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Breast and Endocrine Surgery

Breast and Endocrine Surgery

What is breast-conserving surgery?

Breast-conserving surgery involves the removal of the cancerous area along with a margin of healthy tissue, preserving the rest of the breast and maintaining breast integrity. With the increasing availability of early breast cancer detection, this method is applicable and preferred for many patients. Evaluation of the axillary lymph nodes is also performed during the same surgery. The feasibility of breast-conserving surgery depends on the type and size of the tumor, its spread within the breast, and other patient-specific factors. Oncoplastic surgical techniques allow for the reconstruction of the breast even in cases with large tumors. While many early-stage breast cancers can be treated with breast-conserving surgery, this method can also be applied to advanced-stage breast cancers that become suitable for this surgery after preoperative chemotherapy.

A common concern among patients undergoing breast-conserving surgery is the recurrence of cancer. Studies have shown that there is no difference in survival rates between patients who undergo mastectomy (complete removal of the breast) and those who have breast-conserving surgery. Another important point is that the majority of patients who undergo breast-conserving surgery will require radiotherapy (radiation therapy) after the operation. Adding this treatment reduces the risk of cancer recurrence.

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What is oncoplastic surgery?

Oncoplastic surgery is a treatment method that allows more patients to benefit from breast-conserving therapy for breast tumors. Despite the removal of large tissue areas using various plastic surgery techniques, the breast is reshaped, and the other breast is symmetrically adjusted. This method ensures complete surgical treatment of cancer while achieving better aesthetic results.

What is a mastectomy?

A mastectomy is the surgical removal of all breast tissue. It is a surgical treatment option for patients who are not suitable for breast-conserving surgery. It is preferred in certain types of cancer, large tumors, patients who have previously received radiation therapy to the breast, and in the presence of some other patient-specific factors. There are different methods of mastectomy. Following a mastectomy, breast reconstruction can be performed either simultaneously or at a later stage, using prosthetics or the patient's own tissues. Risk-reducing mastectomies are performed on both breasts in patients with hereditary cancer or genetic mutations detected before cancer development.

What are the surgical methods for lymph nodes in breast cancer?

The lymphatic drainage of the breast is largely towards the axillary (underarm) lymph nodes. The presence or absence of tumor spread in these lymph nodes is important for the staging and treatment of breast cancer. In the past, axillary lymph nodes were extensively removed in every patient during surgery. Nowadays, with advanced treatment options, these lymph nodes are often preserved. Surgical procedures for lymph nodes can be performed at the same time as breast cancer surgery or as a separate procedure. There are two main types of surgery for lymph nodes.

What is a sentinel lymph node biopsy (SLNB)?

  • A sentinel lymph node biopsy is a method used to identify the first lymph nodes to which lymphatic drainage from the breast flows, using special dyes or nuclear medicine techniques. These lymph nodes are then evaluated for the presence of cancer cells. In patients with no suspected spread to the axillary nodes based on preoperative examination and imaging, 1-3 lymph nodes identified with this method are pathologically examined during surgery. If no spread is detected, extensive surgery to the remaining area is avoided. This minimizes side effects such as pain, movement restrictions, and arm edema. This method can also be used in patients with advanced tumors who respond fully to preoperative chemotherapy.

What is an axillary lymph node dissection (ALND)?

  • Axillary lymph node dissection is a surgical procedure where a significant number of lymph nodes in the underarm are removed in patients with tumor spread. Though required much less frequently nowadays, it is still necessary for some patients.

What is breast reconstruction during or after a mastectomy?

Breast reconstruction can be performed simultaneously or at a later stage, both after breast-conserving surgeries and mastectomies. This involves using prosthetic materials or the patient's own tissues to reconstruct the breast.

What is endocrine surgery?

Endocrine surgery involves surgical procedures for diseases arising from the body's endocrine glands. It includes surgeries for diseases related to the thyroid, parathyroid, adrenal (suprarenal), and pancreatic glands, which are part of general surgery.

Which diseases are surgically treated in the endocrine surgery department?

In our endocrine surgery department, we perform surgical treatments for conditions caused by nodular or general enlargement of the thyroid gland, thyroid cancers, parathyroid gland diseases, and diseases affecting the adrenal (suprarenal) glands.

What is a thyroid nodule?

Thyroid nodules are mass formations that occur within the thyroid gland. These nodules can be completely solid, fluid-filled, or a combination of both.

What are the symptoms of a thyroid nodule?

Many thyroid nodules do not cause symptoms unless they create noticeable swellings in the neck. They are often detected during examinations and ultrasound imaging. Some nodules may press on the airway or esophagus, causing symptoms such as shortness of breath and difficulty swallowing. Nodules with excessive hormone secretion may cause symptoms such as palpitations, excessive sweating, and hand tremors due to high hormone levels.

How are thyroid gland diseases diagnosed?

Thyroid gland diseases are diagnosed through neck examinations, ultrasonography, and the detection of changes in thyroid hormone and other related blood tests. Palpable nodules or symptoms related to high or low hormone levels can be identified during an examination. Thyroid ultrasonography evaluates the structure of the thyroid gland and can detect thyroiditis, nodules, and their characteristics. Blood tests can diagnose hyperthyroidism, hypothyroidism, and other thyroid-related diseases.

Fine-needle aspiration biopsy is used to evaluate detected thyroid nodules. Cells obtained from suspicious nodules are pathologically examined, and the need for surgery is determined based on these findings.

What are the current surgical methods used in the treatment of thyroid gland diseases?

In Graves' disease, the most common cause of hyperthyroidism, a total thyroidectomy, which is the complete removal of the thyroid gland, is performed. If hyperthyroidism is caused by an overactive nodule and there are no other nodules in the other part of the gland, a unilateral thyroidectomy is performed. When cancer is detected in the thyroid gland, a total thyroidectomy, which involves removing all thyroid tissue and, in some cancers, the regional lymph nodes, is typically performed. In certain special cases or cancer types, a unilateral thyroidectomy may also be performed. These surgeries are conducted through a 3-4 centimeter incision in the front of the neck.

What is the parathyroid gland?

The parathyroid glands are four small glands located on the thyroid gland on each side of the neck, responsible for secreting parathyroid hormone (PTH), which regulates the body's calcium balance.

What are parathyroid gland diseases?

Hyperparathyroidism can occur when one or, rarely, two or all of the parathyroid glands grow excessively and secrete hormones uncontrollably. When this condition affects individual glands, it is called parathyroid adenoma; when it affects all glands, it is called parathyroid hyperplasia. Increased parathyroid hormone levels lead to elevated blood calcium levels, causing issues such as kidney stones, bone loss, arterial hardening, and mood disorders.

How are parathyroid gland diseases diagnosed?

A key indicator of hyperparathyroidism is elevated blood calcium levels. This condition can be detected incidentally during routine blood tests or while investigating conditions like kidney stones and bone loss. Parathyroid adenomas can be identified using ultrasonography. Although parathyroid hyperplasia may not be visible on ultrasound, elevated calcium and parathyroid hormone levels detected through laboratory tests confirm the diagnosis. Special diagnostic methods such as scintigraphy can be used to locate abnormally positioned parathyroid adenomas.

What are the current surgical methods used in the treatment of parathyroid gland diseases?

In cases where one or two parathyroid glands are found to be enlarged and overactive, a targeted parathyroidectomy is performed, allowing the glands to be removed through a smaller incision. For hyperplasia involving all glands, a subtotal parathyroidectomy is performed, similar to thyroid surgery, where one half of one gland is preserved, and the rest are removed.

What is the adrenal gland?

The adrenal glands, also known as suprarenal glands, are two glands located on top of each kidney. They secrete several vital hormones for the body.

What are adrenal gland diseases?

Surgically treatable adrenal gland diseases include pheochromocytoma, which causes symptoms like palpitations, hypertension, and facial flushing; Conn's syndrome, characterized by low potassium levels, hypertension, fatigue, and weakness; and Cushing's syndrome, which results from excessive steroid hormone production.

How are adrenal gland diseases diagnosed?

Most adrenal gland diseases are diagnosed through the detection of elevated hormone levels in blood tests and the localization of adrenal masses using imaging techniques such as CT scans, MRIs, and scintigraphy.

What are the current surgical methods used in the treatment of adrenal gland diseases?

Today, most adrenal surgeries are performed using laparoscopic (minimally invasive) techniques. This method allows the diseased gland to be removed, enabling the patient to recover quickly.