Dr. Jayanthi Ramdas

A mastectomy is surgical removal of a breast. The surgery depends on various factors and choosing a type of mastectomy best suited for an individual suffering from breast cancer requires experience and expertise. With advancing technology, there are more options available for women to opt for surgeries, which are minimally invasive and conserving in nature. Following are the various types of mastectomies and the factors, which influence them:

Types of Mastectomies

1. Total or simple mastectomy

This is a surgical procedure which involves complete removal of the breast including the nipple. The lymph nodes, which are small glands, are an important part of your immune system and are kept intact during the surgery. This form of surgery is most suitable if the cancer has not spread to the lymph nodes.

2. Preventive mastectomy

Preventive mastectomy, also known as prophylactic mastectomy, is an option for women who have a high risk of developing breast cancer. Preventive mastectomy reduces the risk of breast cancer by a huge margin. In certain cases, removal of the entire breast along with the nipple is advisable. Women who develop cancer on one breast often opt for preventive mastectomy and remove the other unaffected breast as well.

3. Partial mastectomy

Women who are in stage I or stage ii of breast cancer can choose this procedure. It is a breast conserving technique where the tumor is removed along with the tissue that surrounds it. It is followed up by radiation therapy on the remaining breast tissue, which terminates the cancer cells and stops them from spreading. There are two types of partial mastectomy, namely, lumpectomy and quadrantectomy.

4. Radical mastectomy

Although this procedure is almost out of use, it is still considered in case the cancer has spread to certain areas like the chest muscle. In this form of surgery, the breast is removed entirety along with muscles beneath it and the lymph nodes.

5. Modified mastectomy

It is a more commonly used procedure characterized by complete removal of the breast including underarm lymph nodes. The chest muscles are untouched in the procedure, therefore allowing a breast reconstruction to follow.

Factors influencing the type of mastectomy:

• Age of the individual

• Health in general

• Size of the tumor

• The spread of the tumor

• The rate of progression of the tumor

• Whether lymph nodes are affected or not. If you wish to discuss about any specific problem, you can consult a Gynaecologist.

Undergoing Brain Surgery can be a very traumatic experience, and it is common for many patients recovering from brain surgery to face sequelae like headaches, spells of dizziness, confusion or weakness post the surgery. Depression is common. It is very critical that family members and friends talk to the patient and be understanding and empathetic towards them. 

It takes approximately 6 months to many years for the brain to heal after a brain surgery. The patient regains his functions slowly and should get back to his daily routine gradually. He has to adjust with residual neurological deficits if any. However in that time they need the complete support and understanding of their families, as well may need help from therapists. This will help the patient in gaining back their independence as well as confidence in their abilities. 

Here are some tips that will help you deal with a patient recovering from Brain Surgery: 

1. After brain surgery, a person may feel disoriented and have some speech or understanding problems for a while. Family members and friends are advised to take pause when talking to the patient, so that he/she can easily understand the conversation. Speaking slowly is not recommended, as patients may recognize it and have an emotional outburst or feel hurt. 
2. Caretakers and family members should also keep reminding the conversation topic at different points to the patient, so that it is easier for them to participate in the conversation. 
3. Family members should also not react adversely in case of emotional outbursts, instead show love and patience to a person recovering from brain surgery. 
4. Caregivers should make sure that the person recovering from brain surgery gets enough sleep and rest to recuperate. He should not be overwhelmed by emotional and sensory burden of anxious relatives. 
5. People interacting with someone recovering from brain surgery should understand that the person's ability to learn and remember will improve daily, and any lapses in attention by the patient are not caused by any act of obstinacy. Your care and understanding will be essential for a person to recover. 
6. Family members should also make sure just to give enough care and not smother the brain surgery survivor. It is essential for them to regain their confidence and a sense of competence. 

Family members should take the patient for a neuropsychological assessment after treatment 6 months later, and a year later to see if they are recovering properly. Caregivers should watch out for emotional outbursts, like rage, uncontrollable laughter, withdrawal and depression. In case of such symptoms it is advisable to take the patient for a check up with medical practitioner.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Diabetes alters the metabolism and functioning of almost entire body system. The most important targets are the circulatory and nervous system, leading to peripheral vascular disease and neuropathy. Diabetic foot is the result of a combination of these two factors in the feet – altered/reduced blood flow to the feet combined with reduced sensation.

1. Neuropathy: When the sugar levels are poorly controlled, then the nerves in the legs are damaged, leading to reduced or absence of sensation. The patient cannot feel pain/heat/cold. Sensory neuropathy causes loss of protective sennsation leaving the foot at risk to repetative unnoticed trauma.
2. Peripheral vascular disease: The blood vessels which are away from the heart are affected, leading to poor blood flow from the legs to the heart. Proper blood flow is essential for overall health, and when this is affected, the peripheral foot health is affected.

Some of the common foot problems encountered in diabetics are listed below:

1. Fungal infections: Whether a person wears shoes regularly or not, they become more prone to fungal infections. The nails become discoloured, brittle, and break off. They are difficult to treat and may require oral medications.
2. Ulcers: Diabetic ulcers are very common. The combined effect of reduced sensation and reduced blood flow leads to ulcers, which are not painful (due to lack of sensation) and therefore are ignored and not treated promptly. They can progress and become severe, even sometimes leading to amputation. Fungal ulcer are most common in between toes and in creases of a diabetic patients
3. Corns: Diabetics are more prone to develop corns which are thick masses of skin near the bony area of a toe. This could be in areas where the shoes rub against the toes or between the toes where there is a lot of friction. Home care includes smoothing it with a pumice stone. The person should not try to remove them on their own.  Warts, bunions, ingrown toenails, hammertoes, etc., are also very common in diabetics.

Prevention/Treatment:

1. The first and most important step is to monitor and regulate the blood sugar levels within ranges ideal for you.
2. Warm water to be used for washing feet, and then to be dried well, to not leave a moist area between toes
3. Regular feet care to check for blisters, ulcers, wounds, etc.
4. Check toenails for overall health
5. Preferably wear closed toe shoes
6. Wear stockings or socks and shoes that fit well
7. Moisturise the skin well to avoid drying
8. Avoid exposing feet to extreme weather
9. Quit smoking
10. Ensure blood flow is maintained by not standing or sitting for prolonged periods and with regular exercise

If you wish to discuss about any specific problem, you can consult a doctor.

A Lower Body Lift is also called a belt lipectomy, is an increasingly popular type of surgery. The aim of this surgery is to eliminate or improve excessive or sagging of thigh and buttock skin from the area. This surgery is mostly opted to enhance the physical appearance and is becoming increasingly popular these days.

Causes to undergo Lower Body Lift:

1. A Lower body lift may be undergone when, due to extreme weight loss or advanced age, the skin in the buttocks, thighs and abdomen becomes loose and appears to be sagging 
2. Apart from loosening the skin, weight loss can also make the buttocks & thighs and abdomen look deformed or de-shaped. In that case, a Lower Body Lift helps the patient correct the area.

Lower body lift are most likely to be successful when: 

1. The layers of fat beneath the skin of the patient are relatively thin. 
2. The patient does not smoke, as smoking slows down the healing process and also increases the risk of post surgery complications. 
3. The patient's weight does not fluctuate a lot. He or she must have stable weight for at least a year before the surgery. 
4. The overall health of the patient is good, and he or she does not suffer from chronic medical conditions.

How is the surgery performed? 

1. Depending on the body type and other condition of the patient, the doctors make a circumferential incision at the waist or slightly below that area. 
2. After that, the excess fat or skin is removed from the soft tissue that is present there. Following this, the skin is closed up in layers and tightened.

Things to keep in mind before the surgery:

1. It may take a few months to recover fully, post surgery
2. Weight gain or loss in the future may affect the results of the surgery

In case you have a concern or query you can always consult an expert & get answers to your questions!