Thyroid, Breast, Endocrine & Cancer Surgeon
Obstetrician, Gynecologist & Laparoscopic Surgeon
Our breast clinic provides a comprehensive and highly specialized treatment for all types of breast problems. We see both men and women with breast disease. These include both benign and malignant conditions of the male and female breast.
We offer all aspects of diagnostic and surgical care including Modified Radical Mastectomy, Breast Conserving Surgery, onco-plastic surgical approaches and immediate and delayed breast reconstruction, breast reduction mamoplasty and surgery for male breast enlargement.We use the sentinel node approach to minimize adverse effects which women can experience after more extensive axillary surgery. Along with surgical treatment we also offer Chemotherapy and Hormonal therapy and do Chemoport Implantation.
⇒ Breast Cancer Screening
⇒ Mamography, Sonomamography, Ultrasound, FNAC and Biopsy
⇒ Breast Cancer prevention counselling
⇒ Patient Education and breast cancer survivorship program
⇒ Genetic Counselling for people who are at high risk of breast cancer.
What is Comprehensive breast care unit?
It comprises of highly qualified specialist who guide a patient towards right treatment plan for any breast related disease.
How does a comprehensive breast care unit (CBCU) help?
Cancers if neglected or left untreated will progress to an advanced stage and threaten the life of the patient in the long run. Therefore, it is important to spread awareness on the disease as well as ways and means to prevent the disease or detect it early so that cure rates are maximised. With the latest technological advancements in the medical sector, today there are higher chances of getting diagnosed early leading to better management of the disease. A Comprehensive Breast
What is breast cancer?
Breast cancer is an uncontrolled growth of the cells in the breast gland. In the course of the disease, the cells acquire the capability to spread to other parts of the body via the bloodstream or the lymph channels and continue the uncontrolled growth, ultimately killing the patient.It is estimated that the precursor lesions of breast cancer are about 10 – 15 years in the breast before a cancer develops. Initially, the cancer grows very slowly for several years. For two or three years, it is only detectable by mammography (before it can be detected by doctors or the woman herself by feeling for lumps). If it is detected and treated during these years, it is curable in the majority of cases. Once it can be felt as a lump, its growth has become rapid; treatment will have to be intensive and the chances for a cure decline fast.
What are the pathologies related to breast?
The disease of breast can be described as benign (not cancerous) and malignant (cancerous). Benign Breast Disease includes conditions like fibroadenoma, breast cysts, fibrocystic disease, cyclical mastalgia (breast pain), breast abscess, granulomatous mastitis, etc.
However, breast malignancies depending on their stage can be classified as:
⇒ Operable Breast Cancer – This describes cancer that is confined to the breast and/or the lymph glands in the arm pit (axilla) on the same side of the body
⇒ Locally Advanced Breast Cancer – An invasive cancer that may be large or have spread to several lymphnodes in the armpit (axilla) or other areas near breast, or have spread to other tissues around the breast such as skin, muscle or ribs
⇒ Metastatic Breast Cancer – This is the most advanced stage of breast cancer where the cancer cells have spread past the breast and axillary lymphnodes to other areas of the body (like bone, lungs, liver or brain) and continue to grow and multiply in these affected organs
Are you at high risk for breast cancer?
Ideally both men and women can get breast cancer. But more than 99% of the cases occur in women. The greatest risk factor for developing breast cancer is being a woman and the incidence of breast cancer in woman increases with advancing age.
Risk factors for breast cancer include:
⇒ Older age
⇒ Personal history of breast cancer
⇒ Family history of breast cancer or having other relatives (in either your maternal or paternal family) with breast cancer or ovarian cancer
⇒ Changes in certain genes, such as BRCA1 or BRCA2
⇒ Early menarche (onset of menses) or menopause (cessation of menses)
⇒ Nulliparity (no child births) or late childbearing
⇒ Exposure to radiations
⇒ Using Hormonal Replacement Therapy (HRT) for prolonged periods
⇒ Women whose mammograms show a larger area of dense tissue than the mammograms of women of the same age
⇒ Chance of getting breast cancer after menopause is higher in women who are overweight or obese
⇒ Women who are physically inactive throughout life may have an increased risk of breast cancer.
⇒ Studies suggest that the more alcohol a woman drinks, the greater her risk of breast cancer
Having a risk factor does not mean that a woman will get breast cancer. Most women who have risk factors never develop breast cancer. However, women who think they may be at risk should discuss this with their doctor.
What are the signs and symptoms of breast cancer?
Breast cancer is not always visible to the naked eye. Its early signs are often hidden within the breast tissues. In early stages, breast cancer usually has no symptoms. However, as the tumour progresses, you may note the following signs:
⇒ A lump in the breast, is often the first apparent symptom of breast cancer, breast lumps are usually painless, although some may cause a prickly sensation. Lumps are usually visible on a mammogram long before they can be seen or felt
⇒ A noticeable flattening or indentation on the breast which may indicate a tumour that cannot be seen or felt
⇒ Any change in the contour, texture or temperature of the breast, reddish, pitted surface like the skin of an orange (called peau d'orange) is symptomatic of advanced breast cancer
⇒ A change in the nipple, such as an indrawn or dimpled look, itching or burning sensation or ulceration, scaling of the nipple is symptomatic of Paget's disease, a localised cancer
⇒ Unusual discharge from the nipple that may be clear, bloody or of another colour, is usually caused by benign conditions but possibly could be due to cancer as well
⇒ Swelling in the armpit can suggest presence of breast cancer as this lymph node swelling probably could be felt due to the presence of a primary lump, which may be deep seated and impalpable
⇒ If you notice a lump, or are experiencing anything unusual, you must report the symptoms to your doctor as soon as possible.
What is the importance of screening?
Screening and early detection of breast cancers with help of mammography, breast ultrasound, magnetic resonance imaging and gene profiling helps in early detection of cancer, thus helping the doctor in better management of the disease. Besides diagnostic methods, a monthly self breast exam is one of the best ways to notice any changes in your breasts.
There is strong scientific evidence to suggest that annual screening mammography starting at the age of 40 years (or 10 years before the age at which a woman's first-degree relative developed breast cancer) reduces the chance of dying due to breast cancer significantly. In younger patients, a sono-mammography is also done as it can provide valuable information that might be missed on a mammogram performed in isolation. Annual MRI screening is recommended in women with hereditary breast cancer, i.e., those women who are BRCA 1 or BRCA 2 positive. The BRCA status needs to be ascertained by performing a genetic profiling in women with more than one first degree relative with breast and/or ovarian cancer.
What is Breast Self examination?
Step 1 : Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips.
Here's what you should look for
⇒ Breasts that are their usual size, shape, and color
⇒ Breasts that are evenly shaped without visible distortion or swelling
⇒ If you see any of the following changes, bring them to your doctor's attention:
⇒ Dimpling, puckering, or bulging of the skin
⇒ A nipple that has changed position or an inverted nipple (pushed inward instead of sticking out)
⇒ Redness, soreness, rash, or swelling
Step 2 : Now, raise your arms and look for the same changes.
Step 3 : While you're at the mirror, look for any signs of fluid coming out of one or both nipples (this could be a watery, milky, or yellow fluid or blood).
Step 4 : Next, feel your breasts while lying down, using your right hand to feel your left breast and then your left hand to feel your right breast. Use a firm, smooth touch with the first few finger pads of your hand, keeping the fingers flat and together. Use a circular motion, about the size of a quarter.
Cover the entire breast from top to bottom, side to side — from your collarbone to the top of your abdomen, and from your armpit to your cleavage.
Follow a pattern to be sure that you cover the whole breast. You can begin at the nipple, moving in larger and larger circles until you reach the outer edge of the breast. You can also move your fingers up and down vertically, in rows, as if you were mowing a lawn. This up-and-down approach seems to work best for most women. Be sure to feel all the tissue from the front to the back of your breasts: for the skin and tissue just beneath, use light pressure; use medium pressure for tissue in the middle of your breasts; use firm pressure for the deep tissue in the back. When you've reached the deep tissue, you should be able to feel down to your ribcage.
Step 5 : Finally, feel your breasts while you are standing or sitting. Many women find that the easiest way to feel their breasts is when their skin is wet and slippery, so they like to do this step in the shower. Cover your entire breast, using the same hand movements described in step 4.
How are breast tumours treated?
Depending on the pathology, your treating doctor will decide what treatment/s will bring better results. Some of the treatment methods are as mentioned below:
⇒ Surgeries for breast cancer include Breast Conservation Surgery or Modified Radical Mastectomy with or without whole breast reconstruction
⇒ Oncoplastic Breast Conservation Surgery for Breast Cancer combines the principles of plastic surgery and cancer surgery to facilitate cosmetic surgery in patients with breast cancer and allow reduction or augmentation surgery in the same sitting
⇒ Partial and Whole Breast Reconstruction with or without silicone implants, followed by reconstruction of nipple and areola
⇒ Counselling the patient and relatives over the histopathology report and discussing therapeutic options regarding adjuvant therapy along with individual risk-benefit ratios and overall risk reduction after adjuvant therapy
⇒ Placement of indwelling chemotherapy ports for administration of adjuvant chemotherapy and management of patients with chemo ports
⇒ Delivery of adjuvant chemotherapy and targeted therapy by a medical oncologist specialised in breast cancer chemotherapy
⇒ Specialised Radiation Therapy (whole breast or chest wall radiotherapy) delivered by experts in the field, using the latest technology. Radiation therapy also includes palliative radiotherapy in metastatic breast cancer for bone and brain metastases
⇒ Detailed instructions on exercise and diet by the respective experts after completion of therapy and follow-up advice
⇒ Diagnosis, counselling and medical/surgical treatment of benign breast conditions such as cyclical mastalgia (breast pain), breast cysts, fibrocystic disease (ANDI)
⇒ Diagnosis and treatment of significant nipple discharge
⇒ Management of breast abscess by conservative treatment (if <3cm) or surgical drainage (if >3 cm)
⇒ Genetic Counselling in patients with a family history of breast cancer or hereditary breast cancer
What is the possible prognosis?
Prognosis of a case widely depends on the type of the disease, how much the disease has progressed at the time of diagnosis and how the disease has reacted to the treatment given. For cancer, staging is the process physicians use to assess the size and location of a patient's cancer. Identifying the cancer stage is one of the most important factors in selecting treatment options. Several tests may be performed to help in grading breast cancer including clinical breast exams, mammogram, biopsy, LFT (Liver Function Test) and certain imaging tests, such as an isotope bone scan, CT (Computed Tomography) scan of chest abdomen & pelvis and PET CT (Positron Emission Tomography CT) scan. These tests are not performed on every patient but only those who have extensive disease within the breast, i.e., breast lump more than 5 cm or tumour involving skin or presence of large matted axillary or neck nodes.
The greatest misconception that the common person has about cancer is that all patients eventually die of cancer. It is very important to realise that breast cancer is one of the most curable cancers in the human body. All patients who are cured live a normal life for their entire lifespan. Regular follow ups after the treatment will help in identifying relapse, if any.
Can a woman get pregnant after breast cancer treatment?
Pregnancy can be planned after treatment of breast cancer in selected patients. Pregnancy is safe and does not increase the risk of relapse. Patients who receive chemotherapy can get chemotherapy-induced premature menopause, thereby interfering with post-treatment fertility. Cryopreservation of oocytes and ovarian tissue are the common methods that can enable such patients to bear children even if they become menopausal after chemotherapy.