BREAST SURGERY

Breast surgery (or mastectomy) is the surgical treatment of diseases that affect the breast area. Its main fields of interest concern breast cancer therapy and breast reconstruction. In general, surgical oncology is one of the pillars of breast cancer treatment.
The history in breast intervention is marked by various stages following the evolution of medical knowledge and some important discoveries in this field. These interventions offer women a real possibility of healing which fully respects their physical integrity.

Today we have established the concept of pre-clinical diagnosis, meaning the ability to detect the tumour before it becomes visible. Pre-clinical diagnosis allows avoiding unnecessary destructive surgery while significantly increasing the survival and healing rates. It is not surprising that in surgical oncology and especially in breast surgical oncology, the choice of intervention depends upon the disease stage at the time of diagnosis.

Awareness is being raised thanks to several elements:

• Information and screening campaigns that have helped raise awareness among women towards prevention;
• Advances in instrumental diagnostics: mammography studies have been helpfully supported by ultrasound diagnostics and the arrival of increasingly sophisticated equipment that allow the detection of early-stage cancer about the size of a few millimeters;
• Diagnostic Protocols: fundamental in the development of the best practices, including treatments.
Surgical and medical therapy
Current views on breast cancer surgery generally foresee that the tumors revealed at an early stage which are thus small in size, can be treated with breast-conserving surgery whilst mastectomy should be chosen for bigger tumors.
The guidelines on surgical treatment breast cancer involve a series of procedures that are protocol-based:
• Breast biopsy and lumpectomy: a breast biopsy involves the removal of tissue fragments. This may be incisional to allow the removal of a small part of a bigger tumor or excisional where the entire neoplasm is removed. Lumpectomy is the removal of the breast tissue and some surrounding tissue affected by the tumor.
• Quadrantectomy: is a partial mastectomy involving the partial removal of the mammary gland with the overlying skin and the underlying pectoralis major muscle fascia.
• Mastectomy: there are various types of mastectomy. Radical mastectomy means the complete removal of the breast, large and small pectoral muscles and axillary lymph nodes.
Surgical therapy represents the main but not the only treatment in the therapeutic process. Based on this and a series of further evaluations, other therapies may be used also known as adjuvant therapies that help the body fight any micro-metastases that mat be present during surgery.
The need and the type of adjuvant therapy are evaluated based on the status of lymph node involvement, hormonal receptors status, woman’s age and menopausal status. An exception is when there is a tumor in a particularly advanced stage corresponding to stage IV. In this case, it is necessary to put the patient on chemotherapy or radiation therapy aimed at reducing the tumor mass. Only then and if necessary should the patient proceed to radical mastectomy. The therapy preceding the intervention is called neoadjuvant therapy.
It is worth emphasizing the importance of a correct approach from an ethical and psychological point of view to cancer patients. The specialist in charge of the treatment, should it be a mastectomy, needs to thoroughly explain and guide the patient through it, indicating that a breast reconstructive option would be the natural conclusion to the surgery. In this way, the patient will have an informed consent but most importantly it will help her overcome the psychological trauma besides the physical one.