Prevention
Modern medicine is increasingly transitioning towards preventive care. This shift towards prevention has also been observed in breast cancer care in recent years, particularly with the discovery of the BRCA gene. Subsequently, multiple genes and risk factors have been identified. Depending on these factors, a personalized screening strategy can be chosen. Therefore, it is crucial to understand these genetic and risk factors.
Diagnosis
I was diagnosed with cancer ... This website serves as a portal designed to assist you and your loved ones in accessing personal information and finding solutions to your concerns.
The primary goal of this website is to offer guidance and support to patients as they navigate their journey toward recovery and improved quality of life. The "Diagnosis" section of our website is divided into two main categories. Firstly, under "Anatomy and Physiology," we provide fundamental knowledge about the breast. Secondly, in the "Tumors and Disorders" section, we delve deeper into various breast-related conditions.
Moreover, we aim to provide information to women who may be concerned about potential breast issues but are hesitant to seek immediate medical advice. Knowledge and information can often offer immediate reassurance if a woman is able to identify the issue herself and determine that no specific treatment is necessary. Conversely, we also strive to educate women who have received a diagnosis of a serious breast condition, such as breast cancer, and wish to approach their doctor well-informed and prepared.
Treatment
The treatment for breast cancer should immediately include a discussion about reconstruction. Our foundation has no greater goal than to raise awareness of this among patients and oncological surgeons. By making an informed decision beforehand, we avoid closing off options for later reconstruction while still considering the oncological aspect. Of course, survival is paramount, and the decision of the oncologic surgeon will always take precedence.
The "Reconstruction or not?" page contains all the information you can expect during an initial consultation before undergoing tumor removal. This page is comprehensive, and your plastic surgeon will only provide information relevant to your situation.
"Removing the tumor" details the surgical procedure itself. This is the most crucial operation because effective tumor removal remains paramount. We guide you through the various methods of removal, a decision often made by a multidisciplinary team comprising oncologists, radiologists, pathologists, radiotherapists, breast nurses, gynecologists, oncological surgeons, and plastic surgeons.
The "Breast Reconstruction" section includes information and illustrations of the different reconstruction options along with corresponding steps.
Revalidation
Those treated for cancer often need a long period to recover.
Cancer is a radical illness with a heavy treatment. Often, people have to deal with psychosocial and/or physical problems afterwards, such as stress, anxiety, extreme fatigue, painful joints, reduced fitness, lymphedema... This can have a major impact on general well-being.
There are rehabilitation programmes offered by most hospitals. We cover some of the major topics here.
Quality of life
Quality of life is a key factor in coping with breast cancer. Therefore, it is important to find coping mechanisms that work, which will be different from patient to patient. For some, it may be finding enjoyment in activities they engaged in prior to diagnosis, taking time for appreciating life and expressing gratitude, volunteering, physical exercise... Of prime importance, studies have shown that accepting the disease as a part of one’s life is a key to effective coping, as well as focusing on mental strength to allow the patient to move on with life. In this section we are addressing some topics that patients experience during and after treatment and we are providing information to address them.
Segmentectomy and quadrantectomy as part of breast conserving
Removing larger malignant tumors can be performed in different ways; either the breast is removed completely (mastectomy) or only the affected part is widely excised (breast-conserving surgery).
Whether or not breast-conserving surgery is possible depends on several factors. Recent studies demonstrate however that even with a sufficient tumor-free margin, breast-conserving surgery combined with radiotherapy, may result in a slight increased risk for local recurrence compared to a mastectomy. Long-term survival was similar in both groups.
The skin incision is performed over the tumor and the tumor is removed with a cuff of surrounding healthy breast tissue. Certainly with larger tumors, there is always a small chance that the tumor has not been completely removed. The excised part is therefore analyzed by a histopathologist. This doctor fixes the tissue, cuts it into thin slices, stains it and studies the specimens under a microscope to check if the tissue edges are tumor free. This process usually takes at least one week.
A second procedure may be needed if the tumor is not completely removed. Once the tumor has been completely excised, the remaining breast needs to be irradiated. This is done to eradicate any undiscoverable microscopic satellite lesions that could possibly be growing in the remaining breast gland tissue. The combination of surgery and radiotherapy can result into variable degrees of deformation of the remaining breast according to the sensitivity of each person to irradiation.
Figure 1: Breast conservative surgery: examples of breast deformation after segmentectomy and variable reactions to post-operative radiation therapy.
If the lesion is large or if the breast is small then the amount of tissue that needs to be removed may be relatively large in comparison to the volume of the breast. In this case we will use the terms segmentectomy (removing a segment of the breast, fig. 1) or quadrantectomy (removing one quarter of the breast, fig. 2) . In such instances, corrective surgery should be considered in a later phase as the defect can leave some important irregularities in the shape of the breast, specially when combined with radiotherapy (which almost always will be the case).
Figure 2: Breast conservative surgery: examples of breast deformation after quadrantectomy and variable reactions to post-operative radiation therapy.
Reconstructive options should be offered and discussed before performing ablative surgery, preferably with a plastic surgeon specialized in reconstructive breast surgery. The different methods of breast reconstruction are discussed in other areas of this website. Depending on the relative proportion of breast that has been removed, in general, different reconstructive options are proposed.
The table with the algorithm below summarizes the general approach of defects of the breast. Be aware that other or different decisions may be taken for every individual, depending on local tissue conditions. Options need to be discussed with your reconstructive surgeon.
Relative amount of breast gland removal | Reconstructive technique |
< 1/8 of the total breast volume | Re-arragnement of the remaining gland |
Lipofilling | |
> 1/8 and < 3/8 of the total breast volume | Loco-regional pedicled skin flaps |
Lipofilling | |
> 3/8 of the total breast volume | Removal of the remaining gland |
Full breast reconstruction with free flaps or implants |
References
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Trends in the surgical treatment of breast cancer.
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Modified Benelli approach for superior segmentectomy: a feasible oncoplastic approach.
Lanitis S, Hadjiminas DJ, Sgourakis G, Al Mufti R, Karaliotas C. Plast Reconstr Surg. 2010 Oct;126(4):195e-197e.
Quadrantectomy versus lumpectomy for small size breast cancer.
Veronesi U, Volterrani F, Luini A, Saccozzi R, Del Vecchio M, Zucali R et al. Eur J Cancer 2009; 26:671–673.
Oncoplastic approaches to partial mastectomy: an overview of volume-displacement techniques.
Anderson BO, Masetti R, Silverstein MJ. Lancet Oncol. 2005 Mar;6(3):145-57.
Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer.
Hughes KS, Schnaper LA, Berry D, Cirrincione C, McCormick B, Shank B et al. N Engl J Med 2004; 351:971–977.
Better cosmetic results and comparable quality of life after skin-sparing mastectomy and immediate autologous breast reconstruction compared to breast conservative treatment.
Cocquyt VF, Blondeel PN, Depypere HT, Van De Sijpe KA, Daems KK, Monstrey SJ, Van Belle SJ. Br J Plast Surg. 2003 Jul;56(5):462-70.
Breast tumor recurrence following lumpectomy with and without breast irradiation: an overview of recent NSABP findings.
Fisher B, Wickerham DL, Deutsch M, Anderson S, Redmond C, Fisher ER. Semin Surg Oncol. 1992 May-Jun;8(3):153-60.
Veronesi U, Salvadori B, Luini A, et al.
Conservative treatment of early breast cancer: Long-term results of 1232 cases treated with Quadrantectomy, Axillary dissection, and radiotherapy. Ann Surg. 1990;211:250-259.