Breast Surgery

Operations of the female (and male) breasts can be largely divided into two groups.

-Surgery for benign lesions of the breast

-Surgery for malignancy or pre-malignancy

Surgery for benign lesions

The breast is a gland anatomically constructed of a collection of gland sacs (lobuli) and little ducts forming a draining system (ductuli).

This breast tissue changes over the years and through puberty, adolescence, maturity, pre-menopause menopause and post-menopause. This brings around changes in the breast tissue that can lead to clustering and formation op benign tumors such as fibroma's, lipoma's, papilloma's and cystic lesions.

If encountered and symptomatic, these lesions can be removed through little cosmetic incisions in the areolar edge or the skin lines.

The operations are very low risk and are done in daycare.

Breast anatomy

Surgery for malignancy (breast cancer) and premalignancy

Regretfully, breast cancer affects one in 7 women.

We are very committed in the fight against this disease.

We are deeply involved in all platforms in the fight against breast cancer.

Through our multidisciplinary teamwork with the department of oncology, radiology, radiotherapy and pathology every case is discussed for a tailored treatment adhering to European and American protocol.

Also through our efforts with the different cancer foundations (as the Prinses Wilhelmina Fonds) and patient support groups (like Sinta Ros) we try to further support and care for the persons and their families that are afflicted by breast cancer.

"Breast cancer is curable

The key is to catch it early, act swiftly and accordingly and to keep surveying.

So we are always on the lookout for possible premalignancy and malignancy no matter what size."

Screening

Either in collaboration with the screening program of Curacao (Fundashon Prevenshon) or through referral by the general practitioners, patients are screened for malignancy on a protocol basis by history, physical examination, mammograms, echograms and if needed MRI's

Premalignancy

Cells have a long way to go to become cancer, once they start degenerating and before they become cancer they go through various stages. The last stage of this degeneration before they become cancer is called cancer in situ. Nowadays we can find this cancer in situ through screening methods and follow up immediately with removal through breast conserving surgery(in most cases) and if needed radiotherapy

Malignancy

Breast cancer can be of the ducts (ductal) or the glandular sacs (lobular) and once found needs to be treated without delay and according to international protocol

Every cancer patient is treated multidisciplinary, this means in close collaboration with the departments of oncology, radiology, pathology and radiotherapy

Surgical Techniques

Mastectomy

For bigger tumors there may be no other option then to remove the whole breast with axillar lymph nodes.

This is called a mastectomy. Nowadays a reconstruction can be done afterwards through placement of a prosthesis or redirecting own tissue via plastic surgery flap techniques

Breast conserving breast surgery

In smaller tumors a breast conserving technique can be applied in which the tumor is taken out with a margin while conserving the breast. The additional axillar lymph nodes also need to be taken out.

In these cases in addition the rest of the breast needs to be treated with radiotherapy (usually for a period of 5 weeks).

Lymph staging

Why take out the axillar lymph nodes?

The first station breast cancer metastasizes to is the axillar lymf nodes.

This means they need to be taken out to examine them to see if the tumor has metastasized and to treat accordingly.

Novel method: the Sentinel node

Regretfully taking out the lymphnodes can be discomforting to the patient with the possibility of getting postoperative lymph obstruction, this can occur in up to 9% of patients.

Also, in 70% of lymph node dissections on analysis the nodes are clear of cancer.

Thankfully, a novel procedure has been developed over the last years in which the first node can be identified through which the cancer has to go (the sentinel node).

Take that node out, if it has no cancer, you can leave the rest in place, no risks of lymph obstruction, no discomfort for the patient.

We have been involved with the development of this technique from the beginning and has pioneered the way, introducing and making it feasible in Curacao and the region from 2005 on.

Classification Surgery: Minor-Medium

Anesthesia: General (Full intubation and sedation)

Expected hospital stay: daycare or short stay (2 days) hospitalization

Complications and measures

All surgery under general or regional anesthesia carries systemic risks such as deep venous thrombosis, lungembolus, cardiovascular complications: These risks are minimised through preoperative screening procedures and prophylactic(preventing) measures (anticoagulation agents, antibiotics on indication)

Specific complications due to this surgery:

-Postoperative bleeding (low chance, less than 10%)

-Wound infection (low chance, less than 5%)

This is an anonymous patient instructional video of the sentinel node procedure with blue dye only by an AAH staff surgeon.

The video is for academic and patient instruction purposes.