Surgery is undoubtedly the most important step in the treatment of breast cancer. As a patient, it seems that you are always helpless because how the surgery is done happens in the operating room, and it is impossible for the patient to have the opportunity to see how the surgery is done, let alone understand how to evaluate the high or low level of a surgery. All that can be done is to be confused and left to fend for themselves, and to find someone with a big head who thinks it’s not far off.
This is unfair. Information asymmetry is the reason for doctor-patient conflicts.
So as a patient how do you know if the surgery is good or bad?
Actually, a good surgery does not need too much talk, even a layman can understand it. As breast cancer surgery, one can look at the following aspects.
Time of surgery
However, it is an old experience that “the quickest radish does not wash the mud” and “slow work makes fine work”, so maybe a radical breast cancer surgery takes one hour, maybe a slow one takes three hours, but the quality may be similar. But if you can do eight surgeries in eight hours a day, and take away the anesthesia time, each surgery takes less than an hour, it is undoubtedly a shoddy job.
If the patients are like a herd of pigs blown in like a herd to do surgery, then the quality of surgery is obviously very poor. Nowadays, surgery is no longer the era of pursuing speed, how to remove the tumor exquisitely and cleanly, reduce side injuries, accelerate postoperative healing and prevent complications is the goal pursued by modern surgery.
A surgeon who pursues one surgery in twenty minutes is no different from a pig killer – but which patient wants to be operated on by a surgeon like a pig? The operating room is the studio of the doctor’s artistry!
Look at the skin
A good radical breast cancer surgery will not have significant skin flap necrosis. Skin necrosis may be inevitable in slightly more advanced patients due to excessive skin excision, but the average breast cancer under 5 cm is less likely to have skin necrosis due to excessive skin excision.
Rough surgery often leads to necrosis of the skin flap because the flap is not separated evenly enough or the knife is not used skillfully enough. The effect on the patient is that the necrotic skin often takes a long time to heal, during which time you cannot shower, and after healing the skin feels allergic, afraid of pressure and touching, and it hurts to wear clothes.
In terms of details, making a scarless suture, a small incision, is also a comfort to the patient’s soul and humanistic care for the patient.
Look at the drainage
After breast cancer surgery (axillary clearance or mastectomy), all carry 1-2 drains, and generally good surgical drains are removed in 3-5 days. In some cases, it takes several months to heal and the patient suffers a lot. The amount of drainage fluid is related to factors such as the patient being fat or thin, whether or not they have diabetes, etc. There are also individualized differences.
If a doctor removes the tube in about 4 days for most patients, and occasionally there are a few patients with a long tube, it can be said to be an individual difference, but if, throughout the ward, patients generally have a tube for more than a week, that is a technical problem.
Look at the lymph nodes
We say “the skin is the face, the axilla is the conscience”. When the axilla should be cleared but is not cleared, it can indeed create the illusion of less drainage, but unclear axillary clearance is a more frightening thing than long drainage time, because it may be related to recurrence. So how much of the axilla should be cleared?
For patients who should have their lymph nodes cleared, 10 is the minimum standard. Our hospital controls over 20, and the current average is 30, because only such a clearance can ensure a clean clearance with no lymph nodes remaining, and facilitate the correct formulation of a comprehensive treatment plan.
Are axillae individualized anymore
The American College of Surgeons released seven surgical errors this year, the first of which is “performing axillary lymph node dissection in patients with negative or unknown axillary lymph node status”. In other words, when there is no tumor metastasis in the axillary lymph nodes, only the anterior lymph nodes should be cut and the axilla should be preserved, not blindly.
In contrast, for patients with positive axillary lymph nodes and tumor involvement, we should try our best to clear the axillary lymph nodes as soon as possible, and the criteria, as I have just mentioned, are generally more than 20, with an average of 30 and some more than 40.
Although the number of axillary lymph nodes is different for each person and there is a large individualized difference, if most of the patients in the whole ward have more than 30 lymph nodes cleared, and occasionally there are a few dozen, that is an individualized difference, if the whole ward is generally cleared with more than a dozen lymph nodes, that is a technical problem.
If there is lymph node metastasis, the clearance is necessary for the condition and is a natural disaster, if there is no lymph node metastasis, the clearance is a man-made disaster – preserving the axilla for patients with negative axillary lymph nodes is caring for the patient, and clearing the axillary lymph nodes for patients with positive axillary lymph nodes is responsible for the patient.
Are breast-conserving attempts made for those who can preserve their breasts?
Breasts are undoubtedly one of the sources of a woman’s self-confidence, and preserving them for patients who can preserve them is caring for the patient. However, breast conservation takes time and effort. A shoddy surgeon who wants to make more money is quicker, but does not have the time or interest to give you breast conservation.
It is impossible to ask such a surgeon to carefully design a treatment plan for you, to preserve your breasts, and to do breast reconstruction if breast preservation is not successful.
Function of the arm after surgery
A good breast cancer surgery, even a radical one, with twenty days of post-operative exercises and driving is not too much of a problem, and a crude one three months after the surgery the arm is not intended too to be as high as the opposite side, and it is often edematous.
If it is caring and respectful for patients with uninvolved axillary lymph nodes to take the time to do surgery that preserves the axilla, it is responsible and caring for patients who must have their axilla removed when enough lymph nodes are cleared without significant dysfunction of the upper extremity!
Look at the axilla
As already stated above, the axilla needs to be individualized, but how can patients with axillary preservation and axillary clearance tell? This is also easy. If the surgery is done to preserve the axilla, but the axilla is deflated, even if only 4 lymph nodes are taken, it is still an axillary clearance, but it is just a botched clearance.
If it is an axillary sweep, as I said earlier, it needs to be a clean sweep, the axilla must be deflated and deeply depressed, usually a depression about 5-10 cm deep, if the axillary sweep is finished and the result is a flat axilla without a 5-10 cm deep depression, then obviously the sweep is not in place.
It is good to keep the axilla well said, after axillary clearance patients, often see in other hospitals on the pathology sheet written only a dozen lymph nodes cleared, the result is the axilla is flat, and there is not a 5-10 cm depression, then at this time the layman can also see that this one axillary clearance is not high quality.