Breast Cancer Surgery

Breast Cancer is one of the most common cancers in women across the world and second only to cervical cancer in India.

The most common presentation is with a painless lump in the breast or some skin / nipple retraction.

A Mammogram is the first investigation to evaluate a breast lump and characterises it into Benign / Boderline / Highly Suspicous.

This is usually combined with or followed by a Tru Cut needle biopsy to get a histological confirmation of cancer if suspected.

Staging is then done using a PET CT scan.

Early Stage Breast cancers - stage 1 & 2 are best treated with upfront surgery with an option for Breast Conservation ( Lumpectomy with Axillary lymph node sampling / clearance ) or Modified Radical Mastectomy ( complete removal of breast ).

This is followed by Chemotherapy / Radiation / APBI - Accelerated Partial Breast Irradiation / Targeted therapy / Hormone therapy depending on final Histopathology.

Locally Advanced Breast Cancers ( Stage 3 ) usually involve the overlying skin, underlying muscle and /or bulky regional lymph nodes.

These are best treated with upfront systemic Chemo / Targeted therapy followed by Surgery and Radiation.

Metastatic or advanced stage breast cancer implies that the disease has spread beyond the organ of origin to distant organs such as the lungs / liver / brain / bones.

Treatment at this stage is usually palliative with Chemo / Targeted / Hormone therapy.

The overall outcome of breast cancers is good if detected early and treatment followed as per standard guidelines.

Nipple discharge recurring from a specific site is an occasional concerning symptom if blood stained and should be evaluated with a Mammogram to rule out an underlying breast lump.

The cause of this is commonly a benign mushroom like papilloma blocking one of the ducts of the breast glands and can be treated with a simple surgery - Microdochectomy wherein the culprit gland and duct are removed in toto.

Incidence of breast / ovarian cancer in first blood relatives increases the risk by approximately 10 % and indicates screening and evaluation for inherited genetic mutations.