Breast cancer is the most frequent malignant pathology in women and the first cause of mortality in the female population worldwide. Fortunately, the prevention campaigns promoted by the different sanitary sectors, both private and public, allow an early diagnosis and therefore, a multidisciplinary management of the same with very large expectations of healing.
The therapeutic arsenal available is large, although mammography and ultrasound are the recommended initial studies, it will be magnetic nuclear resonance that provides the most precise and reliable information in cases where the suspicion of cancer is high. As is known, breast lesions are of two types; The palpables, those that the patient and the doctor are able to locate and whose puncture for biopsy is easy and the non -palpables, those that have an abnormal finding in the radiological exploration performed and that will require being biopsied by combined techniques such as vacuum (biopsy Vacuum assisted), the biopsy guided by magnetic resonance or the puncture led by conventional ultrasound.
Both in one case and another, the study will be completed with an axillary ultrasound to provide information on the appearance of regional lymph nodes that are the most frequent place of seat of metastases. In case of suspicious adenopathies, the same biopsy will be puncture since the treatment differs significantly in case of metastatic ganglionic involvement.
Once the diagnostic protocol is finished and the existence of breast cancer is confirmed, the case is submitted to the Tumor Committee, mandatory weekly meeting of oncologists, gynecologists, radiologists, pathologists and surgeons for global evaluation and decision making about which would be The ideal handling in each patient.
Thanks to scientific evolution, today we talk about breast cancer subtypes whose therapeutic treatment or plan varies substantially depending on the information provided by immunohistochimia in previous biopsy (hormonal receptors, proliferative activity, etc.); In fact, the sequence of radical surgery, chemotherapy, radiotherapy and hormone therapy is obsolete since in frequent cases, this order is invested or modified or simply any of the previous steps does not proceed to take them into consideration. Completed all the steps above, if surgery requires, the patient is referred to the breast pathology unit, which program the relevant surgical intervention. This procedure requires the detection of the axillary sentinel ganglion during the operation, whether it is conservative (tumorelectomy, quadrantctomy) and radical (mastectomy).
The information is intraoperatively remaining the patient in the operating room until the reception of it. In case of negativity, surgery is over and if it is positive (metastasis), axillary ganglional emptying (axillary lymphadenectomy) is continued, which will require the use of drainage in the postoperative period.The average hospitalization plant is 24 hours in conservative surgery and 48 to 72 hrs in the radical. Once the final biopsy is obtained, the patient is sent to the Medical Oncology Service to optimize her treatment.
What role does plastic and reconstructive surgery play?
Today a breast unit is not conceived without the active participation of the plastic surgeon.
Fundamentally in mastectomies, the reconstructive options are multiple and varied. If the mastectomy is due to a risk breast (those of difficult radiological clinical control or with premalignant lesions) or in patients carrying genetic mutations (BRCA 1 and 2) we practice immediate reconstruction, either through prostheses or using tissue of the own patient (autologous) composed of skin and partially muscle.
Mastectomized patients who have received postoperative cancer treatment are tributaries of the so -called deferred reconstruction, which is always done with the patient's own tissue (autologous) with microcirgery techniques (DIEP) and that moves a skin and muscle flap, ora Abdominal dorsal, for its implant instead of the amputated breast with spectacular results.
A third group of patients are those that have undergone a partial resection of their mammary gland with subsequent radiotherapy in the remaining breast, they may present a defect in the form of depression or hole in the removal area, for this reason an excellent option It is the fat transfer of the patient itself (abdomen, hips, etc.) to the problem area. It is called lipofilling.
As can be seen, the management of the patient with breast cancer is extraordinarily complex and requires experience, technical means and human material specifically trained for this purpose. The Breast Unit of the HLA Vistahermosa Hospital It has all the necessary means to respond to all the challenges that this pathology requires, being one of the reference centers in the Valencian Community in the overall management of breast cancer.
This makes us permanently updated scientificly and technically to be able to offer a solution to this frequent problem, making the sick woman feel, welcomed and protected by a multidisciplinary team of recognized prestige to help both her and her family In these hard moments.
Surgery unit of the Hlavistahermosa Hospital Alicante
Breast pathology area
Dr. José María Lloret Spirit
If you want to clarify doubts about this topic and/or expand information you can contact the unit through the Contact form Or if you prefer you can call the phone number directly.
