Dr. Ilker Murat Arer

Simple cysts or fibrocysts and fibroadenomas are the benign lesions of the breast. They have no malignant potential but need close follow-up. They are usually controlled for every 6 months with physical examination and radiological evaluation (Breast ultrasound usually). Some cysts and fibroadenomas need core biopsy or surgical excision. This decision is made upon advise of Breast Surgeon. 

Breast cancer is the most COMMON cancer type seen in women. It is seen in one of 8 women over 40 years of age. It spreads the body through lymphatic and vascular route. There are some risk factors for breast cancer; 

- Obese or overweight

- Unable to do daily physical activity

- Alcohol and cigarette consumption

- First birth over 30 years of age or nulliparity

- Early menarche

- Late menopause

- Female sex, old age

- BRCA-1, BRCA-2 mutations

- History of breast cancer

- Radiotherapy to the chest

- Family history of breast cancer

- Hormone replacement therapy

Symptoms of Breast cancer;

- Mastalgia (%2,60) 

- Lump in the axilla (%0,94) 

- Skin changes (%1,21) 

- Lump in the breast (%89,91) 

- Nipple discharge (%1,06) 

- No complaint but diagnosed with screening mammography (%4,2)

- Routine annual physical examination (Breast Surgeon)

- Annual Mammography >40 years and Breast ultrasound < 40 years

- Self breast examination

Treatment of Breast cancer is in combination of chemotherapy, radiotherapy and surgery. Every patient should be managed individually. Expectations of the patient and postsurgical results are evaluated. Oncoplastic surgery can be performed with acceptable aesthetic results. Silicone prosthesis or musculocutaneous flaps can be used to replace breast tissue. Some patients recieve Neoadjuvant chemotherapy before the operation. For more info please contact your physician.

 What is Obesity?

We call obesity to have more fatty tissue in our body than it should. In obesity, if there is a general fat accumulation in the body, especially if the fat accumulates around the abdomen, we call it central obesity or visceral obesity. Central obesity is the most dangerous form of obesity, and in the case of prolonged central obesity, it is almost always associated with diseases such as diabetes, hypertension, sleep apnea, dyslipidemia, ie high blood fats, and fatty liver.

Obesity is a preventable or curable disease and obesity is one of the most important causes of preventable death.

How is Obesity measured?

Although there are different calculation methods, the most widely accepted obesity calculation method in the world is the Body Mass Index calculation. In this calculation, your weight in kg is divided by the square of your height in meters (kg / m2) and a value is obtained. If your body mass index (BMI) value is 30 and above, you are in the obesity group and you have to do something to solve this problem!

Why is Obesity so dangerous?

Today, obesity is accepted as a disease alone and it is one of the elements of a very dangerous syndrome called Metabolic Syndrome. The most common components of metabolic syndrome are; central obesity, type 2 diabetes or insulin resistance, dyslipidemia and hypertension. In addition to being a part of the metabolic syndrome, obesity is the main factor that constitutes the metabolic syndrome. Most of the patients who are obese for a long time will develop very serious and life-threatening problems such as diabetes, blood pressure and blood fat disorder.

What are the treatment modalities for Obesity?

The easiest treatment of obesity is prevention of obesity, that is, never encountering this problem, but unfortunately the wrong eating habits, not doing sports, not having access to exercise opportunities, not having access to healthy and natural food, sedentary life, excessive TV watching, rupture from nature, depression, parental unconsciousness, parental obesity and it is no longer unlikely that obesity is a problem due to certain genetic conditions.

If we are experiencing obesity problems, the first thing to do is always to get used to the right diet, to reduce calorie intake and to increase calorie consumption as soon as possible and to take steps in this direction.

In cases where exercise and diet precautions do not work, our patients with obesity problems should never be despaired and should turn to other treatments. There are non-surgical and surgical treatments of obesity.

As non-surgical treatment, drug therapies (GLP Analogs), non-surgical therapies such as gastric balloon, gastric botox, constitute surgical treatments of obesity; tube stomach surgery (gastric reduction), gastric bypass, sadi, sadi S, duodenal switch creates many operations such as. In the surgical treatment of obesity in the world and in Turkey, the most commonly used method is Gastric Sleeve Surgery ( Sleeve gastrectomy )

What is the surgical treatment of Obesity?

Surgical treatment options for obesity are Gastric Sleeve Surgery, Gastric Bypass,Mmini Gatsric Bypass, Sadi, Duodenal switch. In all of these surgeries, the stomach needs to be reduced to a certain extent. This reduces stomach volume and low calorie intake due to early saturation, and another effect of obesity surgery is a significant reduction in appetite. Nowadays, the most common surgical obesity treatment in the world and in our country is Gastric Sleeve Surgery.

What is Gastric Sleeve Surgery ?

Vertical Sleeve Gastrectomy is based on the principle of vertically reducing the stomach by 75-80% and turning it into a tube. By reducing the stomach after  Gastric Sleeve Surgery, the volume is reduced and much less caloric intake is provided, so that the patient enters a rapid weight loss process after the operation. In addition, a portion of the stomach, called the Fundus, is removed during the reduction of the stomach. It is known as the appetite center because of the appetite hormone Ghrelin secreted by the Fundus. Since the Fundus is removed, the appetite decreases after gastric surgery and the appetite control is very easy, in this way the weight loss is very easy.

Who are candidates for Gastric Sleeve Surgery?

Gatsric Sleeve Surgery is not an aesthetic surgery but a surgical obesity treatment, so for the purpose of performing Gastric Sleeve Surgery, the patient must be included in the obesity group and could not lose weight with exercise and diet before. Patients with a body mass index of 35 and an additional chronic disease, or patients with morbid obesity with a body mass index of 40 or more, are eligible for Gastric Sleeve Suregry or other kinds of bariatric surgeries.

How is Gastric Sleeve Surgery performed?

Gastric Sleeve Surgery is performed by laparoscopic method under general anesthesia via 4 millimetric incisions.In this operation a HD camera called laparoscope and laparoscopic hand tools are used, the stomach reduction process is applied with a special tool called stapler. In Gastric Sleeve Surgery, the stomach is reduced by 75-80% and the appetite center of the stomach called Fundus is removed. Laparoscopic Gastric Sleeve Surgery is an operation that lasts approximately 60 minutes, patients stay in hospital 2 nights and 3 days after surgery. After the surgery, firstly water and then liquid diet is started, depending on the bowel movements and the patient's readiness, foods such as soup, yogurt and sugar-free protein pudding are started gradually.

How does Gastric Sleeve Surgery work?

Gatsric Sleeve Surgery is a restrictive bariatric operation. In this type of bariatric surgery the size of the stomach is reduced by reducing the volume of the stomach by 80%. The reduced stomach becomes more easily saturated with food, so caloric intake will be severely reduced, and the appetite-reducing effect of the gastric sleeve surgery is evident, as the stomach called the fundus is removed. Decreased appetite will be a very  effective element in weight control.

Benefits of Gastric Sleeve Surgery

In the group with indication, that is, obesity patients who need bariatric surgery because of having very high body mass index, Gastric Sleeve Surgery has an effect that prolongs life, improves quality of life. Gastric Sleeve Surgery treats or alleviates metabolic syndrome, treats or alleviates 2 diabetes, improves psychology, improves, facilitates and improves social life. Although having many aesthehtic results, It should not be forgotten that Gastric Sleeve Surgery is never an aesthetic surgery.

Risks of Gastric Sleeve Surgery and complication reduction strategies

Gastric Sleeve Surgery is not a miracle but is a very effective surgical obesity treatment, so as in every surgery, there are some risks. Some of these risks may be caused by surgery and some of them may be caused by anesthesia and some of them may be caused by the patient's obesity and metabolic syndrome. General risks of the gastric sleeve surgery are; infection, deep vein thrombosis, embolism, bleeding, gastric leak and anesthesia based risks. Although it is not possible to reduce these risks to zero, it is possible to reduce them significantly. A good and detailed preoperative preperation, the initiation of the necessary behavioral or drug treatment beforehand, the cessation of smoking and alcohol, the patient education and awareness, the use of high quality materials during the operation, the use of high-quality hospital with an adequate level of intensive care unit, the use of bio- adhesive materials or manual re-suturing method to the incision line, embolic prophylaxis, lung exercise, and, if any, pre-treatment of diseases such as Asthma and COPD are some of the risk reduction measures.

 What is a gastric balloon?

A gastric balloon is a soft, smooth, durable balloon made of silicone rubber. It is designed to be placed in the stomach to reduce its capacity and help you feel full with less food.

The deflated balloon is inserted through the mouth and into the stomach by a doctor using an endoscope (a thin, flexible tube).

The balloon is then filled with saline solution (saltwater) to occupy space in the stomach, leaving less room for large amounts of food and drink. The idea is to help you feel full faster after eating smaller meals, and maintain that feeling of fullness longer so you are less hungry between meals.

Who may be a candidate for a stomach balloon?

A gastric balloon procedure may be a weight loss option for some adults who:

- Have a body mass index (BMI) of 30 to 40 — BMI reflects the relationship between a person’s weight and height. A BMI of 30 or above is a sign of obesity. The procedure may be recommended for people with a BMI higher or lower than 30 to 40 in some circumstances.

- Have not been able to lose weight with diet, lifestyle modifications and medications

- Prefer a less invasive alternative to anatomy-changing bariatric surgery

If your doctor recommends losing weight before a planned surgery, such as joint replacement, or to assist with fertility, a gastric balloon can help you achieve the desired weight in a relatively short period of time.

What happens during the gastric balloon procedure?

The minimally invasive, outpatient procedure to insert the gastric balloon with an endoscope takes about 15 to 20 minutes, and is performed in an endoscopy center.

To place the balloon in the stomach, the doctor uses a flexible, narrow tube-like camera device, equipped with lights, that is called an endoscope.

You are sedated, so you are very sleepy and comfortable. Once you are under sedation, you lie on your side while the doctor performs the procedure.. 

- The doctor inserts the endoscope into the mouth and carefully examines your esophagus, stomach and small bowel to ensure there is nothing that would make having a gastric balloon unsafe, such as a large hiatal hernia or stomach ulcer.

- If everything looks normal, a narrow tube called a catheter is inserted alongside the endoscope. The deflated balloon is attached to the end of the catheter.

- The endoscope guides the catheter through the esophagus and into the stomach.

- Once the balloon is in place, it is filled with saline through the catheter until the balloon is about the size of a grapefruit.

- The doctor uses the endoscope to detach the catheter from the balloon, which seals itself with a valve.

- The doctor withdraws the endoscope and catheter, leaving the filled balloon behind in the stomach.