Breast surgery unit

J. Torrent Institute has a unit specialized in breast cancer, devoted to the study, control and treatment of both the healthy breast and the breast with pathology, from the focus of Senology.

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Breast cancer

For early diagnosis and treatment of breast cancer techniques are applied such as digital mammography, tomosynthesis (3D mammography), ultrasound and interventional techniques (punctures for diagnosis: PAAF, BAG, pre-operative and intraoperative localization in case of lesions that cannot be localized tactually. System for localization of non-palpable tumours – intratumoural markers- that we place on affected nodes, on the tumour, placement of harpoons and intraoperative ultrasound.

The majority of breast tumours are diagnosed in early stages, before they have extended to other organs.

The multidisciplinary treatment includes different modalities:

Surgery

This implies removing all of the recognized disease, with minimal margins of healthy tissue, as “safety” measure. The current tendency is to do the minimum necessary to cure. Being more aggressive does not cure more and results in major sequelae

  • Regarding the axillary nodes: Axillary clearance, selective biopsy of sentinel node, and including complex procedures to not perform axillary clearance in patients with diseased nodes prior to chemotherapy, in which we can show that the treatment has “cured” them such as the TAD.
  • Regarding the breast: This implies for the removal of the tumour that, currently, in at least two-thirds of the patients, it can be done without sacrificing the breast or, when a radical mastectomy is necessary, an immediate mammary reconstruction can be proposed (in many cases it often requires an additional minor intervention a few months later).
“Systemic” treatment

Can be chemotherapy, hormonotherapy, anti-target treatments or “biotherapy”. There are numerous medications in development, with the intention of adapting to the diverse profiles of each subtype of tumour. In cases of doubt, there are genetic tests that allow a much more personalized indication to be made, avoiding unnecessary chemotherapy.

Radiotherapy

Controlled radiation, administered with technology of very high complexity, safety and precision. It is obligatory for the patients that keep the breast, and necessary in some patients that have been treated with mastectomy (criteria by tumour type, existence or not of axillary disease, size, age, etc. -it is assessed by the Oncologic Committee in each case -). When we perform breast-conserving surgery, two different doses are usually given: a “general” one for the entire breast, and an “extra” one, for the place where the tumour was “tumour bed or margins”. This second one can be administered, in many cases, during the surgical procedure by intraoperative radiotherapy. It is fundamental to be able to treat the tumour bed with precision in surgery when we carry out complex techniques such as oncoplastic techniques, because with these, on remodelling the breast to “reconstruct it”, these margins can be moved and make the work of the radiotherapist more difficult.

There are various types of breast cancer, with different development profiles and response to the different treatments. For this reason, it is fundamental to specify the diagnosis well to adapt the treatment in the most individualized manner possible.

The most critical moment for the patient is the one of the first decision

  • With which equipment will they be treated?
  • Do they start by operating?
  • Will they be treated before operating?
  • What “road map” is planned?

Fortunately, in the immense majority of cases, a diagnosis of breast cancer does not involve urgent action, and for this reason, at JTI Surgical Oncology, we believe that the decision must be taken by our Multidisciplinary Team of the Breast Committee jointly.

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