No woman in the modern world is immune from the development of a benign tumor of the breast. This problem is very common both in Ukraine and around the world. An important task of a specialist in this industry is the timely detection and treatment of such neoplasms in order to prevent complications, the most serious of which is malignancy of the breast tumor.
Estet-portal.com talked about the problem of diagnosing and treating such tumors with a participant of the Visiting professor Program II conference, held on September 2-3, 2016 under the auspices of the International Society of Aesthetic Plastic Surgeons (ISAPS) and the All-Ukrainian Association of Plastic, Reconstructive and Aesthetic Surgeons , oncologist, surgeon of the highest category, head of the surgical and surgical department of LISOD and the Center for Modern Mammology Andrey Valentinovich Zhigulin.
What benign diseases of the mammary glands are most common in your practice
Benign diseases of the mammary glands are quite common. According to various authors, these diseases account for 10-20% of breast diseases, which is detected during intravital biopsies. Since not all patients with benign breast tumors come to the doctor, the prevalence of these diseases is approximately 3 times higher.
The most common pathology among benign breast diseases is fibroadenoma. This disease is found in approximately 10% of women.
The peculiarity of such diseases lies in the fact that they require a balanced approach, which consists in the correct selection of the ratio between aggressive and expectant treatment tactics, since these are still benign formations that often need not be operated on, but limited to careful monitoring of them.
What is the indication for surgery to remove a benign neoplasm of the breast
There are several principles and algorithms for diagnosing, evaluating and managing patients with this disease. If we are dealing with a benign formation, i.e. if the patient came with some kind of complaint (for example, felt some compaction in the breast), she must undergo a full mammological examination, which includes at least ultrasound, for older patients – mammography, according to indications, an MRI can also be performed.
However, the most important examination that should be carried out is a histological examination – a biopsy of the breast, which allows you to determine the nature of the neoplasm, especially if it has a solid (nodular) character. If we are talking about cysts (also a fairly common pathology), which can cause discomfort in patients, which is associated with their size and signs of inflammation, then ultrasound and puncture with a cytological examination of the biopsy are performed again. A further decision is made depending on the result of the biopsy.
Tell us about the features of surgical intervention for fibroadenoma and about what you should be afraid of in the postoperative period
The question of fibroadenoma is quite interesting as it is a fairly common problem in many women. Unfortunately, many surgeons speculate on this and overestimate the indications for surgery. In fact, fibroadenoma belongs to the so-called non-proliferative formations and in the vast majority of cases does not pose a particular threat, especially when it comes to young women, in whom it occurs more often and often requires only observation.
Indications for removal of a fibroadenoma are height, large size (greater than 2.5 cm), and suspicious radiological features.
If, nevertheless, a decision is made to remove a fibroadenoma, then the key point in the tactics of the operation is to focus on the fact that this is a benign neoplasm, and surgery in this case should also be "benign", i.e. should not lead to deformation of the mammary gland, cause discomfort.
Therefore, the planning of surgical intervention is very important:
- correct access, which will not be noticeable later (an incision in the skin directly above a benign neoplasm should be avoided, which will later be visible for a lifetime; modern technologies make it possible to avoid this);
- adequate closure of access and application of all technically correct techniques that are used in breast surgery.
In the postoperative period, a number of complications should be feared. The most common complication is bleeding as fibroadenoma is more common in young women who have a very good blood supply to the breast tissue.
If the formation is properly isolated, the incision goes through the parenchyma, because of which the vessels passing there are injured. Therefore, technically correct execution of hemostasis is very important. Proper planning of the operation also makes it possible to avoid complications such as breast deformities.
What are the difficulties in diagnosing breast cysts
Cysts are, relatively speaking, simple and complex. Simple ones have one chamber, thin walls and do not cause any suspicion during the initial examination. They are conducted conservatively, they are observed, and in case of their large size they are punctured with the study of the contents that were removed during the puncture.
If the cysts are complex, i.e. have a thin wall, heterogeneous structure, jumpers, then these are already suspicious signs that require a more serious approach, i.e. one biopsy is not enough and a tissue biopsy should be performed – thick-needle or surgical, sometimes even. Sometimes it is even rational to excise this formation in order to exclude malignancy in one of the parts of this cyst.
What techniques do you use for breast reconstruction? Does the approach change depending on the disease?
Reconstructive breast surgery – this is a very interesting and big topic. The factors that influence the choice of reconstruction option are primarily
- Tumor-to-breast size ratio,
- distance from the edge of the tumor to important anatomical structures (skin, nipple-alveolar complex, chest wall),
- immediate condition of the skin,
- the size and characteristics of the gland (a gland of small size and spherical shape requires one approach, and a large gland with ptosis and involutive changes - a completely different one).
The stage of the disease is also important, as chemotherapy is sometimes required before surgery to reduce the size of the tumor. Be sure to take into account the need for radiation therapy, since radiation therapy significantly affects the level of complications, especially after reconstructive surgery.
Both in our country and all over the world there is a trend towards an increase in the number of reconstructions, which is quite logical, since the goal of treatment is not only to save lives, but also to maximize the struggle for the quality of life. Among all reconstructions, the leading place is occupied by implant reconstruction, since this is a technically simpler operation and has a lower cost. Of course, there are also reconstructions with own tissues, but this already requires more serious preparation.
Please share your impressions of today's event. What would you like to wish your colleagues?
I am very glad that I am here, because the conferences of Vasily Vasilyevich Khrapach – this is the ray of light that until recently was the only one in Ukraine where one could meet with colleagues in a normal European atmosphere, hear interesting reports, discuss at a professional level (problems of plastic and reconstructive surgery – ed.).
Now, of course, there is more choice, but, nevertheless, the conference of V.V. Hrapach – this is one of the key events in the life of plastic and reconstructive surgeons in Ukraine. It is always a great pleasure to meet interesting people, a rich program and a high level of presentations, so I miss them.
Tell me, please, what is your honest opinion about Estet-portal?
I want to say that such resources, in my opinion, are extremely important and play a huge role in terms of educating patients, conveying objective information, which is very important. We are in difficult living and economic conditions, and it is very important that the patient and the doctor interact for a common result.
To do this, the patient must be well informed and prepared, and be able to ask the right questions. Resources such as Estet-portal are the most effective method for solving this problem, so thank you.
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