Development of Breast Cancer Surgery
Today, the first option in breast cancer treatment is surgery. However, breast surgery, which was first performed successfully by William Stewart Halsted in 1882, has undergone many changes and developments over the past 125 years.
In which Hasted performed, a part of the breast and the chest wall were completely removed along with the armpit lymph nodes. “radical mastectomy” surgery has maintained its place as the gold standard in breast surgery for many years. However, scientific studies and research carried out while applying treatment methods showed that after a while there was no need to perform such an extensive surgery and that it did not provide additional benefit to the patient, and as a result, the surgery took the form of "modified radical mastectomy". This method, which was used as the only option until recently, is still preferred in some cases today.
The fastest development in the 125-year history of breast surgery occurred in the last quarter. The increase in radiotherapy (radiation therapy) options, the modernization of radiotherapy devices and their widespread use have contributed to reducing the size of the surgery to be performed. It has been revealed that in very advanced cases, there is no difference between removing the entire breast, removing only the tumor, and then giving radiation to the remaining breast. Thus, the concept of "breast-conserving surgery" has become established and surgeons have begun not to remove the entire breast unless they have to.
More recently, It has been determined that sentinel node application is sufficient instead of axillary dissection (removal of armpit lymph nodes), which is one of the reasons for complaints such as arm swelling and numbness experienced by some breast surgery patients. Thanks to this method, it is revealed whether axillary dissection is necessary for the patient, and if not, dissection is not performed and the patient is protected from the discomfort of this procedure. With the spread of the necessary equipment and experience among the surgeons involved in the application of this technique, patients are now free from the problems they experience with their armpits and arms.
Oncoplastic Surgery
Last In the years, "Oncope" in breast surgery The concept of “rubber surgery” emerged. The definition of oncoplastic breast surgery means planning a surgical intervention due to breast cancer together with a cosmetic intervention that will create a better aesthetic result in the breast. These methods, which were implemented by combining the principles of oncological surgery and plastic surgery, enabled women who had previously lost their breasts due to breast cancer to have a new breast.
More recently, in breast cancer surgeries, in cases where the entire breast must be removed, in the same surgery. The breast is removed and a new breast is created in its place, so that the patient who is put to sleep for breast surgery can see her breast in its place when she wakes up. Thus, one of the most important problems of breast cancer, the deterioration of body integrity and the damage to the self-perception, was eliminated before it even emerged. If the procedures to be performed in the postoperative period will prevent simultaneous reconstruction, the reconstruction of the breast can be postponed to a later session.
Thanks to these applications, when a breast is operated on due to cancer, the opposite breast, which is too large and causes discomfort to the patient, can also be reduced. Thus, the patient who undergoes surgery due to breast cancer gets a boost of morale by leaving the surgery with two healthy and good-looking breasts instead of losing one breast.
Methods applied in oncoplastic breast surgery:
The failures of reconstruction procedures performed only with prosthesis and the fear of silicone have made breast reconstruction with the patient's own tissues more popular in recent years. However, it should be emphasized that the ready-made prostheses used in recent years have changed a lot and eliminated old concerns.
If it is desired to use the patient's own tissues to create the new breast, latissimus dorsi muscle-skin flap (LD flap - back muscle) and transversus rectus. abdominis flap (TRAM flap – anterior abdominal wall muscle and fat tissue) is used.
Latissimus dorsi muscle-skin flap
This method, which was first used in the 19th century, started to be used for breast reconstruction in 1976. . Latissimus dorsi muscle-skin flap in patients with medium-sized breasts It is a suitable choice for construction. When necessary, appropriate symmetry and appearance can be achieved by placing a prosthesis under the flap.
Transversus rectus abdominis flap
It is preferred in patients who need more tissue to achieve appropriate symmetry with the opposite breast. There are two types, either by preserving the veins or by re-bringing the veins. It is not a suitable choice for patients who have previously undergone abdominal surgery.
Reconstruction with synthetic prostheses
Two types of prostheses are used: tissue expanders placed temporarily and permanent fixed volume breast implants.
Tissue expanders are used to provide flexibility to the breast skin before the placement of the permanent prosthesis. They are inflated by injecting increasing amounts of salt water into the chamber inside. When the time comes, it is removed and a permanent implant is placed in the resulting space. It is possible to leave some special types of tissue expanders in place as permanent implants.
Fixed volume permanent implants are generally silicone-based products. Studies conducted in recent years have shown that the use of silicone for this purpose is safe.
Implants are mostly used in aesthetic breast surgery (such as breast enlargement). The use of only synthetic implants for reconstruction purposes is preferred by patients who cannot use the patient's own tissues, who need to complete the operation in a short time, and who do not want surgery on their back or abdomen.
Synthetic implants are preferred in those who have received radiotherapy to the chest wall or who are likely to receive post-operative radiotherapy. Reconstruction with implants is not a good option. It provides a better cosmetic result in women with small and medium-sized other breasts.
In reconstruction procedures performed with either tissue expanders or permanent implants, the prosthesis is usually placed under the muscles of the anterior chest wall.
Oncoplastic surgery. Nowadays, it is also used in high-risk patients to remove breast tissue before cancer occurs and to create a prosthesis or a breast from the patient's own tissues. By removing both breasts in this way, the risk of cancer is completely eliminated. It does not increase from , but it decreases by 90%. However, in order to prevent this practice from being abused by patients and surgeons, the indication (necessity) must be determined very accurately. Because every surgery, whether small or large, carries a risk. In addition, while there is no need to remove even the cancerous breast thanks to today's modern methods and diagnostic tools, there must be very reasonable and scientific justifications for removing both breasts due to the current risk.
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