HEALTH – Breast Cancer, The Emotional Impact After Mastectomy

Breast cancer is one of the most shocking pathologies in a woman's life, not only because of the uncertainty regarding her management and prognosis, but also because this patient will face a body deformity that will make her feel mutilated.

The consideration is by Julio César Peña Encarnación, head of the Plastic and Recostructive Surgery Service, of the Dr. Heriberto Pieter Oncology Institute, who ensures that the emotional impact of the mastectomy is profound, not only because the patient has to deal with the stress of that disease, but also because it must conform to the altered image of your body by the disappearance of some of your breasts, which in addition to being the clearest exponent of female anatomy and morphology, is also the representation of your beauty, sexuality, motherhood and youth

The specialist says that the above is the acceptance or rejection of his partner, which in many cases leads to the end of the relationship. Its physical, emotional, sexual, interrelation with family and related repercussions could be more serious than the disease itself. Its treatment includes surgery, partial or total resection of the breast, and / or adjuvant treatments: chemotherapy, radiotherapy, support or hormonal therapy, etc.

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In response to these conditions of women, different methods have been created and will continue to be developed for the reconstruction of post-mastectomy breast cancer, with autologous (own patient's) or prosthetic (not patient's) tissues, as well as different techniques, to in order to give a better shape to the reconstructed breast.

William Halsted was the first surgeon he performed in 1889, a radical mastectomy. He considered that the reconstruction of the breast violated the local control of the disease and that this reconstruction could hide a possible local recurrence or adversely modify the evolution of the disease.

For a long time, the treatment applied to breast cancer was mastectomy with its variants. At present, this concept of removing the breast has varied and it is from the studies of Dr. Richardson Fisher, a Canadian doctor, that it was shown that breast cancer “is a local disease of a systemic disease,” resulting in surgery minimally invasive, as in other surgical areas, that is, not sacrificing large volumes of breast tissue in exchange for mutilation or deformity, is conservative surgery with local disease control.

With the advent of conservative breast surgery, traditional or conventional mastectomy is less necessary every day, since a large percentage of mastectomies leave serious aesthetic problems that facilitate the memory of the disease, without counting on the emotional side effects that lead to same in the feminine appearance of women.

With the integration of oncology and reconstructive surgery: oncoplasty, surgical oncological principles are integrated with reconstructive principles in plastic surgery, in order to achieve tissue preservation and immediate reconstruction in exchange for maintaining the shape and resemblance to the breast contralateral and, therefore, aesthetics; hence the importance of the participation of the plastic surgeon as an entity of the multidisciplinary team, to avoid or reduce the psychological consequences of mutilation of a breast for a woman.

Oncoplasty goals

1- Perform surgery that meets the cancer criteria.

2- Do the reconstruction considering the different techniques of plastic and reconstructive surgery.

3 – That the reconstruction is immediate of preference, adequate, and aesthetic, preserving the shape of the breast.

4- That the asymmetry is corrected as much as possible.

The application of plastic surgery techniques in the oncoplastic reconstruction of a breast involves oncological and reconstructive knowledge, and its alternatives will range from the simplest procedures such as the use of breast prostheses, to that of large flaps of muscle-cutaneous tissues or the remote microsurgical flaps, hence the importance of the management of conservative surgery in breast excision until minimization of scars, that is, when breast reconstruction is referred, the plastic surgeon must enter the new modality of treatment of Breast cancers, applying techniques, procedures and knowledge of plastic surgery for breast reconstruction in order to give patients quality of life.

VARIATIONS

Mastectomies
Keeping skin
Preserving skin and areola
Preserving skin and cap
Preserving skin and groove
Preserving skin, groove and areola
Preserving skin, groove and cap

Immediate Reconstruction
The oncologist surgeon selects the patient, the technique and the time of the oncological surgery. Take into account size, volume and position of the cap.

Conservative surgery
For its realization and the application of oncoplastic techniques in the management of breast cancer, it is essential not to violate the surgical oncological principles.

Difficulties
The plastic and reconstructive surgeon faces a series of difficulties in handling these cases, ranging from total ignorance by the patient to the difficulty of breast cancer itself

Orientation
Some oncologist surgeons do not guide patients to find a suitable alternative to their new problem, which is the reconstruction of their body image.

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