Surgical Expertise

Surgical Expertise

Mastectomy

Radical Mastectomy: The breast tissue (with skin and nipple) is removed along with the underlying muscles and the lymph nodes in the armpit.

Breast Conservation Surgery (BCS)

This term is used to describe a surgical technique where the tumour is removed with a margin of normal tissue around it.

Sentinel Lymph Node Biopsy (SLNB)

SLNB is a surgical procedure in which the first draining lymph node is identified and removed. Traditionally, in breast cancer patients undergoing surgery

Axillary Lymph Node Dissection (ALND)

ALND involves removal of all the axillary lymph nodes in level I,II and sometimes level III.

Oncoplasty

Oncoplasty refers to the surgical technique used during breast conservation to ensure

Whole Breast Reconstruction

After mastectomy i.e. breast removal, patients have the option to get reconstruction of the whole breast i.e. creation of an artificial breast.

Lumpectomy for benign tumours

Even if a woman does not have breast cancer, she may need surgery for removal of various breast lumps which have been proven to benign

Microdochectomy and Radical Duct Excision

In certain women presenting with pathological nipple discharge, i.e. nipple discharge which is bloody, watery, profuse

Vascular Access Devices

Chemoport or vascular access devices are placed to allow ease of administration of chemotherapy for patients with cancer

Wire guided excision

Wire guided excision is a procedure which is done for impalpable lesions I.e. which cannot be felt

Mastectomy

Mastectomy means removal of the entire breast including the area containing the tumour. It can be of direct types:


After mastectomy, patients may experience some soreness, pain, tingling or numbness and arm stiffness depending on the way the axilla has been addressed. Generally, a surgical drain (plastic tube attached to a box) is placed after mastectomy to prevent fluid collection which is removed after 7-10 days.

Breast Conservation Surgery (BCS)

This term is used to describe a surgical technique where the tumour is removed with a margin of normal tissue around it. The margin is checked using frozen section (rapid technique) intraoperatively to ensure that it is tumour free. Along with this ‘lumpectomy’, the axillary lymph nodes are addressed separately using either sentinel lymph node biopsy or complete axillary dissection.

Breast Conservation Surgery is safe with acceptable local recurrence rates compared to mastectomy. It allows a woman to be tumour free while saving her breast and body image. generally, BCS is accompanied by oncoplasty- a procedure to ensure that the size and shape of breast are well maintained. However, radiation therapy for 3-5 weeks is compulsory after breast conservation surgery

BCS is possible in most cases of early breast cancer and even in certain cases of locally advanced disease after neoadjuvant therapy.

It is contraindicated in inflammatory breast cancer or in patients who cannot take radiation therapy. In cases with more than one tumour, the surgical decision making has to be individualised.

Sentinel Lymph Node Biopsy (SLNB)

SLNB is a surgical procedure in which the first draining lymph node is identified and removed. Traditionally, in breast cancer patients undergoing surgery, all axillary lymph nodes were removed. This leads to potential shoulder stiffness, numbness and possibility of lymphedema(arm swelling). To decrease this morbidity, now sentinel lymph node biopsy is done for patients with node negative breast cancer and in certain, post chemotherapy cases.

In this technique, 2 dyes are used to select the first draining nodes which are then removed and sent for rapid testing called frozen section. The decision to remove further lymph nodes depend on whether cancer has involved the sentinel lymph node or not. This helps us in improving quality of life of our patients without compromising their oncological safety.

Axillary Lymph Node Dissection (ALND)

ALND involves removal of all the axillary lymph nodes in level I,II and sometimes level III. It is the procedure of choice to address the axilla in a lady with node positive breast cancer. It is done with either mastectomy or breast conservation.

After ALND, some patients may experience shoulder stiffness, numbness, swelling in armpit (seroma) or lymphedema(swelling in arm). A surgical drain (plastic tube attached to a box) is placed after ALND to prevent fluid collection which is removed after 7-10 days. Arm exercises are taught to patients to improve movement and decrease chances of swelling.

Oncoplasty

Oncoplasty refers to the surgical technique used during breast conservation to ensure that the cancerous tumour is removed with negative margins while getting a 'cosmetically acceptable’ breast. It is a combination of ‘oncosurgery’ and ‘plastic surgery’ methods.

Depending upon the size, shape of the breast, size and number of tumours, closeness to skin and nipple, patient’s age and comorbidities, breast density and various other factors, the surgeon chooses between various oncoplasty techniques so that after the surgery, the patient is left with a breast which looks as similar to the opposite breast. Sometimes, local breast tissue may be used to cover the defect and sometimes tissue may be taken from elsewhere to get good results.

Whole Breast Reconstruction

Following are the techniques used to Reconstruct Breast:

After mastectomy i.e. breast removal, patients have the option to get reconstruction of the whole breast i.e. creation of an artificial breast. It can be of two types :
Whole breast reconstruction can be done by various methods such as using

A discussion regarding the option of whole breast reconstruction must be had with all patients while planning their mastectomy and various pros/cons must be discussed.

Lumpectomy for benign tumours

Even if a woman does not have breast cancer, she may need surgery for removal of various breast lumps which have been proven to benign. Lumpectomy may be needed in cases of:

These are day care procedures which are done in a way to ensure that the size, shape and look of the breast doesn’t change after procedure.

Microdochectomy and Radical Duct Excision

In certain women presenting with pathological nipple discharge, i.e. nipple discharge which is bloody, watery, profuse, single duct or spontaneous, need of surgery may be established after thorough evaluation.

Microdochectomy is removal of a single milk duct using special surgical techniques. If a woman has multiple diseased ducts or recurrent episodes of ductal infection called periductal mastitis, she may need radical or total duct excision.

These are day care procedures which are done in a way to ensure that the size, shape and look of the breast doesn’t change after procedure.

Vascular Access Devices

Chemoport or vascular access devices are placed to allow ease of administration of chemotherapy for patients with cancer who need multiple intravenous injections over a prolonged period of time. It is a simple procedure which is done under local anesthesia/sedation and involves placement of an implantable port under the skin. The catheter attached to the port is inserted into the internal jugular vein or subclavian vein.

Wire guided excision

Wire guided excision is a procedure which is done for impalpable lesions I.e. which cannot be felt. Sometimes patients find an abnormality on a mammogram which cannot be clinically seen or felt. Also in patients, who have received neoadjuvant therapy i.e. chemotherapy before surgery, the tumour may shrink so much that it cannot be felt. In these cases, wire guided techniques are used to correctly localise the tumour so that the surgeon can easily remove the exact involved area. The radiologist places a wire under ultrasound or stereotactic guidance on the morning of the surgery and this aids the surgeon during the operation.