What Does Breast Surgery Mean?
The branch of surgery aiming at correction of breasts with scalpels and incisions is known as breast surgery. A variety of reasons may be attributed for surgically managing the breasts. As for example, a metastatic cancer can only be corrected by removal of the affected breast, a term called mastectomy. Breast can also be operated for the correction of sagging, enhancement of small sized breasts, upliftment or reduce the extra baggage of fats in the breast region. A thorough clinical examination is mandatory before opting for any of the surgical procedures with proper content of the female patient taking into consideration the expectations and apprehensions.
Causes of Breast Diseases:
- Infection of the ducts, glandular tissues by mode of bacteria, fungus or virus may cause swelling, tenderness along with mild to high grade fever and varying degrees of discomfort. Infections often lead to development of abscess and cysts of variable sizes and numbers.
- Injury to the breast or chest region during stabbing or road traffic accidents may lead to intense pain, hematoma and alteration in the size.
- Medications such as oral contraceptives, steroids, hormonal therapies may cause swelling in the breasts.
- During or around menstrual cycle, breasts may feel tender and heavy which many a times maybe a normal finding unless a nodule or lump is felt.
- Benign tumors often are detected by a hard or soft tissue mass called lump or nodule felt in the breast region with varying levels of pain, if present. The mass maybe composed of epithelial cells of the breast, milking glands, atypical cells, collagen fibers, red blood cells or pus cells.
- Metastatic tumors tend to involve the entire glandular tissues with the ductal system as well mammary tissues.
Signs & Symptoms of Breast Diseases:
- A lump like feeling in and around one or both the breasts
- Hardened mass/nodule like feeling in the breasts
- Pain in the axillary or breast region
- Soreness, redness around the nipple
- Dimpling of the skin of the breast
- Pus or blood discharge from the nipple
- Heaviness in breast region
- Visibility of engorged blood vessels giving the breast a cyanotic (blue) appearance
- Scanty to dense hair growth over and around nipple/skin over breast areas as a secondary symptom to polycystic ovarian disease PCOD.
- At times, referred pain in the neck, back and arms
Diagnostic Tests for Breast Diseases:
- Self examination: Often an anomaly in the breast region is first detected by the female herself and later on consulted with a physician. Once a lump or nodule is detected, females are also trained for assessing them in terms of their position, size and palpations at timely intervals.
- Physical/clinical examination by surgeon/gynecologist: A proper diagnosis is done by means of observation and palpation, often done by a surgeon.
- Observation: The surgeon stands in front of the patient who is sitting with arms relaxed and uncovered breasts. The shape, size, symmetry and contours of the breasts are observed. The skin is observed for any redness, swelling, breaches and ulcerations. The size and contours of the nipples are also observed.
- Palpation: With the patient’s arms stretched at 90 degrees to the plane of the body, the surgeon carefully palpates the breast, one at a time, to confirm the findings of the observation. Breasts are squeezed at particular areas for detection of any lump, hard and soft masses and nodules. The nipple is checked for tenderness, pus or blood discharge. Axillary nodes in the arm pits are palpated for any tenderness or swelling.
- Ultrasound/ultrasound scanning/sonography/USG: It is an imaging technique either used as a diagnostic method or as a screening alternative. It is a non invasive procedure making use of sound waves to depict the internal structure of breasts, radiation is not used at all. The procedure of USG may be done alone or as an adjunct to mammogram depending upon the severity of the condition. It helps in the detection of abnormalities whether they are fluid filled as in cases of breast cysts and abscess or hard like in cases of tumor masses.
- Doppler ultrasound: It is a special technique of USG which helps to study the pathways and curvatures of the arteries and veins in the breast region. Thus the lesions occurring as a result of arterial blockages and venous engorgement can be assessed with the help of this method.
- Mammography: It is a routinely followed screening examination for the detection of breast cancer. The report which comes in the form an x-ray is called as a mammogram. This procedure no doubt gives a full image of the breasts, having a full scope for the evaluation of the breast region. However, certain types of cancer masses may be missed in a mammogram. Also something which is not a tumor mass may be portrayed as cancer and require further investigations for its confirmation.
- Biopsy: It is a procedure which finds its involvement in both the diagnosis and treatment of breast lesions. When used for the purpose of diagnosis, it can be assisted with sonography and/or mammography. When used for treatment, a surgical approach is always used. Biopsy is the procedure of removing a portion of the lesion such as a lump or a nodule in order to examine it histopathologically in the labs to confirm its nature. In core needle biopsy, a needle is inserted in the suspected lesion with the help of an ultrasound and the contents are aspirated. In stereotactic biopsy, a mammogram is used to detect the location of the lesion and then a needle is inserted for the extraction of its mass or contents. In fine needle aspiration cytology FNAC, the lesion is palpated manually, held in place and then a long, hollow needle is inserted into it for aspiration. If the lesion happens to be a cyst or an abscess, a USG or a mammogram maybe required for the detection of its location prior to the insertion of the needle. In incision type of surgical biopsy, a small portion of the breast mass is removed for examination. Contrary to it, the excision biopsy removes the breast lesion for confirmation of the type of disease.
- Magnetic resonance imagining MRI: It is a non ionizing radiation technique which makes use of strong magnetic fields to help in the detection of breast lesions. It is the best and the finest methods to locate and give the number of lesions present, determine the consistency of the lesion along with giving every detail of the glandular tissues, blood vessels, duct system, pectoralis muscles and bone in and around the breasts.
Types of Breast Diseases:
- Infections and inflammations: Bacterial or viral mastitis i.e inflammation of the breast occurs commonly due to bacterial and viral infections respectively. Tuberculosis and syphilis of breast also is a condition manifesting due to micro-organisms in the glandular tissues of breast. A condition called engorgement of milk in the ducts during lactation period causes secretory stasis. Imbalanced hormonal levels also add to breast enlargement. Engorgement of blood capillaries also may occur in the breast giving it a cyanotic blue appearance. Infections most commonly progress to abscess and cysts of variable size and number in the retro mammary and sub mammary areas.
- Fibrocystic changes: These are named by quite a few terminologies with the same signs and symptoms. These include fibrocystic breast disease, chronic cystic mastitis, mammary dysplasia or diffuse cystic mastopathy. These are age related, pregnancy and lactation related changes seen in the breasts. The glandular tissue may become dense in terms of epithelia and collagen fibres leading to an overall hard texture and consistency of the mammary tissues. The fibrocystic changes may or may not lead to a tumor.
- Tumors: Masses of cancer in the breast can be either benign or malignant both as can be in any other part of the body. The commonest form of a benign tumor is a fibroadenoma which is a lump like feeling in the breast. It is restricted in the breast region and may or may not cause pain. Discomfort and uneasiness are however major symptoms. A malignancy involving all the breast tissues is termed as cancer.
Treatment Of Breast Diseases:
- Surgical approach/ breast surgery: A variety of surgical approaches are available for the cosmetic and pathological correction of breasts. These are as follows:
- Breast augmentation: It is purely a cosmetic approach intended at increasing the size of the breasts. Most commonly used techniques are the surgical placements of silicone implants and fat grafts. Women who wish to enhance the size and contour usually opt for this treatment approach. The implants and fat grafts are placed below the pectoralis major muscle giving it a contour. The size of the implants is predetermined by the female. A small sac is attached to the implant which is filled with water and saline. In certain cases, implants may rupture or disrupt due to prolonged use.
- Breast reduction: Yet again a cosmetic procedure, large busty females tend to go for this approach. The extra fat and adipose tissues which add bulk to the breasts are removed keeping the other vital structures intact.
- Breast reconstruction: It is one of the methods to correct asymmetry of both the breasts, skin texture over breasts or correction of sagging. Breasts which have been removed as a part of treatment for cancer are also reconstructed and artificial reservoirs can be placed to enhance the overall appearance of the female thereby boosting the confidence.
- Mastectomy: It is the procedure of complete removal of one or both the breasts in cases of malignancy of the mammary tissues. This can be followed by a reconstruction approach to restore the healthy tissues and give a proper contour to the remaining structure.
- Lumpectomy: It is the removal of the lump or lumps present in the glandular tissues. In the same procedure, aspiration of cysts, abscess and resection of nodules is also done. Care is taken to remove only the infected part along with a small margin of healthy tissues in order to avoid recurrence.
- Mastopexy: It is the surgical approach for the upliftment of breasts. Many a times the loose areola and skin over the breasts fail to give a proper shape to the breasts giving them a saggy appearance. The skin therefore is tightened and the muscles tucked hard in order to be able to manage the weight of the breasts.
- Microdochectomy: A simple incision in the mammary tissues is called as microdochectomy. It is the process of removal of a lactiferous duct which has been infected. It is one of the primary approaches since the removal of the duct will prevent the spread and progress of the infection.
Complications & Risk Factors Associated With Breast Surgery:
- Hematoma generally occurs at the site of infection due to a blot clot that fails to resolve.
- Tenderness and pain may persist for a longer duration of time.
- Scarring of the skin may occur around the sutures.
- Wound infection and bleeding may occur if proper care is not taken.
Success Rate in India:
Breast augmentation procedures involving use of silicone implants and fat grafts have the highest success rates with only 2.8 percent failures due to implant rupturing. Removal of cysts, lumps and nodules have a 45.90 percent chance of recurring. Mastectomy shows an overall success rate of 98 percent.
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