Thanks to nipple and skin-sparing mastectomy performed in limited centers, breast cancer surgery can be performed without any aesthetic loss in the breast.
What is Nipple and Skin-Sparing Mastectomy Surgery?
Breast With the head and skin-sparing mastectomy method, the patient's nipple, the colored part around the nipple called the areola, and the breast skin are preserved. The inside of the breast is completely emptied. In the same session, the breast is filled with a silicone implant or the patient's own tissue (taken from the back or abdomen). The patient does not experience any cosmetic loss after the surgery.
What is the Biggest Difference Between Nipple and Skin-Sparing Mastectomy and Breast-Conserving Surgery (BCS)?
In nipple and skin-sparing mastectomy, the breast tissue is damaged. The entire tumor is removed, and the possibility of recurrence is greatly reduced. In breast-conserving surgery (BCS), only the tumor area in the breast is removed to a large extent. While radiotherapy is always applied after Breast-Conserving Surgery (BCS), radiotherapy after Nipple- and Skin-Sparing Mastectomy may be required rarely and in very special cases.
In Which Patients Can Nipple- and Skin-Sparing Mastectomy be Performed?
- Any tumor size
- If there is ductal carcinoma in situ
- If locally advanced breast cancer is diagnosed
- 85-00% of the patients diagnosed with breast cancer have this It falls into this group.
Nipple and Skin-Sparing Mastectomy can be safely performed in most breast cancers (observing certain criteria), except for advanced stage breast cancer. Since the nipple and areola complex is preserved, the cosmetic results are excellent. Its difference compared to Breast Conserving Surgery (BCS) is that, while radiotherapy is applied to all patients without exception in BCS, radiotherapy is not mandatory after this method. (It can be done in some cases, for example, if there is widespread axillary lymph node spread)
Which Physicians from Specialized Fields Participate in Nipple and Skin-Sparing Mastectomy Surgery?
This surgery should be in every breast cancer case. It requires a multidisciplinary approach. The surgery is performed together with a general surgeon experienced in breast surgery and an aesthetic and plastic surgeon experienced in this surgery. It is extremely important to perform the surgery without disrupting the nutrition of the nipple and the remaining breast skin. The surgical team is only It is not limited to narrow limits. In addition, a nuclear medicine specialist and a pathologist participate in the surgery simultaneously. The nuclear medicine specialist is involved in the Lymphoscintigraphy and Sentinel Lymph Node Biopsy (SLNB) phase used in the evaluation of the armpit. The lymph node removed with a special method is given to the pathologist waiting in the operating room. According to the results of the evaluation (Frozen Pathology) made by the pathologist at the time of surgery, it is decided whether the armpit lymph nodes will be removed or not. Experience and the harmonious work of the team in this surgery are extremely important.
Cosmetic Results of Nipple and Skin-Sparing Mastectomy Surgery. What are they?
In this surgery, the patient's nipple, the colored ring-shaped part around the nipple called the areola, and the skin of the breast are preserved; The breast tissue is completely removed. In the same session, a new breast is created by filling the breast skin with a silicone implant or the patient's own tissue (tissues taken from the back or abdominal area). These procedures are generally performed through small incisions made around the nipple or under the breast.
When necessary, some aesthetic interventions (lifting, reduction, etc.) can be performed on the other non-cancerous breast in the same session, in line with the patient's request, to correct the symmetry and cosmetic appearance. It can be done.
How Are the Armpit Lymph Nodes Evaluated in Nipple and Skin-Sparing Mastectomy?
Before the surgery, the armpit and surrounding lymph nodes are evaluated simultaneously with the breast. This evaluation is made by manual examination, breast USG, mammography and, if necessary, needle biopsy of these lymph nodes. But these evaluations are still not sufficient. The decision to remove the armpit lymph nodes is made by Sentinel Lymph Node Biopsy (SLNB), which is performed simultaneously with breast surgery. Sentinel Lymph Node means the sentinel nodule that is first affected by the tumor in the breast.
Sentinel Lymph Node detection is made by lymph mapping called lymphoscintigraphy, which is performed in the nuclear medicine department just before the surgery. Then, at the beginning of the surgery, a sentinel lymph node is detected using a meter called a gamma probe, accompanied by a nuclear medicine specialist, and SLNB is performed through a small incision. The removed piece is examined by the pathologist during the surgery (Frozen pathology) and the final According to the law, unnecessary removal of armpit lymph nodes is prevented.
How Does the Process of Nipple and Skin-Sparing Mastectomy Surgery Work?
The patients' surgery preparations are made without being hospitalized, and they are admitted to the hospital on the day of the surgery. On the morning of the surgery, lymphoscintigraphy is performed first in the nuclear medicine department; Then, the patient is taken into surgery with a team consisting of a general surgeon, plastic surgeon, pathologist and nuclear medicine specialist. After surgery, patients generally stay in the hospital for 1 or 2 days and are then discharged. Drains placed after surgery are generally removed gradually within 1 week. Patients can provide their own needs immediately after the surgery without needing anyone else.
After the surgery, patients are directed to the oncologist and after the oncological evaluation, personal treatment protocols (Chemotherapy, hormonotherapy, etc.) are determined and these are put into practice.
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