Breast conservation surgery

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 [email protected] Cell:09999019149

2. RADICAL MASTECTOMY MODIFIED RADICAL MASTECTOMY

3. BREAST CONSERVING SURGERY

4. BREAST CONSERVATION: Long-term validation

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

6. 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

7. 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 .

8. INDICATIONS Stage I & II ? Stage III

9. 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

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

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

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

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

14. GUIDELINES OF SURGERY Incision Technique Closure Axillary Dissection

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

16. 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)

17. RADIOTHERAPY IN BCT Intraoperative radiotherapy Post operative radiotherapy Brachytherapy

18. BCS : Procedures Lumpectomy with 2 cm clearance Lumpectomy with Axillary Dissection Quadrantectomy with Axillary Dissection

19. 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 %

20. 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

21. Thank You