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Breasts are bilateral organs located in front of the chest wall in the body. They are essentially modified sweat glands. While they do not have obvious functions in men, they are the organs that provide postpartum breastfeeding in women and where breast milk is produced and secreted. For these reasons, breast-related diseases mainly concern women. Although men also experience breast-related diseases, this rate is much less than women.
BREAST IMAGING METHODS
MAMOGRAPHY
It is the most common and most common imaging method for imaging the breast. It is also used as a scanning method. It is recommended that women over the age of 40 have mammograms regularly every 2 years, even if they have no complaints. It does not provide sufficient information due to the density of the breast in women under the age of 35, therefore it is not recommended. It gives information about the size of the masses in the breast, their extension to the surrounding tissue and their location, and is very useful in detecting calcifications. It can guide for biopsy. It cannot distinguish between solid masses and cysts. It contains radiation because it is taken with an X-ray beam. Provides much more information when used with breast US.
BREAST ULTRASONOGRAPHY
It is widely used in breast imaging. Today, it can be easily reached in many centers. It is useful in evaluating the breast of women of all ages. It is the most effective method for distinguishing solid mass and cyst. It gives information in terms of the structure, size and relationship of the mass with the environment, the information it gives about the location of the mass is limited compared to mammography. It does not contain radiation as it gives an image through sound waves, it can be used in pregnant women. It guides the physician in the biopsy procedures to be performed, it can be applied more easily since it is portable. It gives much more information when used with mammography.
MAGNETIC RESONANCE EXAMINATION OF THE BREAST (BREAST MR)
It is not the first choice for breast imaging. It is generally used to obtain more information in a diagnosed disease or in cases where a complete decision cannot be made with mammography and US. The most common area of use is to determine the localization of multiple and small tumors in the breast. It should always be evaluated together with other imaging modalities.
CYST OF THE BREAST (FIBROCYSTIC CHANGES OF THE BREAST)
Cysts, by definition, are fluid-filled sacs. When they are located inside the breast, this condition is called fibrocystic change of the breast. First of all, they cause pain complaints. The reason for this is that the volume of the fluid containing the cyst increases due to hormonal changes and the wall is stretched. Practically, the cysts are not expected to turn into malignant disease, so the removal of the cysts is out of the question. In cases where large and small cysts combine to form a single large cyst, if the cyst becomes palpable, the contents of the cyst are evacuated with a needle, and if the content is bloody, it is sent for analysis. From time to time, if a separate abnormal tissue (solid component of the cyst) is detected adjacent to the cyst, it is necessary to conduct an examination for this.
BREAST INFLAMMATION (MASTITIS)
It is often seen in postpartum lactating mothers and is called lactation mastitis (lactation mastitis, puerperal mastitis). It occurs when the microbes enter through the cracks formed on the nipple during the baby's sucking and cause inflammation in the breast tissue. There is a red, swollen and painful breast and fever. It is treated with antibiotics. Breast tissue should be evaluated by ultrasonography and it should be determined whether there is an abscess in the breast. If there is an abscess, the abscess should be drained and antibiotic therapy should be given at the same time. The duration of treatment is about 10 days, breastfeeding should not be interrupted during the treatment. If for some reason the breast is not breastfed, the breast should be emptied continuously with a pump to prevent swelling.
Inflammatory breast disease that manifests itself with recurrent abscesses, mass formation due to scar tissue formation in the breast and discharge from the skin is called granulomatous mastitis. In the treatment of this disease, it is treated as drainage of the abscess, antibiotics, steroids (cortisone) when the abscess occurs, and removal of the mass when the mass develops. The treatment is long-term, it takes time to get results.
FIBROADENOMA OF THE BREAST
It is a benign mass that is often seen in young women. There is practically no conversion to malignant disease. If detected, it can be removed or monitored as it grows. It is recommended to be removed if it grows.
BREAST CANCER
Breast cancer is the most common type of cancer in women. Today, with the development of imaging methods and the increase in breast cancer awareness in the society, this disease is noticed much earlier than in the past, and this situation has a positive effect on the treatment results. In terms of treatment approaches, there are very important developments and changes compared to the past. While the predominant approach was to remove the breast when this disease was detected in the past, the increase in the use of radiation therapy (radiotherapy) and drug therapy (chemotherapy) in the future limited the size of the surgery applied, and the rate of treating patients without causing organ loss increased (breast-conserving surgery). The most important post-operative problem of women who have undergone surgery for breast cancer is the disfigurement caused by the removed breast. The fact that breast prosthesis applications are more easily accessible has also eliminated this problem to a large extent, providing a wider range of action for physicians dealing with the treatment of breast cancer. Today, many studies are carried out on the prevention of breast cancer, and preventive surgery can be offered to some women at risk much more easily.
EVALUATION OF THE BREAST
The first complaint of breast cancer in patients is usually a palpable mass in the breast. When a mass is detected after the examination in patients who apply to the physician, the breast is examined by imaging methods (mammography, breast US, breast MRI) in order to obtain detailed characteristics of this mass. With radiological methods, information is collected on subjects such as the structure of the mass and its relationship with the surrounding tissues, and this information is interpreted by the radiologist to make a prediction about the possibility of cancer. This is similar to a scoring system and is called BI-RADS (Breast Imaging-Recording and Data System). According to this:
BI-RADS 0 – Cases that cannot be evaluated due to insufficient data
BI-RADS 1 – Normal findings
BI-RADS 2 – Benign findings
BI-RADS 3 – Possible benign findings
BI-RADS 4 – Suspicion of malignancy
BI-RADS 5 - Malignant findings with high probability
BI-RADS 6 – Pathologically confirmed malignancy.
According to this scoring system, the interpretation of the radiologist is important. If the BI-RADS 0 opinion is given, the examination is not sufficient, it must be renewed. No follow-up or treatment is required for BI-RADS 1 and 2 imaging. There is no malignant disease in the cases evaluated as BI-RADS 3, but they are followed up intermittently for at least a period of time because of the concern that such a transformation may occur in the course, then either treatment is recommended or they are excluded from the follow-up. If it is interpreted as BI-RADS 4 and 5, a piece of the detected mass should be taken and examined pathologically, and the treatment is planned according to the result. After the BI-RADS 6 examination, the patient is taken directly to the treatment program, and this interpretation is made in additional detailed imagings for the preparation before treatment planning in patients who have already been diagnosed. _cc781905-5cde- 3194-bb3b-136bad5cf58d_
TREATMENT OF BREAST CANCER
In the treatment of breast cancer, General Surgery, Medical Oncology, Radiation Oncology, Nuclear Medicine, Radiology, Gynecology departments work together to plan the treatment of patients. The stage of the disease (how much it has spread to the body) is revealed by the examinations performed after the diagnosis of the patient. In addition, if necessary, research on possible genetic origins of the disease is carried out. In light of all these data:
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Drug-hormone and/or radiation therapy after surgical treatment
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Surgical treatment and hormone, radiation/drug therapy after drug therapy
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It is only recommended to the patient with a joint decision that is the most appropriate among the hormone beam/drug therapy options.
SURGICAL TREATMENT
In surgical treatment, the entire breast can be removed (mastectomy) or the breast can be left in place by removing only the tumor area (breast-conserving surgery). If the breast is to be left in place, radiation therapy is mandatory to prevent tumor recurrence after this surgery. Removal of the entire breast can be done in two ways. It can be taken along with the skin on the breast, or the breast tissue can be removed with the skin preserved (skin-sparing mastectomy). The purpose of skin-sparing mastectomy is to replace the breast removed in the same session with cancer surgery . In suitable patients, this is a much more natural solution than using an external breast prosthesis.
The first area where breast cancer spreads after the breast is the lymph nodes in the armpit. For this reason, the armpit is evaluated in the first examination, and if there is evidence of spread, the armpit is cleaned during the operation. If there is no evidence of spread in the examination, it is investigated by various methods whether there is spread in the armpit during the operation (blue dye, lymphoscintigraphy-gamma probe), in the presence of disease the armpit is cleaned, otherwise the armpit is not touched. The process of examining the armpit for the presence of disease during surgery is called sentinel lymph node biopsy (SLNB).
According to the pathological examination of the surgically removed part, the final and definitive stage of the disease is determined, and the treatment program is finalized. _cc781905-5cde-3194-bb3b-136455cf58d_
SURGERY PROCESS
Preparation for breast surgery is completed with blood tests and anesthesia consultation. The patient is hospitalized on the same day as the surgery and has the surgery. Although it varies according to the type of surgery, the patient can go home after being hospitalized for 1-5 days on average. After the surgery, radiation/drug treatments are planned according to the stage. These treatments begin a few weeks after surgery. Patients undergoing breast-conserving surgery should receive radiotherapy (radiation therapy) for approximately 1 month after the operation.
