Mastology deals with all breast diseases, whether benign or malignant, in women and men.
In adult women, it deals with the tumor pathology that accounts for the highest number of deaths, especially in more developed countries: BREAST CANCER.
Although the ratio “number of new cases/number of deaths” is changing in favor of survival of patients affected by this pathology, especially due to earlier diagnosis and discovery of new drugs, many patients have delayed diagnosis and miss the best opportunity to be healed from this disease.
Nowadays surgery is still the most important treatment to fight breast cancer, therefore it deserves extreme care in its planning. Choice of procedures to optimize and enjoy all the advances that science has achieved and to provide the patient with conditions to resume their daily activities with as few sequelae as possible should be performed by a multidisciplinary team whenever possible.
Advances in science over the past years have shown that breast cancer is not a single disease, but a distinct group of tumors with different behaviors and treatment responses. That is why it is extremely important to know the type of tumor the patient is facing, so that it can be more precisely attacked.
The main weapon to beat breast cancer is still early diagnosis, which makes annual mammography indispensable after 40 years of age. It has the power of detecting very small tumors and increases the chances of cure.
A breast tumor can be detected in its early stage through a mammography by presence of subtle clustered microcalcifications (calcium deposits caused by presence of tumor) or a large nodule that is already in an advanced clinical stage. However, the tumor clinically found in an advanced stage is not always more dangerous than that identified in an early stage. This is because today it is known that some biological characteristics of cells comprising these tumors are responsible for determining their behavior and treatment response.
Initial treatment can determine disease course. For that reason, there is the need of studying each case from diagnosis to choosing the most suitable treatment, ensuring higher chances of cure or disease control for the patient.
Despite the great effort by the medical community in following the advances of medicine, our country is still affected by restrictions of access by the population to these resources in due time, including for clarifications and diagnoses. On the other hand, as in developed countries, there are centers in Brazil prepared to identify and treat patients with breast cancer, providing the most advanced resources in individual therapy for breast cancer.
It is extremely important to have infrastructure for a fast and accurate diagnosis of breast changes, such as nodules, nipple discharge, asymmetries or pain; in the case of diagnosing a malignant tumor, thorough individual oncological treatment should be offered from diagnosis, as well as surgical planning of tumor excision and breast reconstruction until the patient resumes her social activities after the treatment.
Two patients with apparently equal history of breast cancer (that is, tumors of same size, similar breasts and same age) can be given completely different treatments. This is so because when the tumor is biopsied some biological characteristics of such tumor that determine its behavior and treatment response can already be studied. After this information is obtained, even surgical management can be different. One patient may be recommended to remove only the region where the tumor is located with some healthy tissue involving the lesion, and for another patient it may be favorable to prophylactically remove both breasts and undergo a simultaneous breast reconstruction.
This work requires major interaction between everyone involved in the task and takes much time from the team, analyzing and discussing each item. This can be more favorable to each patient at the diagnosis and in each stage of reevaluation of disease course and response to proposed treatments.
Breast tumors have three basic presentations identified through the expression of specific proteins:
Approximately 60% of cases are sensitive to hormonal manipulation and have positive expression of estrogen and progesterone hormone receptors. Some of these patients, especially after menopause, are more benefited from using new generation hormonal blockers than from using chemotherapy. Knowing this characteristic can release many patients from chemotherapy and maintain their quality of life.
About 20% of breast tumors express the HER-2 protein. Specific medication associated with chemotherapy can reduce mortality rates in 50% in an early diagnosis disease.
When none of the proteins above are identified, one should rely only in the power of conventional chemotherapy.
Today information is available for the entire population on the Internet, but when a patient finds a nodule in her breast, due to her atavistic records, there is despair and insecurity and an urgent need to clarify the meaning of this finding. The patient’s affliction can lead to precipitation and adhesion to the first – and not always the most adequate – treatment proposal, including a negative commitment to the next therapeutic steps.
That is why it is important, in good times, to pay attention and identify professionals that actually study and are dedicated to the treatment of these cases, and that are accredited by national and international professional societies, and particularly by the local society.
Knowing where to safely find someone who has the answers we need at a time like this spares the patient and family from suffering and certainly shortens the path to total healing, which is the main desire of all: patients, physicians and society.
Breast cancer surgery
Planning of the treatment strategy for breast cancer.
Conservative breast surgery
Surgical procedure to remove the breast area affected by the tumor, which can be combined with a procedure for symmetrization of the contralateral breast.
Surgical procedure to remove the whole breast, which can be combined with simultaneous breast reconstruction.
Surgical treatment of the axilla
Surgical procedure, with imaging identification of the sentinel lymph node to remove only part of the main lymph node draining the axilla.
Surgical procedure to remove axillary lymph nodes.
Surgical procedure to treat tumors in both breasts for breast cancer prophylaxis.
Using abdominal tissue
surgical procedure using abdominal tissue for breast reconstruction. In some cases it is possible to reconstruct the breast while mastectomy is being performed.
Using back muscles
Surgical procedure using the latissimus dorsi muscle, skin and subcutaneous tissue for breast reconstruction. In some cases it is possible to reconstruct the breast while mastectomy is being performed.
Using an implant
Surgical procedure using silicon implant for breast reconstruction. In some cases it is possible to reconstruct the breast while mastectomy is being performed.
Using expander and implant
Surgical procedure using expander (silicon bag), placed under the pectoral muscle and expanded throughout a treatment that aims to obtain tissue (skin) for the new breast. A procedure to replace the expander for a silicon implant is performed after the expansion.
The omentum flap is removed by videolaparoscopy
Surgical procedure for breast symmetrization after treatment of breast cancer in only one breast.