Breast Cancer Treatment

Current Strategy for Breast Cancer

Breast cancer is a heterogeneous disease that presents in different ways and in patients who have different biological, social, and human characteristics. The chances for a well-studied surgery, chemo and radiotherapy are higher than in the past.

Today, well-studied strategies are used for the prevention of breast cancer surgery remains the main weapon aided by intra or post-operative radiotherapy to prevent local recurrence and adjuvant or neoadjuvant chemotherapy. The making of hormonal receptors and 2HRNEW opened a new field in hormonal treatment and with herceptin in the treatment of difficult cases of breast cancer with very good results.

Surgical Treatment of Breast Cancer

Scientific thought has evolved from modified radical surgery of the MADDEN or PATEY type towards the direction of conservative surgery with breast preservation. Modified radical mastectomies are used when the masses are larger than 3 cm or when they are located near the areola or in the central quadrant.

Axillary clearance must be very careful non-traumatic, without bleeding, to avoid arm edema which is very difficult to treat.

In conservative breast surgery when the tumor is 2 – 3 cm, it is enough to go 1 cm away from the edge of the tumor. Today, studies from the Milan Institute by Prof. Umberto Veronezi recommend going up to 2 cm or more away from the edge of the tumor to avoid local recurrence.

In the tumor bed, 3 titanium clips are left one in the middle and 2 on the sides to direct BOOST radiotherapy. In the world today, intraoperative radiotherapy of 1600 up to 2000 RAD is applied in these cases.

Studies continue to verify which is better, fractionated radiotherapy or intraoperative. Such a trial has been undertaken by the Milan Tumor Institute under the direction of Prof. Umberto Veronezi.

To achieve conservative operations in breast cancer when the mass is larger than 4 cm, neoadjuvant chemotherapy is used to reduce the mass and perform conservative surgery in order to avoid local recurrence.

Today, with the introduction of oncoplasty in cases of breast cancer, operations that ensure breast preservation are achieved even when the tumor is larger than 4 cm. These techniques were introduced for the first time in Albania at the Amavita clinic and before 10 days we had a successful report at the European Institute of Oncology in Milan.

In cases of wider excisions such as quadrantectomy and more, we have covered the defect with a latissimus dorsi muscle flap. In these cases, we also performed subareolar biopsy.

For excisions of large tumors in order not to deform the breast, the techniques of Madlen Le'jour and Benelli have been successfully used. In young women or girls when mastectomy has been necessary, immediate or delayed reconstructions with silicone prostheses have been made. In these cases, postoperative radiotherapy is not recommended to prevent deformation and contracture.

With the realization of breast reduction techniques with inferior or superior peduncle, it has been achieved in medium-sized breasts to excise masses larger than 4 cm. In cases where the peduncle has been too long, which risks necrosis of the papilloareolar complex, the reduction according to Torek with free plasties of the papilloareolar complex has been made.

In very difficult cases, TRAM reconstruction has been made. (Rectus Abdominis Myocutaneous Flap) and epigastric fasciocutaneous flap. Recently, for wider excisions of the breast and to have good cosmetic effects, modifications of the Madlen Le' jour technique are used by creating internal flaps that fill the created cavity.

Today in the world in High Risk cases, BRCA1, 2 positive in diffuse mastopathies especially in post – menopause, in multiple breast calcifications, prophylactic mastectomies with preservation of the papillo areolar complex and immediate or delayed reconstruction with placement of the silicone prosthesis preferably retro muscular are performed.

In the Amavita clinic, sentinel node biopsy in breast cancer has been performed. This technique is performed with Patent Blue 2% - 2cc injected subcutaneously at the margin of the tumor. In breast reconstructions with prostheses or with autologous flaps, the reconstruction of the nipple according to Star Technique has also been performed.

In the scientific plan of our surgical sector for the correction of various asymmetries and small defects, we will perform Lipofilling according to a technique we have understood well but which requires some special equipment.

In cases of tumors with medial placement for good demarcation, biopsy of the internal mammary artery lymph nodes is used, which has also been performed at the Amavita clinic, a technique that is still used today by the Milan Institute despite the Lymphoscintigraphy done.