Natural Health and Herbal Remedies Blog

Because ‘-otomy’ means cutting a hole into, you could think of this as cutting a hole in your lap. It is the name given to the operation surgeons use to explore and treat the abdomen and pelvis.

Aims and indications. It may be performed for a variety of reasons, usually diagnostic and/or therapeutic. In gynaecology, a woman may undergo a laparotomy in order to have any of her pelvic organs examined or operated on, for example removal of an ovarian cyst, microsurgery on the fallopian tubes, assessment of the spread of ovarian cancer after treatment, etc.

Method. A general anaesthetic is given, and a cut is made on the abdomen. In gynaecological surgery, this is usually along what is known as the ‘bikini line’, just above the pubic hair (which has been shaved to make for cleaner, easier surgery). Surgeons love giving things names, and this cut is actually known as the Pfannenstiel incision, presumably after Dr Pfannenstiel. The various layers are carefully cut and dissected (skin, fat, muscle, peritoneum), so the organs inside are visible, and whatever needs to be done is done, then the whole opening up routine is reversed, layer upon layer. Women need to stay in hospital for a few days after the operation.

Complications. These would vary according to the reason for the laparotomy, who is performing it, and who is having it done to them. Any surgery carries with it risks, such as bleeding and infection, and anaesthetic-associated risks.

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The treatment of breast cancer has changed dramatically over the last fifty years. Extensive surgery used to be routine, and was generally quite disfiguring. The trend now is for less extensive surgery, combined with other cancer treatments, like radiotherapy and chemotherapy.

Assessing the stage of the cancer is important in not only giving some idea of prognosis, but also in planning treatment, as the suggested options vary depending on the size of the tumour and the level of spread.

Staging involves collating information from different sources to determine:

• the size of the tumour

• whether or not there is spread to axillary nodes

• whether or not there is evidence of distant spread (metastases).

Apart from the investigations already outlined, specific tests to check for distant spread will usually be undertaken if any of the preliminary tests have proven malignancy. A chest x-ray, blood tests for liver function and blood count, and often a bone scan and liver ultrasound will be performed, as breast cancer tends to spread to the chest, liver and bone.

Examination of the excisional biopsy will give information regarding the size and type of the cancer, and whether the lump has been fully removed, along with an adequate margin of normal tissue around it.

The surgeon will usually operate on the axilla (armpit), removing as many lymph nodes as possible. The reason for this is that breast cancer tends to spread to these nodes, and finding out whether spread has occurred or not is a useful staging procedure to plan management.

Treatment options can also depend on other factors, apart from the staging. The wishes and health of the woman, whether she is pre- or post-menopausal, and where in the breast the tumour is situated are important. The aim of treatment may be to cure the cancer (the usual aim with earlier stage disease), or palliation. Palliation means relieving symptoms, and this would be the aim of treatment if the chances of cure were thought to be extremely small, as is usually the case with more advanced breast cancer.

Most treatment options involve surgery. Surgeons tend towards more conservative surgery where this is possible.

The term total mastectomy is used to describe an operation in which all the breast tissue is removed. The skin overlying the breast tissue, together with the breast and surrounding fat are removed, and the skin is closed with sutures. These days die muscles under the breast are usually left in a routine mastectomy, as this helps to improve function of the arm, and is less disfiguring than the more extensive operations performed in the past (radical mastectomy).

Variations on the garden-variety mastectomy include leaving the skin, nipple and areola, or inserting a prosthesis at the initial operation to allow for early reconstruction. This may be done in the hope of a better cosmetic result, but individual factors may mean that some women are nor suitable for these variations, which are called partial mastectomies.

Operations which remove less than the total breast tissue are commonly performed. These are called sub-total mastectomies, or segmentectomies (removing a segment of breast), or lumpectomies, or clear local excision, depending on how much tissue is removed. Some of these operadons can be performed without much alteration to the breast shape and size, and are often chosen by women for their cosmetic result These less disfiguring operadons may give the same success rates as the more extensive operations, as they are usually combined with other therapies, like radiotherapy and chemotherapy.

Very early cancer, with no evidence of invasion into the surrounding breast tissue, is potentially curable with surgery alone. Removal of the breast tissue by mastectomy (partial or total) may be all the treatment recommended.

If the tumour shows spread into the breast tissue, removal of the breast tissue by some degree of mastectomy would usually be recommended. The axilla would also be operated on, and the nodes removed in what is known as axillary dissection.

If a less than total mastectomy is performed, radiotherapy to the remaining breast tissue will usually be recommended. Radiotherapy involves exposing the remaining breast to specific forms of x-rays that have a damaging effect on cancer cells.

If the lymph nodes show evidence that the cancer has spread, then chemotherapy may be suggested. If the woman is not yet menopausal, the chemotherapy will usually be in the form of cancer-treating medication, similar to those used in other cancers. A course of several doses would be given. Anti-cancer medications are known for their tendency to produce unpleasant side-effects, like nausea. There are several different specific types, and the ones usually used for breast cancer may give some short-term problems, but they are usually fairly well tolerated, as far as chemotherapy goes.

If the woman has already become menopausal, it is likely that she will be offered a different kind of medication. This is a drug called Tamoxifen, and it has an anti-oestrogen action, which has been shown to be of benefit in treating breast cancer in post-menopausal women. It is not like the other general anti-cancer drugs, and is said to produce very few side-effects.

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What can I expect after the micro-inserts have been put in place?

When the micro-inserts are being put in place, or just after the procedure, you may have some cramping like period cramps, and some bleeding. You may even feel sick for a little while, but these feelings normally don’t last very long. Some women don’t feel anything much at all. Any pain or discomfort in your abdomen, or bleeding from your vagina should be over within three days.

During the three months it takes for the Fallopian tubes to become completely blocked, you will not be able to rely on the micro-inserts for contraception. You will need to use some other method to protect you from getting pregnant if you have sex during this time, so talk to your doctor about this before the procedure.

Three months after the procedure you may be asked to have a special kind of X-ray to make sure the Fallopian tubes are blocked. Your doctor will explain it to you. Some doctors no longer feel this test is necessary and don’t do it routinely. Once you have been told the procedure has been successful you can stop using any other method of contraception.

Where do you get micro-inserts?

You must see your general practitioner or a doctor at a Family Planning Centre to get a referral to a specialist who has been trained to do the procedure. You will go to a public or private

hospital to have the procedure.

What do micro-inserts cost?

The cost for two micro-inserts is about $1,100.00. If you are in a medical fund you can claim the cost of micro-inserts and hospital fees, depending on the level of your cover. If you are not in a fund you will need to ask the doctor about the cost You will need to pay for the micro-inserts themselves and probably have to pay the difference between the specialist’s fee and the Medicare rebate. Be sure to sort out the costs before you book in for surgery, and to check first with your health fund if you are thinking of making a claim through them.

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What should I expect after a Progestogen IUD Insertion? You will probably have cramps, like period cramps, and bleeding or spotting during the first few days after the IUD is inserted. If you take aspirin or paracetamol, and hold a hot water bottle on your abdomen, any discomfort you may have will usually settle down. If the cramps last more than a few days, go and see your doctor.

You should not put anything into your vagina for three days after the procedure because of the risk of infection. You should not have vaginal sex, or use tampons, or have baths or spas, or go swimming during that time.

You will need to go back to the doctor for a check up after six weeks. It is quite common for women with a Progestogen IUD to have some spotting or bleeding in the first few months after it is inserted. Once this settles you just need a check up every two years with your normal Pap test If at any time you experience pelvic pain, fever, unusual discharge from your vagina, heavy bleeding, or you think you may be pregnant, you should go to your doctor for another check up.

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You should start on the first pack of pills when you have a period. Read the instructions on the pack to find out exactly what to do for the type of Pill you have. Ask your doctor if it will work straight away or if you need to use another type of contraceptive, like condoms, if you have sex during the first seven days when you take the Pill for the very first time. You may want to use condoms whenever you have sex even though you are on the Pill, because condoms help to protect you from sexually transmitted infections (STIs).

Anyway, once you start taking the Pill, if you have a 28-day pack, you just keep taking a pill every day. If you have a 21-day pack, when you finish all the pills you have to wait seven days and then start a new pack.

What happens if I miss a pill? If you miss taking a pill, but you remember within 12 hours, take the pill as soon as you remember. Take the next pill at the usual time. You will still be covered for contraception.

If it Is more than 12 hours since you should have taken a pill, take one as soon as you remember and take the next pill at the usual time. Keep taking a pill every day, but it will be seven days before you are fully covered for contraception, so if you have sex during the next seven days it’s best to use condoms or another method of contraception, as well. You can ring a Family Planning Centre or your doctor if you feel worried. It’s better to be absolutely sure what to do than to wait and see what happens.

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