Cosmesis beyond Cure!
Breast Conservation Surgery has been the standard of care for more than twenty years; with local control rates and overall survival being equivalent to Mastectomy. With recent advances in imaging techniques such as MR Mammography, Sentinel Node Biopsy and development of Breast Oncoplasty, the long term and cosmetic results of the procedure have improved.
A 46-year-old pre-menopausal female visited BLK Cancer Centre with a recently noticed lump in the left breast. On clinical examination, a 2x2 cm size well defined lump in upper outer quadrant of left breast was found with no significant palpable axillary lymphadenopathy. Upon further investigation with MR Mammography two other suspicious lesions were seen in close proximity to the main tumour. US guided biopsy of lump was infiltrating ductal carcinoma.
The patient was subjected to Breast Scintigraphy on the day of surgery after injecting radioactive Tc99 nano colloid in retroareolar region of left breast. Gamma scan was performed after 2.5 hours of injection; which showed uptake in two lymph nodes along anterior axillary fold. She was then shifted to the operation theatre. The sentinel lymph nodes were dissected by axillary incision, the radioactivity was confirmed using handheld gamma probe and all hot nodes were sent for frozen section examination, which revealed absence of axillary lymph node metastases. A wide local excision of breast lump was done with a surgical margin of 1 cm circumferentially. The tumour bed was marked with surgical clips to aid in Adjuvant Radiation Therapy planning. The defect created after removal of lump was reconstructed by Breast Oncoplasty with transposition and suturing of adjacent breast parenchyma into the defect.
The surgery was successful and the patient went home the next day. The patient recuperated well after the surgery and is now on the road to full recovery. She would require adjuvant Chemotherapy and Radiotherapy.