Breast Cancer Treatments

A new diagnosis of breast cancer is often unexpected and poses several challenges to the patient and family. Understanding different treatment options and navigating between contrasting opinions can overwhelming. At Pune Breast Care we are committed not only to to making the journey easier while keeping you safe.

Our Approach 

Evidence Based Treatments

Breast cancer treatments are constantly evolving to  to be more effective and less invasive. We stay updated with the extensive breast cancer research being published worldwide to make these advanced therapies available to you . Your safety is of utmost importance so we only follow  scientifically validated evidence based treatments .

Multidisciplinary Planning

Breast Cancer treatments can be more effective  when you get inputs from multiple specialists from breast surgical oncology, medical oncology, radiation oncology, onco-pathology and radiology . We meet weekly  and review your case in detail to make a the best possible treatment plan for your cancer.

Personalised Oncology Plans

Every breast cancer is different and so is each individual patient. It is important that treatments are tailored for the type of cancer, stage of the cancer as well as the age and health of the patient. Your individuals preferences, tumor geneticss , all get weighed into making a personalised treatment plan for you

Breast Cancer Surgery

Breast Lumpectomy

A lumpectomy is also called a partial mastectomy or breast conservation surgery. In this procedure, the  tumour is removed with a rim of normal tissue called as ‘margin’. In an appropriately selected early breast cancer patients, lumpectomy combined with radiation is as effective as mastectomy for long term cures.

 

 Mastectomy

A mastectomy involves complete removal of the breast. The procedure may be necessary when multiple tumours area present in different areas the breast, when there is extensive precancerous tissue throughout the breast, or in cases of advanced cancers. A patient with early breast cancer may also choose to undergo a mastectomy to avoid radiation.

Lymph Node Surgery

Surgery of the lymph nodes under the armpit is part of the breast cancer operation.

Sentinel Node Biopsy

In this procedure, the ‘gate-keeper’ nodes in the armpit are mapped out using special dyes. These are then removed and sent for pathology evaluation. If these lymph nodes are not involved by cancer, the remaining nodes in the armpit can be safely spared. Patients who undergo this procedure have shorter hospital stay, usually do not need drains. Selective removal of lymph nodes helps minimise complications such as arm lymphedema, arm movement restriction, pain and swelling.

Axillary Node Dissection

In this procedure, the nodes in the armpit or axilla on the same side are completely removed. Drains are usually placed after this procedure. Patients are advised to avoid needle sticks IVs and prolonged use of 

Chemotherapy- Port Placement 

In Breast cancer, access to veins is limited as only one arm is often available for IVs and blood draws. Also chemo drugs being irritant, often cause thrombophlebitis and scarred blocked veins

A chemoport helps avoid these problems by delivering the chemo via an implanted catheter directly into the bigger veins, bypassing smaller veins. The port is also used for blood draws, blood transfusions, contrast injections and other IV fluids or medications.

Placement involves a short surgical procedure done under local or short-general anaesthesia. The small device can be removed after chemotherapy is completed or be maintained with regular flushes for 2-3 years.

Breast Cancer Treatment FAQs

Is breast cancer surgery painful?


We follow the Enhanced Recovery After Surgery (ERAS) protocl for all our breast cancer surgery. Pain is minimised if well controlled early in the surgical treatment. Towards this goal 1.You may be started on medications that reduce pain on the night before surgery. 2.Local anaesthetic in the form of nerve blocks around the surgical area are routinely used for early pain control. 3.Anti-inflammatory medications and paracetamol are used in regular doses after surgery. With this protocol most of our patients are surprised that when they wake up from anesthesia, they have minimal to no pain. They are able to site up shortly after surgery and able walk on the same day. Read more about ERAS here.




Can I avoid chemotherapy after surgery?


Chemotherapy is one of the pillars of breast cancer treatment. However not every breast cancer patient may need chemotherapy. If you have a tumour is small, has not spread to lymph nodes, is ER+ PR+ i.e. hormone receptor positive and HER2 negative, you may may benefit from a genomic risk assessment of your tumor. These commercially available tests include Oncotype Dx, Mammaprint, Endopredict and others. If such testing demonstrates your tumor to be at low risk of recurrence, you may be prescribed endocrine therapy alone for 5-10 years. Adding chemotherapy in such situations may provide little or no additional benefit. Contact us for more information on the topic




Will I need radiation after breast cancer surgery?


Need for radiation is determined by the type of surgery you have, the size of the tumor and whether it has spread to the lymph nodes. 1) Radiation is advised in nearly all cases if the type of surgery is a "lumpectomy for breast cancer" or "breast conservation surgery". 2) Radition is also used in locally advanced cancers which are large in size and those that have spread to the lymph nodes 3)Radiation may be omitted in certain small tumors of favorible biology in elderly patients. To know if your case benefits from radiation, contact us for an opinion.




Is chemotherapy painful ?


Most patients to receive breast cancer chemotherapy have no pain or discomfort during the IV infusion. Pain and irritation at the IV site can be minimised by using a chemotherapy port. To know more about chemo-ports click here




How to prepare for breast cancer surgery?


There are several things you can do in the time from diagnosis to surgery, to help with your recovery from surgery. 1) Increase your protein intake in diet 2) If you smoke or use tobacco products, ask your doctor about help with quitting 3) Continue to follow your exercise regimen and go for walks. 4) Ask your doctor about holding your aspirin or other blood thinners if you take them For a more details on preparing for breast cancer surgery, read more here




Is a mastectomy better than a lumpectomy for breast cancer?


In correctly selected patients, the long term outcomes of a lumpectomy with radiation are equivalent to a mastectomy. We only offer you a choice when both outcomes are safe for your cancer. The decision should be taken jointly by the patient and the breast surgeon and may depend on the following points 1) Size and location of the tumor, number of tumors and extent of pre-cancerous tissue in the breast. 2) Need for radiation if a mastectomy is performed 3) Plan for surveillance / followup after surgery 4) Possibility of genetic/ hereditary breast cancer 5) Expected cosmetic outcomes of either approach It is important for the woman to be comfortable with the decision she makes. It is also important for family members to help the patient make her own decision and notjudge them for the choices they make.





Advanced Breast Surgery

 Ensuring Complete Tumour Removal at Breast Cancer Surgery

 

We strive to ensure complete tumour removal in a single operation for which we use techniques such as 

1)Ultrasound-guided Breast Surgery

Intraoperative ultrasound is used to visualise the tumor during the surgery. Necessary margins can removed accurately without unnecessary removal of healthy tissue, and making smaller or hidden scars.

2)Specimen Mammography:  

When performing surgery for suspicious calcifications or in cases where a clip has been placed in the tumour bed pre-operatively, the tissue removed is sent for a mammography exam. This ensures that the area of concern has been accurately and completely removed

3) Intra-operative Frozen section:

The specimen removed is sent to the pathologist while you are still under general anaesthesia for the surgery. The pathologist samples the edges of this tissue and guides Dr Gadgil on whether the removal appears to be complete.

Oncoplastic Breast Surgery

Oncoplastic surgery combines safe oncological principles with aesthetic techniques of  plastic surgery, to obtain a good cosmetic outcomes from breast cancer surgery. We strive to give every patient an appearance that she is satisfied with. Dr Pranjali Gadgil, personally develops operative plans for each patient. A plastic surgeon may be involved if needed, during the operative planning and surgery.

Immediate Breast Reconstruction 

( Breast Replacement) 

Immediate Breast Reconstruction  ​

When undergoing a mastectomy, patients have the option to undergo an immediate reconstruction of the breast in the same surgery. In this procedure, the skin envelope of the breast is preserved and the entire breast tissue removed through a small incision. This is called "skin sparing" or "nipple skin sparing" mastectomy. The breast is then replaced with either an implant or a tissue flap obtained from another area of the body.

Enhanced Recovery After Surgery

(ERAS) for Breast Cancer Surgery

We follow special measures before and after surgery that help you with faster recovery and early discharge to home, from the hospital. This 5 step plan includes 

 

  1. Prevention of Postoperative Pain

Use of local anaesthetic in the form of nerve blocks around the surgical area, helps early pain control. You may be started on medications that reduce pain on the night before surgery. Anti-inflammatory medications and paracetamol are used in regular doses after surgery minimising Opioid medications that cause nausea and constipation 

   2. Prevention of Postoperative Nausea/ Vomiting

Medications are given during and after surgery, that reduce nausea and vomiting in the postoperative period. This allows resuming a diet early and discontinuing need for IV fluids.

   3. Prevention of Surgical Site Infections

You will be given a dose of antibiotic in the operating room, before your surgery. The surgical site is thoroughly cleaned before the operation begins. This prevents risk of wound infections in the post-operative period. You should handle drains and dressings after washing hands clean with soap.

   4. Early Mobilisation after Breast Surgery

We have most patients sitting up and walking on the same day after surgery. If you have drains, you will be given a specially designed sling bag so you can walk with your drains. You may be given special exercises to be done while you still have drains and a different set of exercises to be done once drains are removed.

   5. Use of Absorbable Sutures:

Wherever possible we use absorbable skin sutures so you don’t need to worry about stitches, staples, inconvenience and discomfort from the process of removing them. This also reduces scars and helps scars become less visible with time.

 
 

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Copyright 2020. All rights reserved by Dr. Pranjali Gadgil

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