Breast cancer - a relatively common type of cancer. In Israel, the disease is diagnosed in 4,000 women a year. Each treatment is assigned in accordance with the nature of her illness, it may include the step of, chemotherapy , radiation , hormonal therapy and targeted therapy .
Operations for breast cancer are divided into two categories. In some cases, removed only the affected area - performed lumpectomy , in others - the whole breast - mastectomy. In the past, mastectomy was the most common practice today, doctors are trying to, in extreme cases, to carry out an operation in Israel mastectomy . Currently, this radical intervention differs from running in the past - only removes herself breast and lymph nodes, muscle retained.
30 years ago, during an operation to mastectomy resected and the pectoralis major muscle, which resulted in the loss of armpit crease and made reconstruction very difficult, almost impossible, as required to restore muscle tissue and build it anew. This is one of the most important changes, although the operation is called radical. The fact that the muscles are not removed, allows plastic surgeons to successfully carry out the reconstruction. This combination of advanced technologies for the rehabilitation and changes in the nature of operations mastectomy in Israel, in most cases, makes it possible to reconstruct the breast. Sometimes it is carried out during the removal process, in some cases later.
Indications for mastectomy are:
- Non-invasive breast cancer .
- 1 and stage 2 breast cancer.
- Stage 3 topically - advanced cancer after chemotherapy .
- Inflammatory breast cancer after chemotherapy.
- Paget's disease.
- Multifocal tumor, where there is no option to remove only part of the breast.
- Elimination of the effects of certain autoimmune diseases such as scleroderma or systemic lupus erythematosus.
- disease risk reduction: it is about the patient - carriers of the gene for breast cancer or the presence of a particularly severe family history of the disease.
Surgical intervention may be unilateral or bilateral.
Types of operations mastectomy in Israel
- Modified radical mastectomy involves removal of the breast tissue and the overwhelming majority of the axillary lymph nodes. It is recommended for the majority of tumors, when the cancer has spread to lymph nodes.
- Simple mastectomy is surgery to remove all breast tissue without lymph node dissection. During the procedure can be performed sentinel node biopsy.
- Sparing mastectomy is surgery when the resected breast tissue, but the skin is preserved. So what can be immediately reconstructed.
- Subcutaneous Mastectomy - removes only the breast tissue is preserved skin, the nipple and areola. It may be performed sentinel node biopsy. After the operation is carried out immediately recovery procedure. Performed less often, a higher risk of relapse.
Prophylactic mastectomy in Israel
Breast cancer most often develops in women over 50 years. Is there a family history of the disease, it is recommended to begin testing at an earlier age - 40 years. It is necessary to know if there is any symptom, to the surveys should start even earlier - from 30-35 years. And even if the family history is positive, it is important to go through at least once diagnosis by a doctor in order to know what is a healthy state of the breast. After that, from time to time needed self-examination or examination by experts - mammography, ultrasound, in some cases - MRI.
There are two genes in which mutations were found leading to breast cancer: BRCA1 and BRCA2. For women with these genetic changes in the likelihood of developing cancer breast cancer in their lifetime up to 80%. Therefore, in their case, the survey differ from normal. Diagnostic tools here is the MRI, which takes place every 25 years.
With regard to operations in Israel mastectomy to reduce the risk of disease, there is no consensus, but this is a possibility, and a number of women decided to do it. About 20-30% of patients undergo prophylactic mastectomy. If during the same operation is planned reconstruction is carried out so-called "mastectomy with preservation of the skin", when left part of the skin, which becomes the future "envelope" for the implant. This makes it possible in some cases to implant it immediately, without inserting an expander, which would stretch the skin to the desired size.
If defeat glands confirmed by biopsy, their removal is carried out. In the case of healthy state operation is performed in so-called sentinel lymph nodes or signaling. In a chain of lymph glands characterized by the fact that the likelihood of developing metastases in them - the highest. They give an indication of the remaining lymph nodes. In other words, if the sentinel nodes are healthy, in the glands and there will be no malignant cells, respectively, will not be necessary to remove them. In the case of injury, swelling of the glands may be affected, so you have to remove a large amount of them.
An integrated approach or a multi-therapy
For each patient, passing mastectomy surgery in Israel, convened a consultation, involving oncologists, specialists in mammography and nuclear medicine, social workers, plastic surgeons, psychologist and surgeon.
It is important to remember that breast cancer is different from other tumors in several aspects. It is associated with 3 major fears for the patient. This fear of the consequences of the removal of the breast and procedures, fear of chemotherapy because of hair loss, fear of the cancer itself. Therefore, in such cases there is a support system. It involved a team of people who deal with breast cancer. This multidisciplinary therapy. It is proved that it gives better results - not only in psychological terms, but also in terms of survival.
The course of operations mastectomy in Israel
Before surgery discussed issues of medication, since some of them can contribute to thinning the blood -. Aspirin iboprofen, warfarin, etc. For 8-12 hours stops receiving fluids and food.
Stage before the operation requires a conversation with a plastic surgeon about the cuts. When it is known in advance, which is a tumor, and after plastic surgeons will mark the incision site, introduced blue substance to determine the location of the signal lymph node. Particles of this material behave as tumor cells and penetrate into the lymph node. During surgery lymph node becomes blue.
During the operation, mastectomy, surgeons use the so-called diathermy machine, which has two modes of operation: it makes it possible to cut and burn. And, in fact, all surgery is carried out with its help. Once these operations have been made by a scalpel, surgeons had to pick up and bind all the blood vessels, and today this is not necessary.
Virtually all of mastectomy is the separation of breast tissue on all sides by using the above-mentioned devices.
In the second stage the removal of axillary lymph nodes, the device is used - an indicator, resembling a Geiger counter. It brings to the axillary lymph nodes and check. If there has radioactive radiation, the instrument emits a buzz on its screen appear higher figures. That is, a substance previously entered, is concentrated in the prostate, and doctors know that there are affected lymph node. Fabrics of all the lymph nodes are sent for analysis - a frozen section biopsy, and if a negative result, the surgeon finishes. A team of plastic surgeons to begin breast reconstruction if it was planned.
Often during the operation it appears that the tumor is different from the previously compiled representations, despite the latest diagnostic imaging agent. Although mastectomy is planned as accurate as possible, sometimes it turns out that iron, which is considered to be healthy, really impressed, and it becomes necessary to remove some glands.
After completion of the surgery the doctor receives a confirmation that the entire tumor is resected.
After surgery, mastectomy: Risks and complications
Problems are rare. But among the possible complications, which warns the doctor may be:
- Infection in the postoperative wound.
- Swelling of the hands due to accumulation of fluid in the lymph nodes.
- mobility violation of the arm and shoulder.
- Numbness of the skin of the forearm.
- Postoperative pain, including phantom pain in a remote breasts.
Complications arise for several reasons, including:
- Poor nutrition.
- Recently carry-forward, the current chronic disease.
- The use of certain medications and dietary supplements.
sensory nerves can be damaged in case of removal of the lymph nodes, which is almost always the case. And women who have removed all lymph nodes in the future should take care of hand as one of the functions of the lymph nodes - protection from infections.
Recovery period and the prospects for further treatment
Unless the signal lymph node was removed, the recovery process is very fast. Usually, the patient is discharged the next day after a mastectomy operation . If performed breast reconstruction, hospitalization period depends on how the surgery went, there were there any problems. In the absence of complications in a few days is performed extract.
If resection of axillary lymph nodes is not carried out, there are no restrictions in terms of the mobility of the hand. It is generally recommended not to drive in the first ten days, as some movements can cause pain, but it is difficult to predict.
On the basis of the extracted tissue biopsy results will decide on further treatment - the need for the appointment of chemotherapy or hormone therapy alone. One of the tests performed is called "Mother-print." According to the patient's results are divided into two groups: those with a high risk of relapse and low. It can be used another diagnostic test "Onkotayp", which makes it possible to evaluate the potential benefit of chemotherapy for the patient.
The risk of recurrence after mastectomy surgery in Israel
The likelihood of additional surgery after the removal is relatively low. And this is connected can only be associated with the following fact: for example, there were three or four of the resected glands in them the results of tests was diagnosed with cancer, so it is decided to extract and others, to take samples. Today, it is increasingly rare, and usually no additional operations. After removal of the risk of recurrence is very low. We can not say that it is not, a return of the disease sometimes happens, if in some place left portion of the breast tissue, but, as a rule, given that part of the patients also receive radiation, the risk of local recurrence is very low.
Currently in Israeli hospitals most innovative component of treatment - individual selection of therapies for each patient, and combined them with drugs. It is important to remember that today it is possible to cure breast cancer in 80% of cases, much defines early diagnosis.