Anatomía de la

mama
Dra. Valeria Romo R3 GyO
Localización
Localización
glándula mamaria
Pezón
irrigacíon
drenaje Venoso
drenaje linfático
inervación
 Anatomía
quirúrgica de la
Axila
Dra. Valeria Romo R3 GyO
Axila
Forma de pirámide
Límite Lateral
Corredera bicipital
Límite Lateral
Vértice Paquete vascular y nervioso
Posterior
● M. Subescapular
● M. Redondo mayor
● M. Dorsal ancho
Anterior
● F. Clavipectoral
● M. Subclavio
● M. Pectoral menor
● M. Pectoral mayor
● L. Suspensorio de la
axila
Base

F. Axilar
Medial

● M. Serrato mayor
● M. Intercostales
● Costillas
Medial

● M. Serrato Anterior
● M. Intercostales
● Costillas
Contenido
Contenido-Arteria Axilar

1. Torácica superior
2. Rama acromiotorácica y
mamaria externa
3. Rama subescapular,
circunfleja hemeralopías
anterior y posterior
Contenido-Vena Axilar

● Vena axilar
● Vena cefálica
Contenido-Nervios

● Nervio torácico largo - C5 a C7

● Lesión= Produce síndrome de la
escápula alada
Contenido-Nervios

● Nervio toracodorsal - C6 a C8
● Lesión= imposibilidad de
extensión y aducción del
hombro, disminución de rotación
interna
Contenido-Drenaje linfático
Contenido-Drenaje linfático
● RESPETAR LOS LÍMITES ANATÓMICOS
● PAQUETE VASCULONERVIOSO TORACODORSAL Y NERVIO TORÁCICO LARGO
DEBERÁN SER PRESERVADOS
● DEBE INCLUIR LOS NIVELES I Y II DE BERG
● INCLUIR AL MENOS 10 GANGLIOS
 MASTECTOMÍA
Dra. Valeria Romo R3 GyO
 Indicaciones mastectomía

La mastectomía está indicada en aquellas pacientes:

● Cirugía conservadora esté contraindicada
● Prefieran la mastectomía por motivos personales
● Profiláctica para reducir el riesgo de cáncer de
mama.
 Indicaciones mastectomía

– Enfermedad multicéntrica con dos o más tumores primarios en distintos

cuadrantes.
– Inadecuada o mala relación tamaño tumoral/tamaño mama.
– Fracaso del tratamiento conservador con márgenes persistentemente
positivos
– Microcalcificaciones malignas difusas en mamografía.
– Imposibilidad de tratamiento radioterápico:
• Antecedentes de radioterapia sobre pared torácica y mama que
sobrepase la dosis máxima tolerada
• Embarazo en primer y segundo trimestre
• Enfermedades activas del tejido conectivo que afecten a la piel
Mastectomía profiláctica y profiláctica contralateral

Bilateral:
● Las mujeres con predisposición genética.
● Pacientes con el síndrome hereditario
mama-ovario, con mutaciones BRCA1 y
BRCA2.
● Reduce riesgo 90%

Contralateral:
● Pacientes con diagnóstico de cáncer de mama
unilateral y portadoras de mutaciones
BRCA1-2.
Mastectomía radical o de Halsted

Extirpación en bloque de la
glándula mamaria, la piel
suprayacente, los músculos
pectorales mayor y menor y el
tejido linfograso axilar completo
(Nivel III Berg)
Mastectomía simple

Extirpación de la glándula mamaria

sin linfadenectomía axilar.
Biopsia del ganglio centinela
Mastectomía ahorradora de piel o skin sparing mastectomy

En este tipo de mastectomía se

intenta conservar al máximo la piel
envolvente y el surco submamario
para una reconstrucción inmediata
satisfactoria.

Incluye la resección del complejo

areola-pezón, cualquier cicatriz de
biopsia previa y la extirpación
completa de la glándula mamaria.

Está contraindicada en el
carcinoma inflamatorio debido a la
invasión de los linfáticos dérmicos.
Mastectomía ahorradora de piel total o nipple sparing mastectomy

No se conserva una placa

subareolar de tejido glandular, sino
que solo se conserva la epidermis y
la dermis del CAP y se extirpan los
conductos galactoforos terminales.

El tumor no debe estar próximo al

pezón ni afectarlo - biopsia
interoperatoria. La afectación de la
base del pezón oscila entre un 5-10
% = agresividad
Mastectomía radical modificada
 TÉCNICA QUIRÚRGICA

INCISIÓN ELPITICA
Incisión no debe extenderse a través de la línea axilar
anteror
 Colgajos de piel

Se elevan
● Superiormente hasta el nivel
de la clavícula
● Inferiormente hasta la
inserción de la vaina del recto
● Medialmente hasta el borde
esternal ipsilateral
● Lateralmente hasta el borde
del músculo dorsal ancho.
El grosor del colgajo variará pero
generalmente tiene un grosor
aproximado de 7 a 8 mm.
Disección de la pared torácica

Se diseca el tejido mamario del músculo

utilizando cauterio para disminuir sangrado.

La adherencia del tumor al músculo requiere

extirpación de esa porción con la muestra, con
margen circundante y colocación de clips -
radioterapia.
Cuando se alcanza el borde lateral de la mama, se retrae
el m. pectoral en dirección medial y s hace una incisión
en la fascia clavipectoral para exponer el contenido
axilar.
BORDE LATERAL

La disección se realiza posteriormente hasta visualizar la vena

axilar. Las estructuras venosas transversales altas en la axila nunca
deben ligarse.
 Movilización de la almohadilla grasa axilar

El tejido graso y los ganglios se disecan

Identificación de los nervios motores

Disección Romo justo debajo de la cara medial de la

vena axilar y justo lateral a la pared torácica,
Haz neurovascular, disección en la
mitad de la axila, debajo de la vena
axilar, afluente venoso-vena
toracoepigástrica, se encuentra por
delante de la posición del haz, no
seccionarse hasta confirmar el haz.
Finalización de la disección.
 DRENAJES.

Drenajes axilares disminuyen la formación de seroma y el volumen y

la frecuencia de aspiración de seroma posoperatoria.
Biopsia de ganglio centinela

Las células tumorales que migran desde un tumor

primario metastatizan a uno o unos pocos ganglios
linfáticos antes de afectar a otros. Estos se denominan
ganglios "centinela", cuyo estado predeciría con
precisión el estado de los ganglios linfáticos restantes.
INDICACIONES:
-Cáncer de mama temprano (T1 o T2) que tienen ganglios
clínicamente negativos
-Carcinoma ductal in situ (CDIS) cuando se realiza una
mastectomía.

CONTRAINDICACIONES:
-Ganglios clínicamente positivos
-Cáncer de mama inflamatorio (T4d)
-Cáncer de mama localmente avanzado (relativa)
Técnica
 Técnica
Tinte azul:
● Se inyecta de 3 a 5 ml de tinte azul
(azul de isosulfán al 1 % o azul de
metileno diluido ) alrededor de la
periferia del tumor.
● Se debe masajear la mama durante
cinco minutos para dilatar los vasos
linfáticos mamarios.
● Luego se ingresa a la fascia axilar a
través de una incisión axilar.
● Luego se realiza una búsqueda
cuidadosa y sistemática de canales
linfáticos azules.
● Deben seguirse con una disección
suave, idealmente sin sangre, hasta
que conduzcan a ganglios linfáticos
teñidos de azul.
● Todos los teñidos se extirpan y se
designan ganglios centinela
 10% 40%
Saturn is composed of Jupiter is a gas giant
hydrogen and helium and the biggest planet
Breast Cancer Infographics

Medical control
01 Saturn is composed of hydrogen and helium

Touch
02 Despite being red, Mars is a cold place

Look
03 Jupiter is a gas giant and the biggest planet
 Breast Cancer Infographics

10% 60% 75% 40% 25%

20 - 30 y/o 31 - 40 y/o 41 - 50 y/o 51 - 60 y/o 61 - 70 y/o

Earth is the Neptune is the It’s composed Despite being Mercury is the
third planet farthest planet of hydrogen red, Mars is a closest object
from the Sun from the Sun and helium cold place to the Sun
 Breast Cancer Infographics
Stages of breast cancer

Stage 01 Stage 03
Mercury is the closest It is the ringed planet. It
planet to the Sun and the is composed of hydrogen
smallest one and helium

Stage 02 Stage 04
Jupiter is a gas giant and Despite being red, Mars
the biggest object in the is a cold place full of iron
Solar System oxide dust
 Breast Cancer Infographics

Adipose tissue
Skin
Earth is the third planet Mercury is the closest
from the Sun object to the Sun

Ducts Nipple
Neptune is the farthest Despite being red,
planet from the Sun Mars is a cold place

Lobules Pectoral muscle

Saturn is composed of Jupiter is a gas giant
hydrogen and helium and the biggest planet
 Breast Cancer Infographics

American women
Earth is the third planet 60%
from the Sun African women
55% Earth is the third planet
from the Sun
European women
Neptune is the farthest 50%
planet from the Sun Oceanian women
20% Neptune is the farthest
planet from the Sun
Asian women
Saturn is composed of 10%
hydrogen and helium
 Breast Cancer Infographics

Good rest
Earth is the third planet
from the Sun

Good nutrition
Jupiter is a gas giant
and the biggest planet

Sport
Saturn is composed of
hydrogen and helium
 Breast Cancer Infographics

Community Programs
Despite being red, Mars It is the ringed planet. It
is a cold place full of iron is composed of hydrogen
oxide dust and helium
 Breast Cancer Infographics
Treatment options

Surgery Targeted therapy Radiation Chemotherapy Hormonal therapy

Earth is the Neptune is the It’s composed Despite being Mercury is the
third planet farthest planet of hydrogen red, Mars is a closest object
from the Sun from the Sun and helium cold place to the Sun
 Breast Cancer Infographics
Types of breast cancer

IDC Lobular-ductal
Mercury is the closest It is the ringed planet. It
planet to the Sun and the is composed of hydrogen
smallest one and helium

ILC Rare subtypes

Jupiter is a gas giant and Despite being red, Mars
the biggest object in the is a cold place full of iron
Solar System oxide dust
 Breast Cancer Infographics

30% 60%
Saturn is composed of Jupiter is a gas giant
hydrogen and helium and the biggest planet
 Breast Cancer Infographics

Information Reviews Community Fight

Despite being red, Mars It’s a gas giant and the It is the ringed planet. It Neptune is the
is a cold place full of biggest object in the is composed of hydrogen fourth-largest planet in
iron oxide dust Solar System and helium the Solar System
 Breast Cancer Infographics

Biopsy MRI scan

Mercury is the closest It is the ringed planet. It
planet to the Sun and the is composed of hydrogen
smallest one and helium

Mammogram Lab test

Jupiter is a gas giant and Despite being red, Mars
the biggest object in the is a cold place full of iron
Solar System oxide dust
Breast Cancer Infographics

Flag
Neptune is the farthest
planet from the Sun

Support
Despite being red,
Mars is a cold place

Education
It is composed of
hydrogen and helium
Breast Cancer Infographics
Planning educations

Educations
Despite being red, Mars
is a cold place

Teachers
Earth is the third planet
from the Sun

Students
Neptune is the farthest
planet from the Sun
 Breast Cancer Infographics
How to deal with side effects

Support Psychologist Monitoring

Earth is the third planet Despite being red, Mars Jupiter is a gas giant
from the Sun is a cold place and the biggest planet
 Breast Cancer Infographics

50% 10%
IDC Rare subtypes
Mercury is the closest It is the ringed planet. It
planet to the Sun and the is composed of hydrogen
smallest one and helium

25% 15%
ILC Lobular-ductal
Jupiter is a gas giant and Despite being red, Mars
the biggest object in the is a cold place full of iron
Solar System oxide dust
 Breast Cancer Infographics
Consequences

No consequences Remove a breast Lose hair

It’s the third planet It’s the farthest Despite being red,
from the Sun planet from the Sun Mars is a cold place
 Breast Cancer Infographics
Survival percentage

Lobular-ductal ILC IDC

It’s the third planet It’s the farthest Despite being red,
from the Sun planet from the Sun Mars is a cold place

20% 50% 70%

 Breast Cancer Infographics

Stage 01 Stage 02 Stage 03 Stage 04

Earth is the Neptune is the Despite being Mercury is the
third planet farthest planet red, Mars is a closest object
from the Sun from the Sun cold place to the Sun
 Breast Cancer Infographics
Medical diagnostic

Blood test Genetic testing

Mercury is the closest It is the ringed planet. It
planet to the Sun and the is composed of hydrogen
smallest one and helium

Biopsy Diagnostic imaging

Jupiter is a gas giant and Despite being red, Mars
the biggest object in the is a cold place full of iron
Solar System oxide dust
 Breast Cancer Infographics

Annual reviews Touch

Saturn is composed of Jupiter is a gas giant
hydrogen and helium and the biggest planet
 Breast Cancer Infographics
Foundations
Despite being red,
Mars is a cold place

Community
It’s the farthest
planet from the Sun

Programs
It’s the third planet
from the Sun
 Breast Cancer Infographics
Risk factors

Being a woman Consuming alcohol

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from the Sun object to the Sun

Advanced age Being a mom over 30

Neptune is the farthest Despite being red,
planet from the Sun Mars is a cold place

Obesity Not being pregnant

Saturn is composed of Jupiter is a gas giant
hydrogen and helium and the biggest planet
 Breast Cancer Infographics

Goal 01 Goal 03
Earth is the It’s composed
third planet of hydrogen
from the Sun and helium

Goal 02 Goal 04
Neptune is the Despite being
farthest planet red, Mars is a
from the Sun cold place
Breast Cancer Infographics

Implant
Despite being red, Mars is a cold
place full of iron oxide dust

Special bra
Jupiter is a gas giant and the
biggest object in the Solar System

It’s fine
Mercury is the closest planet to the
Sun and the smallest one
Breast Cancer Infographics

30%
Men
It’s composed
of hydrogen
and helium

90%
Women
Despite being
red, Mars is a
cold place
 Breast Cancer Infographics

Support Education
Saturn is composed of Jupiter is a gas giant
hydrogen and helium and the biggest planet
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