311 338
MEDICAL ADVANCES
311
June14
Most women who have breast cancer
require surgery, so – with the incidence
of breast cancer increasing throughout
the developed world – any new
breakthroughs in this area are very
good news indeed.
DR GEORGETTE CHAN, who has
published widely in the field of breast
surgery and surgical oncology, gave
me her views on four major advances
in her field: sparing the nipple, sentinel
node biopsy, radiation
during
surgery,
and using chemotherapy to shrink larger
tumours
before
surgery.
#1 Nipple-sparing mastectomy
“In my opinion,” she says, “a nipple-
sparing mastectomy is the nicest form
of reconstruction that we can do for a
patient with breast cancer. It’s a real
refinement on other techniques, and
such a boon for women who are good
candidates for it (and not everyone is).
I’ve been doing this procedure for the
past eight or nine years, and patients are
usually very satisfied with the outcome.”
HOW IT’S DONE:
“We remove all the
breast tissue – so it’s as oncologically
clean as possible, but we save the skin
and also the nipple. The nipple-areolar
complex is a challenging area for the
plastic surgeon to reconstruct, so it’s
ideal if we can save the nipple.
“The intact breast skin serves as an
envelope to receive the reconstructive
material immediately; be it an implant or
muscle going in, the plastic surgery can
balance it with the patient’s other breast.”
WHO IT’S FOR:
“The breast tumour
should be situated well away from the
nipple,” says Georgette, and the nipple
itself must be healthy and normal.
“In addition, at the time of surgery, I
shave off tissue just behind the nipple
and have it tested on the spot: if the
pathologist confirms that it’s free of
tumour cells, I will then save the nipple.”
COMMENT:
“Psychologically, a nice
surgical outcome does wonders for the
patient’s outlook and self-esteem.”
#2 Sentinel node biopsy – a less
drastic lymph node surgery
“In order to determine what stage the
cancer has reached,” she explains, “we
ghrelin; removing it will considerably
reduce the patient’s appetite.”
In terms of weight loss and diabetes
remission, he says, it delivers better
results than gastric banding does.
It’s very safe, too, and it avoids the
introduction of a foreign body and the
likelihood of needing to go in again.
Any downside? Yes – if the patient
continues to eat excessively, the stomach
can stretch. “For good, long-term results,
we emphasise the importance of a
lifestyle change with regard to diet and
exercise.”
A third option is
gastric bypass
surgery. Rerouting food from the
oesophagus and the small, upper
stomach pouch, bypassing the rest of
the stomach and delivering it directly to
the intestines sounds radical to me, and
it is, Dr Lim agrees.
“But the patients we’re looking at here
may have BMIs of up to 40 or even 45,
so their severe obesity is already having
a serious effect of their mobility, their
quality of life and their life expectancy. In
these cases, radical surgery is justifiable
and can be very beneficial.”
In through the keyhole
Good news is that
keyhole or
laparoscopic surgery
has made
real advances in this area, and can
successfully be used on 95 percent of
patients.
“Being able to access the stomach
through small incisions into the
abdominal cavity means far less pain
and trauma, less time in hospital and
much faster recovery. With the latest
optics and HD cameras we get a very
clear view of what we are doing.”
A new development is
single-incision
laparoscopic surgery
. “Instead of going
through three or four different ports, we
go in through just one, slightly bigger
port, with all the instruments and the
camera.” Going through the umbilicus,
or belly button, gives a good cosmetic
outcome. One possible downside for
many patients, concludes Dr Lim, is that
they have to buy a whole new wardrobe.