Breast cancer

It is usually not possible to answer why normal tissue degenerates in individual cases. It is assumed that various factors, biological and genetic predispositions, but also environmental parameters (lifestyle, environmental influences) interact to cause the disease. Breast cancer does not normally cause pain or other typical symptoms.

The following symptoms could be an indication of breast cancer and must therefore be investigated further:

• Newly appearing hard lumps in the breast
• Skin retractions on the breast or nipple
• New difference in the size of the breasts
• Beginning depression of the nipple
• Inflammation or reddening of the nipple in women who are not breastfeeding
• Leakage of fluid from the nipple (especially if the secretion is bloody)

Enlarged lymph glands in the armpits

Don't be alarmed if you experience one or more of these symptoms. This does not mean that you have breast cancer. But don't put off going to the doctor. Early detection of breast cancer significantly improves the chances of successful treatment.

Patients with an increased risk of breast cancer

In some families, breast cancer occurs more frequently and at an early age, sometimes paired with ovarian cancer, or there are also cases of breast cancer in male family members. If a genetic test can prove that the predisposition to the disease is inherited in these families, it is referred to as genetic or hereditary breast cancer. These families are known as high-risk families. They are carriers of the disease-causing gene BRCA1 or BRCA2. In such cases, precautionary breast removal with immediate breast reconstruction is recommended. We will be happy to advise you and help you to clarify whether you are at increased risk and which measures would be beneficial in your case.

Breast cancer develops when originally normal cells of the glandular tissue, which consists of so-called glandular lobules or milk ducts, degenerate malignantly. This results in uncontrolled and rapid growth. Over time, firm, irregular lumps form on the surface, which can be palpated by hand.

If breast cancer is suspected, a mammogram and an ultrasound examination are carried out for further clarification. If the type of change cannot be satisfactorily clarified with this, a fine needle aspiration (removal of individual cells), a punch biopsy (removal of a piece of tissue) or magnetic resonance imaging are also carried out.

Mammography

Mammography is a special X-ray examination of the breast and is part of the standard investigations. It images the glandular tissue in two to three planes. In this way, the radiologist can recognise subtle differences in the density and composition of the tissue. Even the smallest calcium deposits, which are often the first indication of breast cancer, can be detected. For the images, the breast is placed between the X-ray tube and the film table and carefully pressed together.

Ultrasound

An ultrasound examination is also carried out to confirm mammography findings. This provides the doctor with two-dimensional images that give him a spatial idea of the size, shape, structure and composition of the breast as well as the soft tissue and blood vessels.

MRI

MRI, also known as magnetic resonance imaging, is a technique for visualising internal organs and tissue. It works with magnetic fields and radio waves. During the examination, the patient lies on a couch in the machine. The advantage of this technique is that it provides a very precise and differentiated visualisation of the body tissue. Even minor changes can be detected in this way. Magnetic resonance imaging is therefore used for unclear breast cancer diagnoses.

Fine needle aspiration

Fine needle aspiration is a technique for obtaining cell material from specific tissue areas. The doctor uses a hollow needle to puncture the tissue from which he wants to take a sample. Experienced cytologists can make a relatively precise cell classification during the microscopic examination in the laboratory and thus confirm suspected diagnoses from the previous investigations.

Punch biopsy

In the case of a punch biopsy, pieces of tissue are removed and examined using a thin cylinder, usually guided by ultrasound. This method is somewhat more painful but more informative than fine needle aspiration and is therefore used if the findings of the previous examinations remain unclear.

The diagnosis of breast cancer causes great uncertainty and despair. The initial shock is quickly followed by existential fears: How bad is my condition? Can my cancer be cured? Will I have to undergo stressful chemotherapy? Will I lose my breast?

These feelings of being overwhelmed and helpless are understandable, but despite all the fear, you must not forget: Breast cancer is curable in the majority of cases if it is recognised in time and treated correctly.

The most important principle in the event of a malignant finding is to remain calm and not make any hasty decisions. You have enough time to clarify your individual situation, examine all medical options and be clear about your needs.

If in doubt, get a second opinion from an onco-plastic surgeon and take someone you trust with you to the consultations. Despite all your fears, you must not forget: Breast cancer is curable in the majority of cases if it is recognised in good time and treated correctly.

The three goals of the right breast cancer treatment

The most important thing in any breast cancer treatment is always the complete removal of the tumour. If this is not possible and the breast has to be completely removed, patients should be given as clear a picture as possible of their options by seeking comprehensive advice and information. Even if action has to be taken quickly: There is enough time for a careful assessment and weighing up the pros and cons of the various treatment options. The right breast cancer treatment is the one that 1) is the most effective oncologically; 2) achieves the best cosmetic result and 3) leads to the goal, the end of treatment, as quickly as possible without detours and unnecessary operations.

Remember:

• Breast cancer is not an emergency! Don't rush into anything.
• You have enough time for a thorough investigation! Do not make any hasty decisions.
• Inform yourself thoroughly.

Does breast cancer mean that the breast has to be removed?

Whether a breast needs to be partially or completely removed depends on the size and type of tumour. In the majority of cases, breast-conserving surgery is possible, i.e. only the affected part needs to be removed. However, in the case of large or multiple tumours, complete removal of the breast is usually unavoidable. In these cases, we offer immediate reconstruction with autologous or foreign tissue in the same operation to restore the woman's physical integrity.

Breast conservation or breast removal?

Thanks to a better understanding of tumour biology, the balance in the treatment of breast cancer has shifted more and more in favour of breast-conserving therapies. Nevertheless, complete breast removal (mastectomy) is unavoidable in around a third of all patients or is preferable to the breast-conserving technique for aesthetic reasons.

Following an operation, an examination and assessment by an oncologist will take place during the wound healing follow-up period based on the detailed tissue examinations that are now available. The oncologist will assess whether additional therapy is indicated. Various chemotherapies and therapies that act on hormone receptors may be considered. Then there is the question of whether radiotherapy is indicated. In the case of breast-conserving surgery, radiotherapy is usually carried out in any case. Whether radiotherapy is also indicated for breast removal depends on the stage and any lymph node involvement. Radiotherapy is always carried out after chemotherapy has been completed.

The treatment of breast cancer is a service covered by health insurance. However, we have found that in certain cases there can be problems with the reimbursement of costs if subsequent reconstructive surgery or symmetrisation surgery on the opposite breast is rejected by the health insurance company on the grounds that the treatment is purely cosmetic. In such cases, our doctors will, of course, advocate on your behalf.

In the event of inpatient treatment at Privatklinik Bethanien, please note that it does not have a general ward and that you will therefore require private or semi-private supplementary hospital insurance if all treatment costs are to be covered by your insurance. With an upgrade, which we calculate individually, patients with general insurance can also be treated at our clinic.

Our patient administration department will be happy to provide you with information on the exact conditions and payment modalities.

The preventive examination is also guaranteed if an implant is present. Ultrasound and MRI are particularly suitable for this purpose.

Today, this can clearly be denied. Scientific studies have shown that breast reconstruction has no negative influence on the prognosis.

In the majority of cases, a cure is possible: with early diagnosis and correct treatment, the chances of recovery are even over 90 per cent. However, the actual chances of recovery depend on the type of tumour and its stage of growth. Unfortunately, a relapse - even many years after treatment - or the appearance of a new tumour can never be completely ruled out. However, the prospect of a continued high quality of life is very good thanks to today's treatment methods.