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Breast conservation surgery
The document discusses breast conservation surgery (BCS) and its relevance in modern surgical practice, particularly in Indian women who may find mastectomy socially devastating. It outlines indications, contraindications, methods of surgery, and new techniques for tumor management, emphasizing the importance of cosmetic outcomes and improved prognosis. Key points include various surgical techniques and the results associated with BCS compared to radical surgeries.
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Breast conservation surgery
- 1. BREAST CONSERVATION SURGERY DR NITINJHA PSRI HOSPITAL,DELHI FORTIS HOSPITAL,NOIDA drnitinjha@yahoo.com Cell:09999019149
- 4. RADICAL MASTECTOMY MODIFIEDRADICAL MASTECTOMY
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- 8. Modern Surgical Practice •Less invasive surgery • More attention to cosmetic outcomes • Improved prognosis
- 9. BCS:Why? • Ca Breastis 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 isa 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 • Multicentricdisease • 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 +Axillarydissection +RT • Lumpectomy+SLN biopsy +RT • QUART- Quadrantectomy +Axillary dissection +RT • CTART- Chemotherapy +RT
- 16. Axillary Dissection • Bettercontrol of locoregional recurrence • Accurate staging of disease • To decide adjuvant therapy • Prognosis
- 17. GUIDELINES OF SURGERY •Incision • Technique • Closure • Axillary Dissection
- 18. NEW TECHNIQUES OFTUMOUR MANAGEMENT • Radio Frequency Ablation –RFA • Cryosurgery • Focused Ultrasound • Percutaneous tumour extraction
- 19. SEQUENCING OF CHEMOTHERAPY ANDRT • 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 • LaparoscopicAxillary Dissection • Laparoscopic Int Mammary Clearance Technically feasible Clearance equal to standard technique Acceptability only after it stands the test of time
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