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Cirugía De La Mama

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Cirugía De La Mama 25,5 mm 15 GUÍAS CLÍNICAS DE LA ASOCIACIÓN ESPAÑOLA DE CIRUJANOS 15 CIRUGÍA DE LA MAMA Fernando Domínguez Cunchillos Sapiña Juan Blas Ballester Parga Gonzalo de Castro Fernando Domínguez Cunchillos Juan Blas Ballester Sapiña Gonzalo de Castro Parga CIRUGÍA DE LA MAMA CIRUGÍA SECCIÓN DE PATOLOGÍA DE LA MAMA Portada AEC Cirugia de la mama.indd 1 17/10/17 17:47 Guías Clínicas de la Asociación Española de Cirujanos CIRUGÍA DE LA MAMA EDITORES Fernando Domínguez Cunchillos Juan Blas Ballester Sapiña Gonzalo de Castro Parga SECCIÓN DE PATOLOGÍA DE LA MAMA © Copyright 2017. Fernando Domínguez Cunchillos, Juan Blas Ballester Sapiña, Gonzalo de Castro Parga. © Copyright 2017. Asociación Española de Cirujanos. © Copyright 2017. Arán Ediciones, S.L. Castelló, 128, 1.º - 28006 Madrid e-mail: [email protected] http://www.grupoaran.com Reservados todos los derechos. Esta publicación no puede ser reproducida o transmitida, total o parcialmente, por cualquier medio, electrónico o mecánico, ni por fotocopia, grabación u otro sistema de reproducción de información sin el permiso por escrito de los titulares del Copyright. El contenido de este libro es responsabilidad exclusiva de los autores. La Editorial declina toda responsabilidad sobre el mismo. ISBN 1.ª Edición: 978-84-95913-97-5 ISBN 2.ª Edición: 978-84-17046-18-7 Depósito Legal: M-27661-2017 Impreso en España Printed in Spain CIRUGÍA DE LA MAMA EDITORES F. Domínguez Cunchillos J. B. Ballester Sapiña G. de Castro Parga AUTORES A. Abascal Amo M. Fraile Vasallo B. Acea Nebril G. Freiría Barreiro J. Aguilar Jiménez C. A. Fuster Diana L. Alfaro Galán P. Garaulet González A. Alonso Amigo R. García Berrio L. Apesteguía Ciriza A. García-Vilanova Comas F. M. Armas Serrano A. García Novoa P. Armendáriz Rubio E. García Olivares C. Artieda Soto A. García Villanueva J. B. Ballester Sapiña J. Á. Garijo Álvarez T. Balsa Marín M.ª Á. Gil Olarte R. Barriga Sánchez J. Gómez Ramírez E. Buch Villa P. J. González Noguera C. Bueno Muiño M. González Pérez R. Calpena Rico I. Gutiérrez Giner P. Cansado Martínez J. R. Hernández Hernández F. Carabantes Ocón J. J. Illarramendi Mañas F. J. Cardenal Murillo C. Jiménez Mazure G. de Castro Parga M. J. Lamas González M.ª V. Collado Guirao P. C. Lara Jiménez L. Comín Novella I. Larrañaga Blanc A. Corominas Cishek D. Legupin Tubío M. Á. Corral Sánchez J. M. de León Carrillo S. de la Cruz Sánchez R. León Ledesma C. Díaz Carballada M. Lloret Sáez-Bravo M. Díaz-Miguel Maseda M. Á. Lorenzo Campos J. Díez Izquierdo M. Á. Lorenzo Liñán F. Domínguez Cunchillos A. Manuel Vázquez M. Fernández Venegas M.ª I. Manzano Martín SECCIÓN DE PATOLOGÍA DE LA MAMA Asociación Española de Cirujanos Y. A. Martínez Mateo R. Robles Fraguas D. Martínez Ramos L. Rodrigo Hernanz F. J. Medina Cano J. M. Rodríguez Alonso J. Medrano González F. X. Rodríguez Alsina J. M.ª Miguelena Bobadilla R. Rodríguez Fernández A. Moral Duarte I. Rodríguez Prieto C. Moreno Sanz A. Rodríguez Sánchez T. Muñoz Fernández C. A. Rodríguez Sánchez M.ª A. Nieto Gallo R. Rojo Blanco E. Olivo Valverde E. Salgado Pascual R. Orellana García F. Sánchez de Pedro M. Oset García S. Sánchez-Molero Pérez S. Ortega Ruiz M.ª A. Santana Borbones J. Petrement Briones M. Á. Sanz de Pablo M.ª E. Pertejo Muñoz A. Sierra García R. Pardo García L. Simón Monterde L. Pina Insausti V. Soria Aledo R. de la Plaza Llamas J. M.ª Sousa Vaquero R. M.ª Quintana de la Cruz G. Tadeo Ruiz J. M. Ramia Ángel R. Tobalina Bonis D. Ramírez Soler N. Torres Waldhaus L. Rabadán Ruiz J. A. Torró Richart M. Ramos Boyero J. M. del Val Gil T. Ramos Grande V. Vega Benítez M. Ribeiro González E. Veloso Veloso F. Ripoll Orts F. Vicente García A. Riquelme Oliveira V. Vigorita S. Rivas Fidalgo F. Villalba Ferrer J. Rivero Déniz L. Zubiaga Toro Presentación Han pasado ya diez años desde la presentación de la primera edición de la Guía de Cirugía de la Mama de la Asociación Española de Cirujanos (AEC). Los avan- ces de la medicina, especialmente en el campo de la oncología y en el manejo multidisciplinar de la patología mamaria, hacen necesarias nuevas actualizaciones de conocimientos, por lo que considerábamos que este tiempo era un periodo más que suficiente para proceder a una actualización de la guía clínica mediante la elaboración de una segunda edición. En la Sección de Patología de la Mama de la AEC se asumió el reto con ilusión y cariño para que hoy, esta segunda edición de la Guía ya sea una realidad. Desde la Junta Directiva de la Sección se distribuyó y se coordinó el trabajo de más de 110 cirujanos, miembros de la Sección y expertos en patología mamaria, que han participado como autores y coautores de los diferentes capítulos. Desde su creación, la Sección de Patología de la Mama está integrada por ciru- janos de todo el país que tenemos en común el interés por este campo de la cirugía y que en la actualidad trabajamos la mama dentro de los servicios de cirugía o incorporados a unidades multidisciplinares de patología mamaria. En los últimos años la Sección ha experimentado un crecimiento progresivo, lo cual es indicador de nuevas incorporaciones de cirujanos jóvenes que nos han ido estimulando para mantener un buen nivel de trabajo. A lo largo del tiempo, la Sección ha desarrollado y participado en múltiples ac- tividades: reuniones, congresos nacionales, cursos de formación en cirugía onco- plástica, cursos de formación para residentes y especialistas quirúrgicos, y, sobre todo, ha sido capaz de crear el clima para favorecer el aprendizaje y compartir experiencias entre nosotros mismos. La elaboración de una guía como esta no es más que el reflejo y la culminación de todos estos aspectos en un documento al que podamos recurrir para aprender y revisar los temas que necesitemos. Por último, y no menos importante, como editores, queremos resaltar nuestro agradecimiento a la Asociación Española de Cirujanos, a su Directiva y a su Co- mité Científico por el apoyo y las facilidades para que este proyecto haya podido desarrollarse. Fernando Domínguez Cunchillos Juan Blas Ballester Sapiña Gonzalo de Castro Parga Prólogo Hace diez años, en el prólogo de la primera Guía Clínica de Cirugía de la Mama de la Asociación Española de Cirugía (AEC), expresaba mi satisfacción por el honor recibido, que atribuía al reconocimiento de mi dedicación a la difu- sión del estudio interdisciplinario de la mama normal y patológica, defendiendo el papel importante de la Cirugía, que venía obligada a asumir la necesidad del trabajo conjunto con todas las especialidades relacionadas. En estos años, el interés creciente en la investigación del cáncer de mama, fun- damentado en la interdisciplinaridad de la Senología, que ya es universalmente aceptada, ha proporcionado grandes avances científicos que aportan nuevos conoci- mientos con repercusión en la clínica. Es imprescindible una puesta al día de la Guía Clínica para incorporar las aportaciones útiles y estar preparados para asumir tam- bién las que continuamente se van produciendo. Sin embargo, esto no es fácil, hay que separar lo sensacional de lo sensacionalista y dar información fundamentada y útil. Según el Institut of Medicine (IOM), una Guía debe contener un “Conjunto de recomendaciones desarrolladas de forma sistemática para ayudar a los profesionales en la toma de decisiones sobre la atención sanitaria más apropiada, seleccionando las opciones de diagnóstico y/o tratamiento más adecuados al abordaje de un pro- blema de salud o una condición clínica específica”. Esto no se resuelve con unos simples protocolos, ni es un proceso estático. Hay que profundizar y analizar las aportaciones para ofrecer al cirujano toda aquella información que sirva, además, para crear un criterio que se pueda ir actualizando y demostrar que la Cirugía sigue teniendo gran importancia y necesita adaptaciones para seguir integrada en el con- cepto de la Senología/Mastología, que, debe reconocerse, ha representado el funda- mento imprescindible para todas las mejoras alcanzadas en la práctica asistencial. Pienso que Fernando Domínguez, Blas Ballester y Gonzalo de Castro han com- prendido bien esta necesidad y nos presentan un trabajo que repasa ampliamente los múltiples aspectos precisos para que la Cirugía siga ocupando el papel que le corresponde en la solución de los problemas de las afecciones mamarias, funda- mentado en el estudio global e integrador de la mama normal y patológica. Por la selección de los temas y la forma de exponerlos, podría considerarse este libro, más que una simple guía, como un tratado de Patología Mamaria, pero ya hemos visto que, para que se cumpla la definición que de Guía hace el IOM, no basta con unos protocolos limitados a un área concreta. En el complejo estado de los conocimientos en este momento, creo imprescindible el esfuerzo que se ha hecho de ofrecer también la información teórica necesaria para que el lector interesado adquiera su propio criterio y esté en condiciones de irlo adaptando a los cambios que siguen produciéndose. Quiero insistir en la oportunidad de esta nueva edición y de su amplio formato, pues estamos en un momento de tal desarrollo de conocimientos –especialmente en relación con el cáncer de mama, pero sin olvidar la importancia epidemiológi- ca de la patología benigna, con aportaciones casi constantes de logros sensaciona- les (y, a veces, demasiado sensacionalistas)– que nos puede hacer creer que ya te- nemos la solución del problema, o al menos de una parte. Seamos conscientes de que, a lo largo de la historia, cada vez que ha aparecido una nueva teoría, un nuevo enfoque de tratamiento, una nueva técnica quirúrgica, nuevos fármacos, nuevas tecnologías, nuevas estrategias (que ahora llamamos cambios de paradigmas), por parte de nuestros antepasados y podría ser que en nosotros mismos, ha habido la sensación de poder tener dominado el cáncer.
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