Sinology and Breast Pathology
Clínica Planas´s sinology concept embraces the comprehensive study of the normal and pathological breast, based on the need to include all related specialties and to obtain a specific formation to solve the more and more frequent problems related with the breast.
The treatment of breast pathologies needs a global and multidisciplinary approach. Thus, besides an expert team of plastic surgeons, breast surgeons, radiologists, pathologist specialized on sinology, the unit counts with specialists on psycho oncology, physiotherapy, rehabilitation and physical medicine and genetic advice.
The targets of the Sinology Unit are:
- Control of healthy women for early detection.
- Pre-operative study of patients who have undergone breast surgery for aesthetic or reparative aims.
- Diagnose and treatment of benign pathology.
- Diagnose of breast cancer through the technique of micro biopsy guided by stereotaxy.
- Breast surgery guided by ultrasound scan. The ultrasound scan during surgery allow surgeon to locate the nonpalpable lesion via the ultrasound image and remove it at the same time.
- Breast cancer treatment with a multidisciplinary approach and with special emphasis on the application of Plastic surgery techniques (oncoplastic surgery, reconstruction).
- Monitoring of women with high risk, women who underwent aesthetical surgery and those treated by breast cancer.
Summing-up, the secret is to add efforts and knowledge to multiply results. This idea created Clínica Planas´s new unit of joint surgery, based on a new working procedure, which is multidisciplinary and collaborative among a team of the best specialists of each specialty.
The reconstruction (immediate or delayed) after a mastectomy) can be done to Clínica Planas´s patients and patients referred from other practitioners, convinced of the excellence of our action at this super specialized experienced unit. The total reconstruction of the breast anatomy has the target to heal as much as possible, including glands and reconnection of lymphatic channels. This is a real revolutionary surgery, since it reduces up to 2% the possibility to develop a lymphodema and practically removes all psychological sequelae.
The reconstruction must be practised on the frame of the interdisciplinary concept of senology:
- An specialist from the sinology unit must evaluate the patient, as well as the oncologist, psychologist and the surgeon in charge of the reconstruction. Breast reconstruction is not recommended when it may interfere on the application of the oncological treatment or when it represents a risk for the health situation of the patient.
- The situation of the other breast must be evaluated as well and it may be necessary the action of two specialists.
- There are several techniques. The surgery must be done in an environment where all options are open and thus the patient can choose the most convenient to her needs.
- The patient must know that reconstruction is part of her comprehensive treatment and will feel more secure when this is done in this collaborative environment.
- Initial senology consultation: oncology and psychology evaluation. Study of the treated area and the other breast.
- Consultation with the specialist on reconstructive surgery and discussion of techniques and specialist´s recommendations.
- Joint consultation with the senology specialist and plastic surgeon to determine a jointed strategy.
- Operation (one or two surgeons)
- Monitoring and /or report for the practitioner in charge.
- Procedure for mastectomy and immediate reconstruction and oncoplastic.
Preventive surgery unit
A highly specialized unit able to solve and advise of all related process, with this information the woman feels more secure about the offerings of scientific advances. The preventive procedures against a proved risk are at this moment: intensive surveillance, chemoprevention and preventive surgery. Preventive surgery includes mastectomy of different types according very specific indication, immediate reconstruction and, sometimes, ophorectomy.
- Consultation. Risk valuation according to the existing models, diagnosis via imaging and, if necessary, anatomopathologic study. Genetic risk cases (possible mutations, etc) can be studied with the external collaboration of the specialist.
- The board advises on the ideal surgery, if necessary.
- Study of technical possibilities.
- Decision of the strategy.
Monitoring unit of treated patients and sequelae
Women who undergo aesthetic surgery need monitoring. The monitoring in the case of operations with breast prosthesis is somewhat more difficult and we had to explain it to women beforehand. Regarding the women treated of breast cancer (conservative treatment, mastectomy with or without reconstruction), they need local monitoring of the area, which is not always easy. They are more likely to have breast cancer again and they can have treatment sequelae, since they may have lost the breast or volume. This unit can answer their needs, for example, with reconstruction techniques or re placement of volume that will improve their quality of life. This unit is also focused on the treatment of side effects or sequelae related with breast cancer, specially the lymphedema. Although it is not general, it is a quite common sequelae of difficult treatment. Lymphedema is a common sequelae on patients that need surgery on the axilla area for the treatment of the breast cancer and it has more chances to appear if there is radiotherapy on this area (between 15% and 30% of cases). Currently, this sequelae is less and less common due to less aggressive treatments and prevention measures. The lymphedema is a block of the lymphatic system, which stops functioning in a normal way, due to an excess of fluid in the lymphatic vessels, showing a chronic swelling in one or more parts of the body. Lymphedema surgery is a self-explanatory example of the Breast Unit´s work. We cover all aspects of the woman´s disease during the whole process, from diagnosis until the sequelae treatment. Procedure - Explication and application of the procedure to patients for breast implants. - Explication of this procedure to all patients with breast implants - Study procedure of lymphedema and indication of various strategies, including new techniques. - The monitoring requires the best method of imaging. A joint action with the reference center must be set. The interpretation of imaging will be done jointly with the assigned specialist, in constant contact with the Breast Unit.
Support therapy to patient and family
Nowadays, breast cancer is still the most common tumour of women in our society. Besides a terrible disease, its treatment frequently implies a mastectomy or extirpation of the breast, with the loss of a breast for the women.
Cancer involves a level of suffering which has an impact on the quality of life of those affected and of their families. Both the diagnosis and the treatment of this disease bring about a change in values and in quality of life on a physical and psychological level, sometimes creating difficulties in adapting to the new situation. On top of this there can also be communication problems with the patient´s partner and family, reduced self-esteem and possibly feelings of anxiety, depression, loss of control and uncertainty. These problems also all occur within the patient´s family, who need to suppress their own feelings and emotions in order to help the patient, without finding an escape valve for them.
Bearing in mind the implications of this disease and its treatment, psychological support may be necessary at different times and for different individuals who are associated with the patient.
The patient is the person who receives the diagnosis and who therefore is the main protagonist. You may need one-off or continued support at any stage in the process. This assistance can be provided in the form of individual or group consultation, according to the circumstances and needs of each person. There are also workshops and general information sessions you can participate in that focus on the psychological impacts of cancer, giving you an idea of what you can expect. In some circumstances this can be done in a home visit.
The cancer patient´s family members are known as second order patients because while they do not suffer the physical consequences of the diagnosis and treatment, they can suffer the same emotional and psychological effects as the patient himself. Furthermore, they sometimes have to support the patient in his critical situation without expressing the emotions this causes. Sometimes there are also obstacles to communication and moments when they do not know how to discuss a delicate topic or respond to sensitive questions. The family can also benefit from on-going individual support in the form of psychotherapy, receiving advice on a specific topic or joining a support group with which to exchange experiences.
Professionals who dedicate themselves to the treatment and care of cancer patients may also need support and counselling sometimes. They may need help with coping with the day-to-day stress of their job but it can also provide them with a better understanding of the patient´s situation and to help him and his family to improve their communication skills. This may be dealt with individually or in a group psycho-educational workshop that is set up to deal with the communication and surrounding needs of cancer patients.
Some patients may find themselves in a psychologically difficult situation in which they are suspected to have cancer and are awaiting test results. There may also be people facing forceful blocks to treatment, (a phobia of certain essential treatment situations) or have cancerophobia, an intense, uncontrolled and irrational fear of cancer.