Psychological respect for patients with breast cancer using radial incision which gives better cosmetic outcome after conservative breast surgery

Abstract

Background Breast cancer is considered as one of the most common cancers affecting women, and remains one of the world's biggest killers. Once diagnosed as a breast cancer patient, a woman can be exposed to psychological trauma that is manifested as stress, anxiety, and even depression. Since surgery is the most important part of breast cancer management protocol, the first time a woman looks to her body after surgery can be harmful. Despite this gloomy picture, there have been some dramatic modifications recently in the treatment of breast cancer, especially in early detected tumors. One of them is the clear shift towards more conserving surgeries that preserve an appreciable part of the breast mass. However, although breast-conserving surgery (BCS) is a good option in the treatment of breast cancer that helps to improve a patient's psychological situation, it has also its side effects, which includes pain, tenderness, tugging sensation in the breast, temporary swelling, or a change in the shape and contour of the remaining breast, together with change in the position of the nipple–areola complex, compared to the other side. Aims In this study, our main concern was how to make female cancer patients satisfied after surgical intervention, to respect their feelings, by not leaving them shy of their bodies for the rest of their lives. Here, the proposed surgical technique helps to achieve the best oncoplastic outcome for the breast shape and contour after surgery and to keep the most possible similarity between the affected breast and the intact one. From different types of skin incisions used in BCS, we chose the elliptical radial skin incision, which gives the best cosmetic configuration. This deeply helps to overcome the psychological trauma affecting these patients, which in turn improves their quality of life. Patients and methods In this study, 23 female patients with early breast cancer, were selected and categorized as stages I, II, and IIa breast cancer. Tumors were located at the supra-areolar region (upper outer and upper inner quadrants), and far from the nipple–areola complex. All patients fulfilled the criteria to undergo BCS, and also they refused any kind of breast reconstruction. The proposed surgical technique includes several steps: elliptical radial skin incision is used in all patients, with or without separate incision for axillary lymph node clearance, according to the tumor location; closure of the dead space after wide local excision, along its vertical axis of the wound, together with subcuticular skin closure. Conclusion We conclude that using this technique, especially in patients with pendulous breast gives a very satisfactory cosmetic outcome to both the patient and the surgeon, which decreases the severity of psychological trauma affecting these patients, and consequently improves their quality of life.

Keywords

• breast cancer
• cosmetic outcome
• radial incision