Phone: 326 332 991
chirurgie - procedures and examinations
MUDr. Petr Podzimek
SURGERY: BREAST SURGERY
- Minimally invasive and sparing procedures
- Ultrasound and peroperative control
- Indicated sentinel node
Anatomy
The female and male breast is a paired organ located on the front of the chest, composed of the mammary gland and varying amounts of fat and connective tissue.
The mammary gland is made up of 15-20 individual glands, which give off their own ducts, the milk ducts, arising at the nipple.
Each of the glands consists of multiple lobules, resembling a grape cluster. The mammary gland is subject to hormonal changes related to the menstrual cycle, pregnancy and breastfeeding. It is influenced by the female sex hormones, estrogen and progesterone, oxytocin and prolactin.
Both the lobules and the ducts of the mammary gland, as well as the surrounding fatty tissue and connective tissue, the skin and the nipple and areola can be affected by the tumour.
Diseases of the mammary gland
- Inflammation - acute x chronic; purulent x non-purulent
- Non-malignant tumours - cysts, fibroadenomas, hormonal nodules, hyperplasia, fibrous-cystic mastopathy of the gland, mesenchymal tumours
- Malignant (malignant) tumors - of the mammary gland ductal and lobular carcinoma in situ, ductal and lobular carcinoma invasive carcinoma, other subtypes of carcinomas, sarcomas, lymphomas, male mammary carcinoma
Risk factors
- Heredity and the presence of mutated genes, called BRCA-1 and BRCA-2
- The influence of the hormone estrogen
- Women having their first menstrual period at a young age and having a later transition
- Women who had their first child at a later age or who have not been pregnant
- Long-term estrogen therapy after transition
- Increased alcohol consumption, smoking, being overweight and lack of exercise
Symptoms
Change in skin discolouration, nipple, areola and skin shape - injection, palpable lump in breast, breast secretions (mainly of a bloody colour), palpable lump in armpit.
Examination of the breast
- The basic principle is self-examination of the patient once a month, i.e. on the 14th day after menstruation.
- Specialist physical examination by a doctor - looking for lumps or nodules, breast secretions, breast biopsy, biochemical blood test for the presence of tumour markers
- Investigative methods - breast ultrasound and mammography, breast MRI, scintigraphic examination
Pre-operative preparation
Pre-operative examination and anaesthetic examination are essential. For malignant tumours, the day before admission, the sentinel node is marked with the Tc99m radiocolloid.
The client arrives on the morning of surgery fasting with a preoperative examination. Older patients with comorbidities are admitted for preparation the day before surgery.
Surgery
For small benign tumors, repeat follow-up in the mammology outpatient clinic. For large benign and or any size malignant (malignant) tumors, surgery is required.
Surgical treatment - removal of the node, partial removal of the breast or removal of the whole breast. Removal of the so-called Sentinel (sentinel) node or removal of nodes from the axillary fossa. If the tumour is malignant (malignant) then radiation or chemotherapy or hormone treatment is needed.
Postoperative follow-up
- Care of the surgical wound, prevention of pain - sutures are removed 10-14 days after surgery
- Prevention and treatment of lymphedema (swelling of the arm)
- Work disability - the length varies individually, depending on the nature of the operation, the cancer, age, general condition, original employment and many other factors.
- Breast epithetics (external breast substitutes)
- Breast reconstructive surgery - see plastic surgery
- Adherence to good lifestyle: proper nutrition, no smoking, alcohol restriction, work environment risks, breast self-examination.
Rehabilitation
- Psychological rehabilitation - starts immediately after diagnosis
- Physical rehabilitation - must be started as soon as possible after surgery
- Social rehabilitation - means reintegrating the patient into society
- Spa care
Breast surgery. Minimally invasive and sparing procedures.
Breast examination. The basis is a self-examination of the patient 1 x per month.
Operations. Surgery is necessary for large benign or malignant tumours of any size.