Mastology is the science that deals with the Pathology and Surgery of the breast, that is, with the regular clinical examination of the breasts (palpation and imaging), with the evaluation of the symptoms presented by the breasts, with the interpretation of the diagnostic examinations, with the conservative or surgical treatment and with post-treatment monitoring and support of women.
Mastology (or Breast Surgery) is not an independent medical specialty.
It is a specialized training, which follows the basic training in a surgical specialty, usually Gynecology, General or Plastic Surgery.
Breast Surgery should be performed today only by specialized Breast Surgeons (Mastologists) because the breast is a whole science that is constantly evolving and requires standard treatment algorithms.
Dealing with breast cancer is a team effort that requires the harmonious cooperation of different specialties: radiologists, breast surgeons, pathologists, oncologists, radiotherapists, physiotherapists, geneticists and psychologists or psychiatrists.
Breast cancer surgery has been for many years a field of intense controversy and discussion but also important developments in the direction of smaller and more targeted surgery (minimal invasive surgery) with better aesthetic and functional results but without compromising oncological safety.
The treatment options today are :
- the surgery of benign breast diseases which in most cases is the removal of tumors. The principle of maintaining the aesthetics of the breast and the absence of deformity must be followed. Also, the surgical incisions should be such that no scars are left.
- concurrent oncoplasty with sentinel lymph node biopsy or complete axillary lymphadenectomy
- the different types of mastectomies with or without simultaneous plastic breast reconstruction
Each of these options has its indications and contraindications, which the breast surgeon must explain in detail to the patient (breast cancer very rarely affects men) before surgery.
Patients who decide to undergo conservative breast maintenance surgery should be informed that they will undergo local postoperative radiotherapy.
Indications for mastectomy - and avoidance of conservative surgery - are:
- the presence of two or more primary tumors in different quarters of the breast
- the bad aesthetic result due to the large size of a tumor in a relatively small breast
- suspected diffuse microcalcifications on a large part of the breast on mammography
- history of previous breast radiotherapy
Preservation of the breast in surgery is the most common treatment because the disease-free period and survival are almost the same in mastectomies and in tumor resections accompanied by radiotherapy.
In most breast centers, conservative treatment (breast preservation) represents the 75-85% of breast cancer surgeries.
One method that is constantly gaining ground is the mastectomy with preservation of the skin and the nipple (subcutaneous mastectomy, skin-nipple sparing mastectomy) with simultaneous plastic restoration.
Many breast surgeons advise their patients to prefer mastectomy with immediate breast reconstruction.
Breast reconstruction can be done in many ways, starting from the placement of silicone and mesh implants in one year or the placement of a tissue dilator and up to the use of flaps (back, abdomen).
Armpit surgery - Lymph node guard biopsy
Underarm sampling with the sentinel lymph node biopsy technique provides information on the condition of the axillary lymph nodes without complete removal of the axillary lymph nodes that can cause problems (lymphedema, pain, dyskinesia). The sentinel lymph node biopsy is performed in cases where there are no clinically suspected lymph nodes in the armpit.
During the operation, the sentinel lymph node is sent for immediate pathological examination (rapid biopsy).
If the lymph node is found to be positive, ie it shows metastases, the surgeon performs a complete axillary lymphadenectomy, ie removal of a sufficient number of lymph nodes in 2 or 3 levels depending on the burden of the disease. If the sentinel lymph node is negative, the surgeon leaves the armpit intact.
Survival outcomes are the same in patients with complete armpit lymphadenectomy and in patients who had a negative lymph node biopsy performed.
Complications of breast surgery
Breast surgeries carry the risk of complications, as all surgeries do.
Hematoma, fluid collection, inflammation, or in case of complete armpit lymphadenectomy may result a lymphedema later.
Aesthetic complications such as deformed or hypertrophic scars, breast deformity, size, symmetry, etc. may also occur.
Fortunately, major complications are rare. The smaller the operation and the manipulations, the rarer the complications are.