Breast Diseases

Breast development begins in the womb, during birth the breast is the same in men and women. It includes only the major milk ducts. It continues to develop in adolescence. Breasts complete their development during pregnancy. Hormones such as estrogen, progesterone, prolactin, thyroid hormones, cortisol and growth hormones are effective in breast development.
The udder consists of glands that produce milk, called lobules, 15-20, and the ducts that carry this milk to the teat, the nipple and the fatty supporting tissue that contains the majority of it. Males have milk ducts and no milk-producing glands. The vast majority of women experience breast-related complaints at some point in their lives. Breast examination should be done once a year after puberty with a specialist physician examination and ultrasound. At the age of 40, an annual breast examination is performed by adding mammography to the examination and ultrasound. If the patient has a family history (breast cancer in close relatives), the age of mammography can be taken earlier. Genetic research can be done if more than one close relative has a history of cancer.
Breast examination, ultrasound or mammography do not prevent the patient from developing cancer. Breast cancer, which may occur with regular follow-up and treatment methods, can be diagnosed and treated very early. The doctor sees the patient once a year. Therefore, every woman has the opportunity to evaluate herself approximately 12 times a year by performing breast self-exams (you can get detailed information in the relevant section) regularly every month. The aim here is not for the patient to self-diagnose, but to share with the physician the abnormality that he has detected before the routine control, without waiting for the annual control.
Some changes in the breast may cause anxiety for the patient. Congenital retraction of the nipple does not constitute pathology. However, newly formed nipple recession should be evaluated with the suspicion of cancer. No woman has a symmetrical breast. While this asymmetry may be so obvious that it can be noticed by the eye, it is often not noticeable. In this case, it does not constitute pathology.
Although many patients think that only mammography is sufficient and they are evaluated by different branches, the follow-up, treatment and surgery of breast diseases are performed by the General Surgery Department. When the examination, ultrasound and mammography are performed together, they form a whole. They are complementary to each other.
Another worrisome situation for patients is X-rays of the breast during mammography. However, it has been stated that mammography performed during routine controls does not increase the risk of cancer.
It is known that 1 in 8 women on average in the world has breast cancer, which makes it important to have regular breast control. This disease can be cured with current treatment methods.

Benign breast diseases;
-Breast cyst/Cysts -Fat Necrosis
-Fibroadenoma -Phylloid Tumor
-Mastodynia/Mastalgia(Breast Pain) -Galactocele
-Nipple discharge -Adenoissis
-Ductal Ectasia -Gynecomastia
-Mastitis -Mondor’s Disease
-Intraductal Papilloma -Granulamator Mastitis

Although breast cancer is the first thing that comes to mind when breast diseases are mentioned, benign breast diseases are more common. Many manifestations of benign breast diseases are similar to breast cancer. For this reason, breast cancer should be treated after excluding it. Not every lump in the breast is cancer. However, a distinction must be made. From these masses;
– cysts in sacs filled with fluid,
We call the ones filled with different textures as solid masses.
Breast ultrasound is used to differentiate these two masses.

Breast Cyst/Cysts;
They are the most common lesions in the breast. It occurs as a result of enlargement of the milk duct glands in the breast. It is more common in women aged 25-45 years. It can be single or multiple. In single and large cysts, the fluid in the cyst can be drained with a needle. Depending on the nature of the fluid taken from the cyst, surgery may be required. Surgery is also recommended for cysts that recur after the cyst is drained. It is mostly noticed with breast pain and a palpable mass.
Surgical indications of the cyst;
-A mass remains after the cyst is emptied,
– Bloody inside the cyst,
– Suspicion of pathological examination,
-Recurrence after aspiration.

It is the most common cause of breast mass after breast cysts. It is common under the age of 30. It tends to grow during pregnancy. They are well-circumscribed, rigid and moving masses. Their sizes are variable. Surgical removal of fibroadenomas of 2-3 cm or more is generally recommended. Fibroadenomas do not turn into cancer. Rapid growth can be seen. The use of birth control pills does not increase fibroadenomas.

Breast Pain (Mastodynia/Mastalgia);
It is the most common breast complaint in women. Most of it is due to hormonal changes before menstruation, which we call physiological pain. The association of breast pain with cancer is rare. Breast cancers are usually painless. The most common cause of breast pain is hormonal changes. Menstrual pain is frequently observed in women with fibrocystic breasts. Every patient with breast pain must be evaluated by the physician. If it is evaluated as normal after examination and tests, it is treated symptomatically. In some cases, caffeine, salt and fat restriction and the use of supportive bras are recommended. It also benefits from medical treatment.

Nipple Discharge;
Nipple discharge can occur at different times. It is considered normal to have a discharge from the nipple by squeezing the breast. In order for nipple discharge to be taken seriously and associated with cancer, it must be spontaneous. In women with nipple discharge, spontaneous discharge and brown-red color may suggest cancer. It is an important finding, especially bloody or brown in color. In such cases, laboratory examination should be performed by taking a sample from the nipple discharge. However, every nipple discharge should be considered pathological until proven otherwise. Most of the nipple discharge develops due to birth control pill, pregnancy, menstruation, traumas, mechanical stimuli and drugs. Physiological currents usually do not require treatment.

Ductal Ectasia;
It is a condition characterized by enlargement of the breast ducts under the nipple and changes called inflammation and fibrosis around them. It may cause a clear, bloody or inflammatory discharge from the nipple. It may be palpable as a mass on examination. Rarely requires surgery. In the surgery, it is sufficient to remove the surrounding tissues together with the enlarged breast canal.

It is an infection of the breast tissue. It is usually seen during lactation. It is formed by bacteria entering through cracks and erosions on the nipple. While hardness, redness, pain and temperature increase occur in the breast, fever, general condition disorder can be seen. If this condition progresses, an abscess may develop in the breast. If signs of infection are detected before a breast abscess occurs, it is treated with antibiotics. Breastfeeding can be stopped. If treatment is delayed, single or multiple abscesses are seen. If an abscess has formed, it must be drained and a culture antibiogram is made from the sample, and appropriate antibiotic treatment is given. Infections that occur outside of breastfeeding are called subareolar mastitis. This is a type of inflammation that develops around the nipple. It is associated with smoking. Antibiotics are used in its treatment. If an abscess develops, the abscess should be drained. It may tend to recur. Patients diagnosed with mastitis can continue to breastfeed while receiving antibiotic therapy. If it is thought that the breast is not empty enough, the milk in the breast is emptied with the help of a pump and warm application can be made before the procedure. Warm application relaxes and accelerates breast discharge. In patients with chronic diseases and immunocompromised patients, infection may develop in other parts of the breast. The treatment should be with antibiotics, if an abscess has developed, drainage, and if there is a suspicious condition or mass, breast cancer should be ruled out by biopsy.

Intraductal Papilloma;
They are benign masses formed in the canals behind the nipple. It is usually seen between the ages of 40-50. It is manifested by nipple discharge. The flow can be of different characteristics. It is less likely to be palpable on examination. When necessary, it is surgically removed together with the canal it is in. It is the most common cause of bloody nipple discharge.

Fat Necrosis;
It is a rare breast lesion. It is seen in breasts rich in adipose tissue. It can occur due to trauma and infection. Mass formation can be confused with cancer because it creates a recession on the nipple or skin. It is common after radiotherapy and segmental resection. Since the examination and mammography findings are very similar to breast cancer, the definitive diagnosis and treatment is made by biopsy or open surgery.

Phyllodes Tumor(Cystosarcoma Phyllodes);
It is considered a type of fibroadenoma. Because it grows rapidly, it is larger than fibroadenoma at first admission. This tumor is usually benign. Rarely, the malignant type is encountered. On examination, it is palpated as a hard, mobile and lobulated mass. Its size is over 3-4 cm. In the treatment of the benign type, it is sufficient to remove the mass together with the breast tissue around it. It has the appearance of cauliflower in appearance and is in the form of a polypoid mass that develops into the cystic spaces. Indistinguishable from fibroadenoma on mammography. It is seen in older ages than fibroadenoma. It constitutes less than 1% of the masses seen in the breast. A simple mastectomy is sufficient for malignant ones. No spread to axillary lymph nodes has been reported. Therefore, underarm surgery is not performed. It often progresses with local recurrences in the breast.

It is a rare disease that occurs during breastfeeding or after breastfeeding has stopped. It is formed by the accumulation of milk in a cystic structure.

It is a benign formation that occurs with the proliferation of milk-producing structures/ducts in the breast tissue. It can happen anywhere in the breast. It manifests as nodules with unclear borders. As the lesion ages, fibrosis develops. A biopsy is performed for definitive diagnosis.

Breast enlargement is the effect of various factors seen in men. Physiologically, gynecomastia can also be seen in the neonatal period, adolescence and old age. Pathological gynecomastia may be associated with many chronic diseases, drugs and tumors. However, in general, gynecomastia does not increase the risk of cancer in the male breast.
Estrogen hormone excess, androgen deficiency and drugs play a role in its formation. Gynecomastia with or without signs of precocious puberty in children under 10 years of age requires endocrine evaluation for tumor. Gynecomastia seen in adolescence is not treated, it resolves spontaneously in 2-3 years and is usually unilateral. Rarely, surgery may be considered if it is severe enough to require treatment or if it cannot be regressed into the control process and causes psychological problems. Gynecomastia seen in old age is usually bilateral. Severe pain, tenderness and social life in patients with gynecomastia require treatment. Medical treatment can be used. Surgical; If a diagnosis of cancer is made and it is done for cosmetic reasons. Surgical removal of gynecomastia tissue called subcutaneous mastectomy. If cancer is ruled out, minimally invasive surgical methods such as liposuction can be used. Gynecomastia is not a lesion that causes breast cancer.

Mondor’s Disease;
It is a state of coagulation and associated inflammation in the superficial veins of the breast. Local trauma and compelling hard movements are responsible for its formation. At the beginning of the event, there is localized pain and tenderness in the breast. Pain subsides within 3-4 weeks. The lesion disappears completely within 5-6 weeks. It usually does not require treatment.

Granulamatous Mastitis;
It is common in developing countries and in immunocompromised patients. It may be among the causes of previous infection and trauma. Cancer can often be confused with imaging methods. Recurrent abscesses may occur despite antibiotic therapy. Despite imaging methods, it is quite difficult to distinguish it from cancer. A biopsy is required for definitive diagnosis. Patients with small masses can be followed. In more than one focus, drugs that suppress immunity can be used. It can be surgically removed if it responds to immunosuppressive drugs. Apart from this, infection causes such as mastitis, tuberculosis, sarcoidosis, typhoid and fungal infections due to infection. Idiopathic lobular granulomatous mastitis is common in young, childbearing patients. Granulomatous mastitis due to such other sources of infection should be ruled out. Often the cause is unknown. Lesions that cause mass, abscess and recurrent discharge are seen in the breast. Depending on this, recurrent mastitis, abscess and nipple recession may occur. Differential diagnosis of breast cancer should be made. In its treatment, it is treated with total excision, including the mass and the draining sinus mouths.

Breast Self Examination;
Breast self-exam is important for early detection of breast lesions. With this examination, patients can detect masses in the breast in the vast majority. A lump in every breast does not mean cancer. Most masses are benign. Newly emerging and growing masses may be important for cancer.
Breast tissue is in different shapes and sizes depending on the age and hormonal status of the woman. The density and size of the breast tissue varies near and during the menstrual period. During this period, the breasts are more sensitive. The first week of menstruation takes its smallest and normal form as the size and sensitivity of the breast tissue decreases.
Breast self-exam is on the 5th-10th day of your period. should be done on the day. Women who do not menstruate should have a breast examination on the same day of each month.
Patients should make a visual examination of the breast by standing in front of the mirror with the upper half of their body completely naked, putting their arms on their waist, opening them to the side and lifting them up. Here, it is checked whether there is a recession, an outward protrusion or an asymmetry in the breast. Then, lying on a flat surface, placing a small pillow under the breast to be examined, placing his hand under his head on the same side, squeezing the breast between the fingertips of the other hand and the chest wall, he starts from the nipple and controls the whole breast with circular movements or in a linear fashion. It completes the examination from the nipple to the outside of the breast, each time a different linear area. When one side of the breast examination is finished, it is passed to the other side.
For the armpit examination, the patient comes to a sitting position. The arm on the side of the breast to be examined is swung down. The entire axillary pit is examined with the fingertips of the other hand. This examination should be done with soft movements and gently.
Breast self-exam should be done once a month. Doing it more often is not more meaningful for the diagnosis of the lesion in the breast. Because the average time it takes for breast cancer to reach 1 cm in diameter is 5 years. The purpose of this examination is not to diagnose the patient. It enables the patient, who is evaluated by the physician once a year, to apply to the physician earlier for an abnormality that he noticed with breast self-examination. The patient should consult a physician in case of any suspicious finding during breast self-exam. If there is no suspicious situation, a physician examination once a year is sufficient. More frequent physician control may be required for high-risk patients (such as family history, patients diagnosed with cancer in one breast).
Patients should be properly informed about breast cancer, and they should not live in fear of cancer.
Cancer is an important health problem in the world and its importance is increasing in our country. Today, it is possible to prevent some cancers, and many types of cancer can be treated. Early diagnosis is one of the basic principles of the fight against cancer. Since cancer is a disease that can be seen in all tissues and organs, early diagnosis can only be possible with regular controls.
Breast self-exam should begin at age 20 and should be done regularly every month. The aim of breast self-examination is for the patient to get to know their own breast better and to notice the change in the breast on their own. The majority of breast masses are found by women themselves. This is very important in early diagnosis. Breast self-exam is an easy-to-learn, harmless, and free exam. In this examination; mass in the breast, abnormal growth of one of the breasts, excessive sagging of one of the breasts, wrinkling of the breast skin, orange peel appearance on the breast, cupping on the nipple, bloody discharge from the nipple, color change in the nipple, swelling in the arm, a palpable mass in the armpit can be detected. (size of detected audience-photo)


The ideal breast size is specified as 300-350 cm3. More than 50% increase in ideal breast volume is called macromastia. These patients mostly complain of neck pain, shoulder pain, arm pain, back pain, low back pain, armpit pressure, bending in the back vertebrae, respiratory distress, breast pain, fungal infection under/between the breasts, cosmetic problem, problem of finding a bra, and limitation of physical activity. . Macromastia is not just an aesthetic problem, it is a health problem. These patients need to be seen by many different doctors due to their current complaints and many examinations are required. Therefore, macromastia is a health problem. For this reason, the complaints of these patients appear as a serious loss of labor, money, and health care. An increase in the number of benign breast diseases is observed in macromastic patients. The incidence of breast cancer is also higher than other patients. It would be appropriate to treat macromastia as a disease.
The vast majority of these patients have accepted these clinical problems and the effectiveness of imaging methods has decreased in these patients. Macromastia is an obstacle to the early diagnosis of cancer. It has been stated that cancer-free reduction surgeries also reduce the risk of cancer. Macromastia is not an aesthetic problem. It’s a real meme addiction.

Breast Cancer;
It develops with the uncontrolled proliferation of the ducts that form the milk glands and milk ducts. (Erzurum provincial health directorate breast cancer photo)
It is an estrogen-dependent, endocrine tumor. Breast cancer is the most common type of cancer in women. It is also the leading cause of death in many countries. It is one of the 10 most common cancer types in women in our country. The breast structure consists of milk-secreting lobules and ducts that carry the secreted milk to the nipple. And with the uncontrolled proliferation of these 2 structures, cancer develops. Cancer that develops in the milk-secreting part is called lobular cancer, and cancer that develops from the milk duct is called ductal cancer. It is the most common ductal cancer and accounts for the majority of breast cancer. The most common cancer in women is breast cancer. Breast cancer is seen in 1 out of every 8 women in the world. The causes and risk factors of breast cancer are divided into two as controllable and uncontrollable.
Uncontrollable risk factors;
1 year;
While it is not common under the age of 20, the risk increases with age. It is common over the age of 50.
Breast cancer is not just a cancer specific to women. 99% of all breast cancers occur in women and 1% in men.
3-Family History;
If the person’s close relatives (mother, sister, aunt…) have breast cancer, the incidence increases. While it has been stated that 5-10% of breast cancer is genetic, approximately 75% of women with breast cancer occur in women with no known risk factors. A person carrying the BRCA-1 and BRCA-2 genes, which are associated with breast cancer, has a greater than 50% risk of developing breast cancer until the age of 70.
4- If there is cancer in the other breast;
A person who has cancer in one breast has a higher risk of having cancer in the other breast than other women.
5- Early Menstruation/Late Menopause;
The risk is higher in women whose first menstrual period is less than 12 years old and menopausal age is older than 50. The reason for this is the increase in the duration of exposure to the hormone estrogen. Reducing exposure to estrogen is thought to be protective.
The effect of infertility treatment on breast cancer risk is not fully known. Breastfeeding reduces the risk of breast.
6- Birth History;
Women who have never given birth are in the risk group for cancer. The risk of cancer is higher in women whose age at first birth is 30 years or older than women whose age at first birth is 20 years old.
7- Race;
Breast cancer is more common in white women than in black women. However, the mortality rate in the black race has been reported to be high. In this case, it suggests that it is due to lifestyle and socioeconomic status.

Controllable risk factors;
The risk of cancer increases with increasing alcohol intake.
2-Fat Diet/Obesity;
It has been determined that diets rich in animal fat increase the risk of breast cancer.
The risk of developing breast cancer due to mammography is considered to be a very low risk (about 1/1,000,000). Exposure to radiation under the age of 30 increases the risk of breast cancer.
4-Use of Birth Control Pill;
It has been determined that the use of OCS under the age of 35 slightly increases the risk of breast cancer. It is recommended not to use in patients with a first degree relative with breast cancer.
5-Hormone Therapy After Menopause;
It has been reported that long-term and uninterrupted use of OCS increases the risk.
It has been observed that the risk of breast cancer is lower in women who exercise regularly.

Signs and Findings of Breast Masses;
1-Mass in the breast;
An important finding in the majority of breast cancer patients is finding a mass. The vast majority of masses are painless. It is most commonly found in the upper outer quadrant of the breast. It is handled as rough and rough, with poorly defined borders. Most of the masses detected in the breast are benign. However, every mass in the breast should be considered as cancer until proven otherwise and necessary research should be done.
2- Nipple Discharge;
About 10% of spontaneous unilateral and bloody nipple discharge may be due to cancer, and every nipple discharge must be taken seriously and evaluated.
In breast cancer, pain occurs more often in the late period. Cancer-related pain without any clinical manifestations is very rare. It is usually seen in benign breast diseases.
4- Nipple Recession;
It is generally seen in cancers located close to the nipple. However, this image can be detected structurally. Structurally determined ones are not pathological. Lateral, unilateral nipple recession should definitely be considered as cancer.
5- Edema on the Breast Skin;
As a result of breast cancer cells clogging the lymphatic vessels, the breast skin thickens and takes on the appearance of an orange peel. This is a sign of breast cancer.
6-Eczema/Rash on the Nipple and Surrounding Skin;
While lesions due to irritation resolve with appropriate treatment for about 1-2 weeks, cancerous lesions do not. And it definitely requires control.
7-The Mass Under the Armpit;
It occurs when the tumor progresses from the lymphatic vessels and spreads to the lymph nodes in the armpit. It must be illuminated.

Early Diagnosis in Breast Cancer;
Although the incidence of breast cancer is increasing, the chance of early diagnosis is also high. And when diagnosed early, patients have a great chance of surviving this disease. One of the biggest elements in early diagnosis is breast self-examination. Women can usually notice a mass that has reached 1 cm in size. In addition to breast self-examination, physician examination and imaging methods for the breast also play a major role in early diagnosis.
1 gram of breast cancer tissue develops in an average of 8 years. In other words, it takes an average of 5 years for 1 cm of breast cancer to develop. If breast cancer is not treated, it dies within 5 years with distant organ metastases. While it is possible to treat it in the early stage, it is not possible to treat it in the distant metastasis stage. Breast cancer treatment requires a multidisciplinary approach. In breast cancer, the aim of early diagnosis is to detect breast cancer without clinical symptoms after its biological onset.

After the examination of the patient, some additional imaging methods may be required, and mammography comes first among these imaging methods for the breast. The earliest method to detect breast cancer is mammography. Mammography is a method applied using low-dose X-rays. The goal is to detect breast cancer as early as possible. It is an imaging method in which the breast is compressed between 2 layers and shot from top to bottom and from right to left. It is known as a very painful method in some women. In the right and experienced hands, mammography will never cause unbearable pain, and it is of great importance in terms of the quality of the mammography. Every woman over the age of 40, with or without complaints, should have a mammogram once a year. This is important for early diagnosis.

Breast Ultrasonography;
Ultrasound is an imaging method obtained using sound waves. The images created by the reflection of sound waves on the screen evaluate the formations in the breast. With ultrasound, the solid or cystic distinction of the mass in the breast is made clearly. Since it does not contain radiation, it can be done as often and easily as desired. It is recommended for patients with dense breast tissue on mammography. It is one of the examination methods that requires the most experience. Experience and experience are important so that the findings are not overlooked and misinterpreted.

Magnetic Resonance (MR);
It is used to identify mammographic abnormalities. It is applied to high-risk women and women newly diagnosed with breast cancer. It may be preferred in patients with dense breasts who cannot be evaluated by mammography. If a mass can only be seen on MRI, a biopsy must be performed. A treated breast cancer can also be evaluated for recurrence.

Positron-Emission Tomography (PET);
It is a new and still ongoing cancer diagnosis method. In practice, the patient is given a radioactive substance. Cancer cells are cells that multiply faster than other cells. And these cancer cells retain the given radioactive substances earlier and faster. It is an imaging method that detects the location of a possible cancer cell with this method. With this imaging method, it is used to detect the spread (metastasis) of cancer and to detect whether there is cancer in the lymph nodes. It enables the patient to investigate the state of the cancer after chemotherapy and radiotherapy, which are part of the treatment. PET is not a preferred method over mammography and ultrasound. It is not used in breast cancer screening.

This imaging method, which has been used recently, can evaluate breast tissue in 3 dimensions. With this method, a large number of images are taken from different angles and it enables the 3-dimensional evaluation of the breast tissue in the form of millimetric sections, such as tomography with a computer system.

Treatment of breast cancer requires a multidisciplinary approach. Although surgical treatment is the first step of breast cancer treatment, other treatments may take priority depending on the size, spread and type of breast cancer of the tumor. Surgery and radiotherapy provide local control, while chemotherapy and hormone therapy provide systemic control. When deciding on treatment in breast cancer, all treatment options are discussed with the patient. Success in the treatment of breast cancer is related to catching the disease at an early stage. A good history should be taken from the patients, examination should be performed and necessary imaging methods should be performed. After all these are done, suitable patients should be diagnosed with biopsy. With all these, the staging of the disease is done. Staging is the process of determining the state of the disease at the time of diagnosis. Accordingly, it enables to decide on the treatment to be applied and the course of the disease after that.

It is the complete removal of breast tissue. Breast-conserving surgery is performed when it is not suitable. If the patient has axillary lymphatic involvement, removal of the entire breast and axillary lymph nodes is performed, which is called modified radical mastectomy.

Breast Conserving Surgery;
The main purpose of breast-conserving surgery is to treat breast cancer by providing a good cosmetic result after surgery. It is now considered the standard treatment for early-stage breast cancer. Increasing the awareness of patients with early diagnosis methods and catching the disease at an early stage enable breast-conserving surgery. Complete removal of the breast in patients causes anxiety, such as depression, emotional disorders, loss of sexual desire, decrease in body image, loss of femininity, and recurrence of the disease, along with psychological trauma. Breast-conserving surgery is a surgical procedure performed by preserving the breast and removing the cancerous part in case of acceptance of the patient, suitability of the breast and suitability of the tumor. In order to perform breast-conserving surgery, all surgical procedures must be explained to the patient and the patient must accept all treatments to be applied. The breast remaining after breast-conserving surgery should be aesthetically pleasing and the patient should be able to reach a center where he or she can receive absolute radiotherapy. Because after breast-conserving surgery, radiotherapy is absolutely necessary.

Sentinal Lymph Node Biopsy (SLNB);
The lymph flow in the breast is mostly towards the axillary lymph nodes. For this reason, the axillary lymph nodes are involved first. In breast cancer, the condition of the axillary lymph nodes makes staging, therefore treatment and follow-up important. The spread of the tumor to the armpit gland requires removal of the axillary lymph nodes. In the SLNB procedure, the blue dye (isosulfan blue or methylene blue) is injected alone or together with a radioactive substance (roll) into the area of ​​the tumor or under the nipple for 10-15 minutes, and when the axillary lymph nodes are reached, the blue dyed lymph nodes or radioactive material Involved lymph nodes are detected and the first (sentinel) lymph node in the armpit is found and removed. Sentinel lymph nodes may be more than 1. And these lymph nodes are removed and whether they contain tumor cells is determined by the pathology during the surgery. If the tumor cell is not seen, the process is terminated. If tumor cells are seen, the axillary lymph nodes are cleaned. Involvement of axillary lymph nodes is an important indicator of how the cancer will progress. In patients whose armpit lymph nodes are cleaned, it is necessary to protect that arm carefully for swelling (arm edema) that may occur in the arm. In order for the lymph nodes under the arm to be sampled correctly, an average of 10 lymph nodes must be removed. These patients should be protected from arm trauma and infection. The incidence of arm edema in SLNB is very low. The patient should definitely do physical exercise after the procedure. After this procedure in the armpit (cleaning the armpit lymph nodes), lymph fluid can be collected. For this, as long as it does not disturb the patient, there is no need for discharge.

Breast Reconstruction (Repair);
It has been shown that there are positive effects on the psychological state of the patients after this operation, and that they can be followed easily without any problems. There is no negative effect on the recurrence of the disease or the success of the treatment.
Breast reconstruction performed only with the patient’s own tissue is called autologous reconstruction. It is mainly done with samples taken from abdominal, hip, back and inner leg tissue. Apart from these, reconstruction with implant (repair with silicone) can be done. These are permanent, fixed breast implants or temporarily placed tissue expanders. The most widely used are permanent, fixed breast implants. These are silicone-enabled, gel-filled, rough-out prostheses. If the patient needs radiotherapy after the operation, it may not be a good option. In this process, if possible, the nipple is protected and the skin of the breast is protected, the entire breast is removed and the procedure is completed by placing a silicone breast prosthesis under the muscle or under the skin.

Risk Reducing Surgery;
Purpose of risk-reducing surgery; To reduce the risk of cancer in patients with a high risk of developing breast cancer by removing breast tissue before it develops. Today, the development of genetic diagnosis methods, understanding the familial transmission, revealing the genetic disorders that cause breast cancer, and calculating the probability of patients having breast cancer are to a large extent. For this type of patient, detailed genetic research should be done to make his selection. Then all details should be discussed with the patient and all question marks should be removed. In risk-reducing surgery, reconstruction with an implant (silicone) after 2-sided subcutaneous mastectomy allows the patient to both reduce the risk of breast cancer and continue his life with an aesthetic breast.

Radiotherapy (Radiation Therapy);
It is a form of treatment using X-rays. And it is done to provide local control of the tumor like surgery. It is used before or after surgery alone or in combination with chemotherapy. It is absolutely necessary to perform breast-conserving surgery in patients. Thus, it has been reported to reduce tumor recurrence. If the entire breast is removed (mastectomy), if the tumor is attached to the chest wall or breast skin, if the number of attached lymph nodes in the armpit is above 4, radiotherapy is recommended. Radiotherapy should be given within 6 months of the completion of surgical wound healing. The longer this period, the lower the chance of success. If chemotherapy is needed within this period, it can be waited for it to end or radiotherapy is given by interrupting chemotherapy, and then chemotherapy is continued. The purpose of radiotherapy is to prevent the cells in the treated area from growing and multiplying. During radiotherapy, normal cells are affected as well as cancer cells, but normal cells recover after treatment. If radiotherapy will be given to the armpit, there may be edema (swelling) in the arm. Radiotherapy can also be performed during surgery in appropriate centers.

Chemotherapy acts systemically on fast-growing cells such as tumor cells. And it is given to stop or destroy the growth of these cells. Chemotherapy can also be used as a single drug, or it usually takes place by administering more than one drug. The aim here is systemic treatment. Chemotherapy is the primary treatment modality in case of advanced disease (in the presence of metastases). Chemotherapy is started approximately 1 month after the operation. Wound healing must be completed. The preferred chemotherapy treatment consists of an average of 4-6 cycles. The average interval between each course is 2-3 weeks, and since chemotherapy adversely affects bone marrow and immunity, blood tests are performed before each treatment. The benefits of chemotherapy outweigh the risks. And any side effects that may occur are temporary.

Hormone drugs are given to patients who have completed their surgical treatment and chemotherapy, if sensitive, according to the status of estrogen and progesterone receptors studied from the tissues after surgery. This treatment is called hormone therapy. The main source of estrogen and progesterone hormones in the body are the ovaries. Since breast cancer is a hormone-sensitive cancer, treatment for these hormones has been found to be protective against breast cancer. For this reason, the most used drug is Tamoxifen. Aromatase Inhibitors are also used in addition to tamoxifen. The use of tamoxifen for protection is 5 years. The use of tamoxifen can cause menopause-like symptoms. Since long-term use may increase the risk of uterine cancer, its use is classified as 5 years. Aromatase Inhibitors given after menopause have side effects such as osteoporosis and joint pain. And these patients should be measured bone density, calcium supplemented, and physical therapy should be recommended.

Targeted Drugs;
These drugs work by a different mechanism than chemotherapy drugs, which attack all fast-growing cells, such as cancer cells. And it only attacks cancer cells. Therefore, they have fewer side effects.

Male Breast Cancer;
1% of all breast cancers occur in men. Familial transmission is important. It is seen 5-10 years older than women. The vast majority are cancers that develop from the canal. Nipple discharge is most often the first finding in male breast cancer. Clinically, 90% of patients have a painless, unilateral, firm mass behind the nipple. Its treatment (surgical and medical) is the same as for women.

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