Breast conservation surgery is an established way of treating Ca breast in early stages. For details plz vist https://drnitinjha.com/

1. BREAST CONSERVATION
SURGERY
DR NITIN JHA
PSRI HOSPITAL,DELHI
FORTIS HOSPITAL,NOIDA
drnitinjha@yahoo.com
Cell:09999019149

4. RADICAL MASTECTOMY MODIFIED RADICAL MASTECTOMY

5. BREAST CONSERVING SURGERY

7. BREAST CONSERVATION:
Long-term validation

8. Modern Surgical Practice
• Less invasive surgery
• More attention to cosmetic outcomes
• Improved prognosis

9. BCS:Why?
• Ca Breast is a local manifestation of a systemic
disease.Local radicality does not change
survival
• Cosmetic Considerations
• Preservation of the nipple ,an important
sensate focus

10. BCS:Why?
• Mastectomy is a socially devastating surgery
for the downtrodden Indian woman and
signals an end to her married life.The
relevance of BCS in the Indian scene cannot be
overemphasised.

11. INDICATIONS
• Stage I & II
• ? Stage III

12. CONTRAINDICATIONS
• Pregnancy
• Multicentric disease
• Diffuse indeterminate micro-calcification
• Previous RT
• Large tumour/ breast ratio
• Collagen vascular disease
• Central tumour Very small Breast
• Advanced / High Grade Disease
• Lactating Breast
• Disease in opposite Breast

13. Small Breast Realities
• In a small breast not much to achieve in
cosmesis
• Recurrence comes as Cancer en Cuirasse

14. Large Breast Realities
• In a large breast recurrences not easily
diagnosed
• A recurrence is viewed as a second primary

15. METHODS
• Lumpectomy +Axillary dissection +RT
• Lumpectomy+SLN biopsy +RT
• QUART- Quadrantectomy +Axillary dissection
+RT
• CTART- Chemotherapy +RT

16. Axillary Dissection
• Better control of locoregional recurrence
• Accurate staging of disease
• To decide adjuvant therapy
• Prognosis

17. GUIDELINES OF SURGERY
• Incision
• Technique
• Closure
• Axillary Dissection

18. NEW TECHNIQUES OF TUMOUR
MANAGEMENT
• Radio Frequency Ablation –RFA
• Cryosurgery
• Focused Ultrasound
• Percutaneous tumour extraction

19. SEQUENCING OF CHEMOTHERAPY
AND RT
• 6 Cycles of CMF followed by RT
• RT followed by 6 cycles of CMF
• 3 Cycles of CMF followed by RT followed by 3
cycles of CMF (sandwich therapy)

20. RADIOTHERAPY IN BCT
• Intraoperative radiotherapy
• Post operative radiotherapy
• Brachytherapy

21. RESULTS
• BCT / MRM T1 & T2
• TUMOUR CONTROL RATE
• 5 YR RELAPSE FREE
SURVIVAL
• RECURRANCE
• ONLY CONS SURGERY
• CONS SURGERY + RT
• 80 TO 90 %
• 70 TO 88 %
• 15 TO 40 %
• 2 TO 10 %

22. Newer Frontiers
• Laparoscopic Axillary Dissection
• Laparoscopic Int Mammary Clearance
Technically feasible
Clearance equal to standard technique
Acceptability only after it stands the test
of time

23. Thank You