Reiland-Smith Juliann
Sanford School of Medicine, The University of South Dakota, USA.
S D Med. 2010;Spec No:31-7.
Counseling a woman about surgical treatment of breast cancer is both challenging and rewarding. The layperson's view of breast cancer surgery is that it is disfiguring, if not mutilating. Today's newer approaches are neither, and informing the patient of these options can relieve anxiety, improve outlook and help maintain the patient's self image. The surgical options for diagnosis and treatment of breast cancer are evolving. Minimally invasive biopsy techniques, (core needle biopsy) are becoming the standard for the diagnosis of breast cancer, replacing open surgical biopsy with its increased cost and large surgical scars. Sentinal lymph node biopsy is now considered the standard of care in evaluation of lymph nodes, compared to axillary lymph node clearance. Oncoplastic surgery improves cosmesis after breast conservation (lumpectomy). Skin sparing, areolar sparing, and nipple sparing mastectomies are becoming common approaches to mastectomy with reconstruction. Immediate reconstruction after mastectomy is now routinely performed with implants or autologous tissue. This article reviews these surgical approaches and will allow the primary care provider a better understanding and ability to counsel their patients in the options for surgical treatment of breast cancer.
就乳腺癌的手术治疗向女性提供咨询既具有挑战性又有意义。外行人对乳腺癌手术的看法是，它即便不是致残性的，也是毁容性的。而如今的新方法并非如此，告知患者这些选择可以缓解焦虑、改善前景并有助于维持患者的自我形象。乳腺癌诊断和治疗的手术选择正在不断发展。微创活检技术（粗针活检）正成为乳腺癌诊断的标准方法，取代了成本更高且会留下大手术疤痕的开放性手术活检。与腋窝淋巴结清扫相比，前哨淋巴结活检现在被认为是评估淋巴结的标准治疗方法。肿瘤整形手术可改善保乳术（肿块切除术）后的美容效果。保留皮肤、乳晕和乳头的乳房切除术正成为乳房切除并重建的常见方法。乳房切除术后即刻重建现在通常使用植入物或自体组织进行。本文回顾了这些手术方法，将使初级保健提供者更好地理解并能够就乳腺癌手术治疗的选择为患者提供咨询。
