After radical resection, the chest swelling
Despite significant success in treatmentoncological patients, there are many unresolved issues, in particular those related to rehabilitation and improvement of the quality of life. Modern methods of treatment of malignant neoplasms - surgical, radiation and chemotherapeutic ones themselves are aggressive factors that have harmful, and often crippling, effects on the patients' body. All this fully applies to patients receiving treatment for breast cancer. In Russia, in the structure of the incidence of malignant tumors, breast cancer (breast cancer) is on the first place and is more than 19%. In the United States, this figure is 29%, in France 28%.
In this article I would like to consider the problemscomprehensive rehabilitation of women after radical treatment of breast cancer, including its immediate and long-term consequences. The development of postmastectomy complications directly depends on the tactics of carrying out radical antitumor treatment. If earlier the development of complications was the result of surgical treatment, now due to the prevalence of methods of combined treatment, the "combined breast cancer treatment syndrome" comes to the fore. The closest postoperative complications in radical mastectomy are determined by the volume of performed surgical intervention and are post-traumatic. The most typical complications of this period are a shift in the parameters of the coagulation system toward hypercoagulation (between the second and ninth days after the operation), phantom pains and asthenic conditions. Against the backdrop of postoperative stress, healing of the wound surface, lengthening of the period of lymph foliation and formation of a rough postoperative scar are often observed.
Considering that after a radicalantitumor treatment, there is an increase in pathological changes in tissues, a timely, begun at the earliest possible time, carrying out rehabilitation measures acquires special importance. The scheme of their conducting is directly connected with occurrence of those or other postmastectomic complications. When diagnosing postmastectomy complications, the patient's complaints and the results of an objective examination should be guided.
A woman after a mastectomy should notlose confidence in themselves and in their abilities, in the possibility of restoring health and femininity. It is possible to achieve the desired results quickly and efficiently with modern means of exoprosthesis. Currently, specialized mammary gland exoprostheses are being produced by foreign firms and the Russian prosthetic and orthopedic industry, taking into account the anatomical and topographic features of the operation performed and effectively eliminating the postmastectomy defect. A properly selected prosthesis is not only a cosmetic product, but it is also used as a curative and prophylactic agent that promotes rapid post-operative adaptation and healing of tissues. Such a prosthesis compensates for weight imbalance, preventing secondary deformations of the body (violation of posture, curvature of the spine, lowering of the shoulders, etc.). An experienced consultant-methodologist is able to select individually for each woman the most suitable for the color, shape, size and weight of the exoprosthesis.
There are symmetric (possibly usingboth on the right and left side) and asymmetric (left and right) mammary gland exoprosthesis. The shape of symmetrical exoprostheses can be different: triangular, teardrop and oval. Exoprosthesis can be divided into several functional groups:
- Postoperative prostheses are light, do not interfere with the healing of the joints, do not injure the skin of the breast, they are prescribed after removal of the drainage and bandages, intended for temporary (2 months) use.
- Prostheses for permanent day wearing - use after 2 months. after operation.
- Lightweight prostheses - recommended for largebreasts; with lymphatic edema of the hand on the side of the treatment; with cardiovascular diseases; for women who lead an active lifestyle. In addition, the use of lightweight prostheses is convenient in hot weather.
- Special prostheses are designed for gymnastics and swimming.
- Contoured dentures - used forsectoral resections. The latest models provide an adhesive system for fixing the prosthesis directly to the surface of the chest, so that the distribution of the weight of the prosthesis between the body and the bra is optimal. This exoprosthesis is better around the body, more convenient to use, with more accuracy corrects defects.
In addition to properly selected exoprosthesis, a properly selected bra is of great importance, the main function of which is the reliable fixation of the exoprosthesis.
There is a special table of compliancethe size of the bra cups of the exoprosthesis. The prosthesis should completely fill the cup of the bra, while the cup should not be smaller than the prosthesis (this can lead to its deformation) and should not be larger than the prosthesis (this leads to its insufficient fixation). Bra should be used together with a prosthesis. The bra should fit tightly, but do not press or press down, the straps should evenly distribute the pressure without bumping into the body, in some cases, recommended unloading straps.
In combination with a special linen or swimsuitThe prosthesis in the literal sense becomes a part of the woman herself. All this allows to accelerate the restoration of the psycho-emotional state of a woman and return to a full life.
One of the most common problems afteroperations on the mammary gland, thorax, with lesions of the axillary lymph nodes, after radiotherapy there is lymphedema - lymphatic edema of the upper limb. According to the recommendations of the National Lymphedema Network, you can avoid this ailment by following the following rules that protect the upper limb on the side of the operation:
- You can not ignore the appearance of even a slight swelling of the hand, hand, fingers or chest (immediate medical consultation is needed).
- For injections, taking blood should not be used by the hand on the side of the operation.
- Measurement of blood pressure is possible only on the intact arm, or leg (thigh).
- Must be observed the necessary hygiene, after bathing should be used moisturizing lotions.
- The patient should avoid repetitive energetic, counteracting something, movements of the injured hand (clean, push, pull, etc.).
- It is necessary to avoid lifting heavy things damagedhand. Never carry heavy bags over your shoulder or in your hand on the side of the operation. Do not wear tight jewelry, elastic bands on the damaged arm and fingers.
- Avoid strong temperature fluctuations during bathing, washing dishes, and also it is not recommended to visit saunas and take hot baths.
- Always protect your hand from the sun. Try to avoid any injuries to the injured hand (bumps, cuts, sun and other burns, sports injuries, insect bites, scratches).
- When doing work around the house, in the garden or other work, in which even minimal damage is possible, gloves should be used.
- It is necessary to avoid cutting the cuticle with manicure.
- When flying, people with lymphedema (or thosewho may have lymphedema) should wear a compression sleeve of the appropriate size. Additional bandages may be required for a long flight.
- Women with large breasts should wearlightweight prostheses (heavy prostheses can put too much pressure on the supraclavicular lymph nodes). Soft pads or strips of matter can be used. The bra should be chosen in the right way: not too tight and not containing "procrastination".
- To remove hair in the armpit area, use an electric shaver.
- People with lymphedema should wear a well-chosen compression sleeve during the entire waking period.
- When rashes, itching, redness of the skin, pain, rising temperature, the patient should immediately consult a doctor.
- It is necessary to maintain a normal body weight. Low-salt (with reduced sodium content) enriched with fiber, the diet should be well balanced.
One of the most serious consequences after the radicalmastectomy is postmastectomy depression. Loss of the breast is not only a physical defect, but also a serious mental trauma that affects the behavior of women in everyday life and society. Women who have undergone a mastectomy tend to exaggerate the cosmetic consequences of the operation, negatively assess their appearance, and focus on the attitudes of others that have changed in their view.
Approximately 25% of women after mastectomythere is a severe depression (difficulties in reconciliation with your appearance, with loss of chest, fear of relapse), up to thoughts of suicide. The impossibility of reconciliation with what happened and the return to normal life requires, in some cases, the help of an experienced psychotherapist.
Together with this, fast and effectivecosmetic correction of postmastectomy defect (exoprosthesis and selection of specialized linen) allow to reduce the level of depressive state, which contributes to the successful adaptation of women in the family and society.
From psychocorrecting methods of rehabilitationIt should be noted that those that hinder the processes of self-isolation and immersion in the disease. From these positions, any kinds of psychotherapy should be conducted in the natural conditions of group communication, which allows to remove the inferiority complex and believe in recovery. At the stage of active rehabilitation, it is necessary to create conditions for attracting women to specialized groups of health-improving swimming, yoga therapy, etc. A special place in overcoming depression belongs to natural and climatic factors during sanatorium-resort treatment. Getting sick in a new environment of a sanatorium, the sick leave their stressful situation more quickly.
As a rule, after a correct (based on the belief in recovery) of a complex of rehabilitation measures, postmastectomy depression can be overcome.
Conducting a comprehensive method of rehabilitationis a necessary condition for improving the quality of life of women after mastectomy. The proposed form of postoperative rehabilitation, approved over the past few years by specialists of the Russian Association of Mammologists, significantly improves the quality of life of patients, contributing to their social and professional rehabilitation.
Thus, the application of the systempostoperative measures allows early on to ensure a high quality of life for a woman, eliminate cosmetic defects and psychoemotional instability, and reduce the impact of factors that lead to disability, which is not only a personal but also a social problem.
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