“Women who are aware of breast cancer and participate in early detection programs should be rewarded with appropriate and sensitive treatment, not penalized with harsh and often unacceptable treatments.”

Dr. Umberto Veronesi

(Former Italian Minister of Health, Onco-surgeon)

Dr. Umberto Veronesi, the former Italian Minister of Health, who is the author of many groundbreaking surgical techniques and approaches in breast cancer treatment such as preventive breast surgery and breast oncoplasty, is an important surgeon who has made medical authorities and health providers accept that “smart” women who continue their routine control programs with full seriousness and without interruption should be rewarded with treatments that they can leave the operating room with much more beautiful breasts, instead of being punished by removing their breasts completely when they get breast cancer.

There have been promising developments in recent years for patients who have breast cancer or who have lost or are at risk of losing their breasts due to cancer. Breast reconstruction is possible for patients in both conditions.

The main goal of modern breast surgery is to treat breast cancer without causing breast loss.

Breast Conserving Surgeries

• Classic Breast Protector
• Macromastide and Breast Reduction

Oncoplastic breast surgery means planning an aesthetic intervention that will create a better cosmetic result in the breast together with a surgical intervention to be performed for breast cancer. The method is applied by combining the principles of oncologic surgery and plastic surgery. Thus, breast reconstruction surgery can be planned at the same time for women who will undergo surgery for breast cancer, and women who have previously lost their breasts due to cancer can regain a breast.

The patient’s oncologic and cosmetic needs should be taken into account when discussing the treatment plan with the patient. A balanced decision should be reached by taking into account the patient’s age, medical and psychosocial status, and the woman’s wishes and expectations.

Patients with breast cancer die not because of cancer recurrence in the breast but because of systemic recurrence, i.e. metastasis. In this case, instead of removing the entire breast, it is preferred to remove the tumor tissue with breast conserving surgery in appropriate cases.

This surgical method includes removal of the tumor and some surrounding intact breast tissue (wide local excision, lumpectomy, quadrantectomy) and sampling of the axillary lymph nodes related to the breast.

It is a frequently preferred option in the treatment of early breast cancer. It allows preservation of a large part of the breast and a good cosmetic result.

Radiotherapy (irradiation) of the remaining breast tissue must be performed as part of this treatment.

Cases where breast conserving surgery is not applicable:

• Patients with tumors in more than one focus in the same breast, (Multicentric tumor)
• Patients in whom the tumor is too large or the tumor/breast size ratio is not appropriate,
• Previous radiotherapy to the same body part,
• Women with connective tissue disease (because radiotherapy cannot be performed),
• Early pregnancy (because radiotherapy cannot be performed),
• Those who cannot undergo radiotherapy at the appropriate time for any reason

There is no difference in the patient’s life expectancy between breast-conserving treatment and complete removal of the breast. The advantage of breast-conserving treatment over mastectomy is the better cosmetic and psychological outcome.

If the tumor recurs in a breast that has undergone preventive treatment, the recommended treatment is mastectomy, the removal of the entire breast. Local recurrence of the tumor does not have a negative impact on survival.

Classical Breast Conserving Surgery

Early diagnosis methods, the level of awareness about breast cancer in women, learning and using breast self-examination techniques allow the disease to be caught in the early stages and breast-conserving surgery to be applied.

As a result of advances in radiotherapy and chemotherapy, large surgeries (mastectomy) have been replaced by surgeries to preserve more breast skin (breast skin sparing) and breast tissue (breast sparing).

In addition, in the approach to cancer treatment, physicians are now focusing on methods that aim not only to control cancer, but also to protect and improve the patient’s quality of life.

As in the surgical treatment of all cancers, the main goal in breast cancer is to remove the tumorous tissue and save the patient’s life. Unlike cancers of other organs, the distress of breast cancer patients is not just the problems caused by the cancer diagnosis.

Surgical removal of the breast (mastectomy) can cause severe psychological effects in many women. After breast loss, women often experience a range of psychosocial problems, including depression and other affective disorders, loss of sexual desire, impaired body image, fear of losing their femininity, worries about recurrence of the disease, difficulty in finding appropriate clothing, and difficulties with external breast prostheses in the form of bras.

Suddenly realizing that the breaking point of life is so close, coping with multifaceted problems and trying to “make life worth living” often makes women more emotional and more vulnerable. Voicing the problem and seeking solutions is made almost impossible by husbands who do not consider the psychology of their wives, the environment that perceives a woman’s desire for breasts as an aesthetic problem, and society where the breast is seen as a sexual taboo.

The suggestion of psychiatric support that would enable women to discover what and how they want, to get to know themselves and to perceive the environment in a healthier way is often pushed back by both relatives and the patient herself.

Women who know, anticipate or hear about these problems may bargain with their physicians to avoid losing their breasts.

If the patient and the tumor are suitable, the recommended type of surgery against breast loss is the removal of cancerous tissue while preserving part of the breast (breast conserving surgery).

In this case, if the tumor is proportionally large compared to the breast, breast conserving surgery may not give the cosmetically desired result. Another issue that should not be forgotten is the necessity of radiation after breast conserving surgery. Therefore, in appropriate patients, subcutaneous or skin-sparing mastectomy (removal of the entire breast leaving the skin intact) should be recommended.

Tumor Removal by Macromastia and Breast Reduction

In breast cancers that develop in women with large breasts, it is possible to remove both breast cancers at the same time and reduce both breasts to the ideal size and take the patient out of the operating room happy.

With this method, patients undergo cancer surgery and get rid of the problems they experience due to large breasts (breast pain, back pain, shoulder pain, limitation of movement, rashes under the breast that do not go away, risk of spinal curvature, etc.).

Until recently, Giant Breast Disease (Macromastia) was an issue that was addressed from an aesthetic point of view. However, the development of breast surgery has revealed that the giant breast is not only an aesthetic problem, but also a functional disease. We now know that the functional problems caused by giant breasts lead to organic and physical problems in the process, and that there is a direct correlation between breast volume and breast cancer.

In breast outpatient clinics, complaints of giant breast disease should be well evaluated, cases should be taken seriously, and referral to physical therapy and neurology clinics or endless analgesics should not be expected to benefit because the underlying problem is not solved.

Risk Reduction Surgery (Prophylactic-Protective Mastectomy and Reconstruction)

Today, the development of genetic diagnostic methods, the complete understanding of the familial transmission of breast cancer, and the discovery of genetic chromosome disorders that cause breast cancer allow us to calculate the probability of breast cancer in patients.

Women with a high familial risk and genetic burden can look for ways to get rid of breast cancer before they get breast cancer.

Prophylactic (preventive) mastectomy evolved out of this need. Women who are candidates for prophylactic mastectomy should first undergo detailed genetic testing for all possible chromosomal disorders. All possible consequences should then be discussed with the candidate for prophylactic mastectomy and all questions should be clarified.

Prophylactic mastectomy, reconstruction with implants after bilateral subcutaneous mastectomy, allows the person to both get rid of breast cancer and continue life with more aesthetic breasts as a secondary gain.

Mastectomy (surgeries in which the breast is completely removed)

Mastectomy is the complete removal of breast tissue. It is used when breast conserving surgery is not appropriate. When the patient has axillary lymph node involvement, a modified radical mastectomy, i.e. removal of the entire breast and a large portion of the axillary lymph nodes, is performed. It is the classical surgical treatment of breast cancer. Good local control; low risk of tumor recurrence.

Who does it apply to?

In the past, mastectomy was commonly preferred for patients with large tumors and/or tumors with widespread distribution in the breast (multifocal tumors) for whom breast-conserving surgery is not appropriate.

In his family, 1. If breast cancer is hereditary in some patients with breast cancer in close relatives, mastectomy can also be performed on the disease-free breast for risk reduction and protection. Such surgeries can also be performed as skin-sparing in early-stage tumors or as ‘nipple-sparing mastectomy’ in tumors that are located far from the nipple. In addition, simultaneous reconstructive procedures for cosmetic purposes can be performed in collaboration with a plastic surgeon. During surgery in which the nipple is preserved, a single dose of radiotherapy (intraoperative radiotherapy) can also be given to the patient’s nipple under anesthesia and on the operating table.