and basically achieve the purpose of local cure. The local recurrence rate after operation is low, and it is mainly used for clinical stage II and III patients.
2. Improved radical operation
There are two types: radical mastectomy with preservation of pectoralis major and pectoralis minor (Auchincloss operation) and radical mastectomy with preservation of pectoralis major only (patey operation). The main advantages of modified radical operation are preserving pectoralis major muscle, making the appearance of chest wall close to normal, reducing edema of upper limbs after operation and maintaining good function, which provides conditions for breast reconstruction after operation. It is mainly used for clinical stage I and II patients, and the ideal indication is micro-cancer wabebo. The 10 year survival rate of patients with microcarcinoma is 95%. However, axillary lymph nodes with obvious swelling and adhesion are generally not used.
Extended radical operation is to remove lymph nodes in 1~4 intercostal internal mammary region during radical operation, and there are two kinds of extrapleural operation (urban operation) and intrapleural operation (margottni operation). The advantage of this operation is that the lymph nodes in the internal mammary region are removed, and all the primary lymphoid tissues of the breast are completely removed. Compared with the classic radical operation, the local recurrence rate is reduced. But its complications are more than other operations. It is mainly used for stage II and III cases, especially for patients whose cancer focus is located inside and in the center of the breast.
3. Simple mastectomy
It's a reduction surgery, only a mastectomy and a pectoralis major fascia resection. This kind of operation is between modified operation and partial resection, which has little advantage and is generally not used.
4. Partial mastectomy
It refers to a segmental or partial mastectomy with axillary lymph node dissection. There are four types: ① lump type; ② Tyler resection); The tumor and a little surrounding breast tissue. ③ Wedge resection; ④ Square resection. This operation is widely used in Europe and America. Its main advantages are less trauma, breast shape preservation and postoperative chemotherapy. The curative effect is close to that of modified radical operation, but the local recurrence rate is high. It is mainly used for patients with early breast cancer who want to keep breast shape. However, in order to ensure the success of the operation, we must strictly grasp the surgical indications, be familiar with the surgical methods, and cooperate closely with pathologists to ensure that there is no tumor at the edge of the specimen. Postoperative local radiotherapy is needed to remove residual tumors inside and outside the breast and ensure the appearance of the breast. In order to cooperate with the timely implementation of comprehensive treatment, Stewart transverse prismatic incision should be used to reduce tension; Pay attention to protect the pectoralis major nerve from injury during operation; Free flap is moderate. Avoid postoperative wound necrosis caused by electric knife burning skin; Thoroughly stop bleeding, smooth drainage, properly bandage the wound, and prevent subcutaneous effusion and secondary infection.