Welcome to the Breast Surgical Oncology and Reconstruction Clinic of Metropolitan General. This is a new, pioneering clinic that combines the high level of expertise of its medical and nursing staff in the management of breast diseases with the most advanced surgical techniques and cutting-edge medical technology.
I feel truly proud to lead, as first among equals, an exceptional team. At the Breast Clinic, we work collaboratively. Medical and nursing staff coordinate their efforts and specialized knowledge to ensure the best possible outcome for each patient.
Our team consists of specially trained professionals in breast diseases, including:
- General surgeons
- Radiologists and breast imaging specialists
- Pathologists
- Medical oncologists
- Radiation oncologists
- Plastic surgeons
- Psychologists
- Physiotherapists
- Nutrition and exercise consultants
- Complementary therapy specialists
We have chosen to provide a holistic approach to the management of women with breast cancer. Our shared goal is to restore to every woman her health, femininity, strength, and confidence.
We work together with knowledge, dedication, respect, and compassion.
As a female physician, I deeply understand the anxiety and uncertainty a woman experiences when faced with the possibility of breast cancer, an anxiety that extends beyond herself to her family, emotional life, and professional environment.
I believe in the uniqueness of every woman. For this reason, I consider it essential to build a relationship of trust and respect with each patient individually. Doctor and patient walk together throughout the journey of treatment and recovery, forming a lifelong bond.
The Breast Surgical Oncology and Reconstruction Clinic of Metropolitan General was created to embrace all women.
Natasa Pazaiti, MD, PhD, FEBS
Director of the Clinic
Clinic Services
- Preventive breast screening
- Diagnostic assessment of benign and malignant breast diseases
- Follow-up of women with breast cancer
- Follow-up of women with hereditary breast cancer
- Breast surgery using the most advanced surgical techniques
- Correction of congenital breast abnormalities (amastia, breast asymmetry, macromastia/gigantomastia)
- Breast reconstruction following mastectomy
- Nipple-areola complex reconstruction
- Comprehensive gynecological assessment by a specialized gynecologist
- Endometrial monitoring in women with breast cancer receiving hormonal therapy
As part of the follow-up of breast cancer patients, regular gynecological surveillance is provided, including clinical examination and transvaginal ultrasound assessment of endometrial thickness.
At the same time, patients attending our Clinic are offered the option of undergoing a Pap test, which is a fundamental screening test for cervical cancer. When clinically indicated, colposcopic evaluation is also performed.
In addition, women with hereditary breast and ovarian cancer syndrome are offered the possibility of completing their full six-month breast and ovarian surveillance within a single appointment.
In this way, our patients receive complete and high-standard follow-up care, in accordance with updated international protocols and guidelines issued by scientific oncology societies for breast cancer.
Diagnostic Evaluation and Treatment of Gynecological Conditions
- Benign gynecological conditions, medical and surgical management thereof (uterine leiomyomas, ovarian cysts, endometriosis, adenomyosis, dysmenorrhea, pelvic inflammatory disease, and chronic pelvic pain)
- Preventive screening (Pap test)
- Colposcopy
- Postoperative follow-up of patients with malignant diseases of the breast, uterus, and ovaries
- Management and surgical treatment of endometrial, cervical, and vulvar cancer
- Hormonal disorders during the reproductive years (menorrhagia, menstrual cycle disorders, abnormal uterine bleeding, cessation of menses/amenorrhea, polycystic ovaries, acne)
- Hormonal management of menopause (hormone replacement therapy, osteoporosis, hot flushes, decreased libido)
- Pediatric and adolescent gynecology (developmental disorders, precocious or delayed puberty)
- Urogynecology (urinary incontinence, uterine prolapse)
- Infertility investigation
- Pregnancy follow-up
Procedures Performed
Minimally Invasive Breast Biopsies
Fine Needle Aspiration (FNA)
A highly reliable test for determining whether a lesion is malignant. It is painless and bloodless. It is performed using a fine needle, like that used for blood sampling, under ultrasound guidance. The procedure takes only five minutes. The sample obtained is examined by a specialized cytologist, and the biopsy results are available within three days at the latest.
Core Needle Biopsy
A highly reliable method. It is a simple and painless procedure when performed by an experienced physician who is fully familiar with biopsy techniques. To ensure diagnostic accuracy, it is always carried out under ultrasound guidance.
Stereotactic Vacuum-Assisted Biopsy of Microcalcifications with Mammotome
When microcalcifications detected on mammography form a small cluster located away from the skin and the nipple, biopsy is performed using the stereotactic Mammotome device. This is a large-bore needle with an elongated side opening at its tip. The needle is inserted under local anesthesia and, following stereotactic localization, guided to the site of the lesion. It is then rotated through 360 degrees, aspirating cylindrical tissue samples from the area of the breast containing microcalcifications. Mammotome biopsy is painless, takes approximately 30 minutes, and does not require surgery.
Surgical Procedures
Excision and Biopsy of Microcalcifications with Wire-Guided Localization
If the group of microcalcifications involves a large area, lies close to the skin, or is located beneath the nipple, biopsy is performed surgically under general anesthesia. Prior to surgery, a fine localization wire (“wire hook”) is placed with mammographic guidance at the site of the microcalcifications, helping the surgeon identify the area of the breast that must be removed. If the biopsy is positive for malignancy and the surgical margins are clear, further surgery may be avoided and the biopsy procedure itself may serve a therapeutic purpose.
Surgical Treatment of Breast Cancer
Surgery is the mainstay of breast cancer treatment. The extent and type of surgery are determined according to the biological characteristics of the cancer, its molecular profile, its extension into surrounding tissues, and are further individualized according to each patient’s specific characteristics—such as age and family history—as well as her wishes.
The surgical procedures performed include:
- Lumpectomy: removal of the tumor with a margin of at least 1 cm
- Quadrantectomy: removal of a large portion of the breast, up to one quarter, including the tumor
- Total mastectomy: removal of the entire breast, including the skin and nipple
- Subcutaneous mastectomy with or without nipple preservation: the breast glandular tissue is removed while the skin is left intact. If the cancer is more than 2 cm away from the nipple, the nipple may be preserved
- Axillary lymph node dissection: removal of the axillary lymph nodes when there is clinical evidence of nodal involvement
- Sentinel lymph node biopsy: a minimally invasive method for detecting even a small metastasis in the axilla and staging the cancer without the need for full axillary lymph node dissection. Only if metastasis is detected is surgical removal of all axillary lymph nodes performed. If there is no metastasis, axillary lymph node dissection is not required, the surgery is less extensive, and the patient’s recovery and quality of life are significantly improved
Oncoplastic and Reconstructive Breast Surgery
Oncoplastic surgery is the incorporation of aesthetic plastic surgery principles into oncological breast surgery. Through oncoplastic surgery, breast cancer can be treated while at the same time achieving a good cosmetic result.
Because breast cancer is often diagnosed at an early stage, the most common surgical treatment is wide for local excision of the tumor. In this way, mastectomy may be avoided; however, reconstruction of the remaining breast tissue is necessary to restore breast shape and volume without defect or deformity.
Oncoplastic surgery often also includes correction of asymmetry in the contralateral breast by means of reduction or mastopexy procedures.
When mastectomy is selected as the surgical treatment, immediate breast reconstruction is offered. Reconstructive surgery using the most advanced techniques enables complete breast restoration either using prosthetic materials (tissue expanders, silicone implants, specialized meshes) or by autologous tissues (the patient’s own tissues, including myocutaneous flaps from the abdomen, back, or buttocks).
Innovative Method of Breast Reconstruction After Radiotherapy Using Fat Transfer
It is well known that when radiotherapy follows mastectomy, breast reconstruction becomes more challenging. Irradiated tissues lose their elasticity and distensibility, often resulting in failure of reconstruction attempts using tissue expanders followed by silicone implants.
In many cases, reconstruction used to be performed with myocutaneous flaps, mainly from the patient’s back. At our Clinic, we apply a new breast reconstruction technique after radiotherapy that avoids sacrificing the latissimus dorsi muscle. This involves the gradual transfer of fat from various parts of the body, such as the abdomen or buttocks, into the breast.
Adipose cells contain stem cells that rejuvenate and enrich the tissues into which they are transplanted. In this way, irradiated tissues regain elasticity and firmness and become capable of accommodating a tissue expander. In many cases, if the size of the healthy contralateral breast is not large, reconstruction can be achieved directly with placement of a silicone implant.
This technique has been applied in recent years at the Paris Breast Center by the Kriishna Clough team. Following specialized training, we introduced this technique in Greece and have applied it with great success in our patients. We are the only Clinic in Greece to offer women the full range of modern options for breast cancer surgery and breast reconstruction.
Immediate Breast Reconstruction After Mastectomy with TiLOOP Bra Pocket Mesh
TiLOOP Bra Pocket
Breast reconstruction with the bra pocket mesh is an innovative method that represents a major advance in reconstructive breast surgery. The bra pocket is a ready-made titanium-coated mesh pocket that holds the silicone implant and supports it like an internal bra beneath the breast skin.
Unlike other methods, it is secured with sutures above the pectoralis major muscle, thus preserving the muscle intact and maintaining its function.
The TiLOOP® Bra Pocket is made of type 1a polypropylene mesh (lightweight and macroporous) with a titanium-coated hydrophilic surface. Compared with other meshes used in surgery, it offers several advantages, including:
- better cellular ingrowth between the mesh and the surrounding subcutaneous tissues
- lower risk of inflammation
- lower likelihood of scar tissue formation
- lower rates of mesh folding
- optimal quality of the capsule formed between the implant and the subcutaneous tissue
- greater protection of the implant against infection
- shorter operating and anesthesia time
- improved tissue elasticity, allowing a better and more natural breast shape
- excellent aesthetic outcome
In addition, this method is painless and bloodless, as placement of the mesh does not require mobilization or division of the pectoralis major muscle.
Immediate breast reconstruction after subcutaneous mastectomy with bra pocket mesh ensures an excellent quality of life for women.
This method of breast reconstruction with bra pocket mesh is performed only after specialized training and certification.
In Greece, this method is performed exclusively by Natasa Pazaiti, General Surgeon and Breast Specialist at the Breast Surgical Oncology and Reconstruction Clinic of Metropolitan General, which she directs, as she is the only surgeon in the country to have received training and certification in this technique.