Operable Breast Cancer

PATIENT DETAILS

Age: 70

CASE PRESENTATION

During our screening camp, we picked up a left breast lump on a 70-year-old post-hysterectomy lady. The examination revealed a 3 cm mass in the lower inner quadrant of her left breast with a 1.5 cm node palpable in the left axilla.

The patient had tubular cup B breasts with grade 2 ptosis due to which her breast was sagging with her nipple approximately 3cm below the breast crease.

She did not have any significant family history of cancer.

DIAGNOSIS

Core biopsy demonstrated Invasive Ductal carcinoma grade III, strongly positive for estrogen and progesterone receptors and negative for the protein HER2 (human epidermal growth factor receptor 2) neu with a Ki-67 of 35%.

TREATMENT

Keeping in mind the stage and tumor characteristics, Dr. Garvit Chitkara took the decision to perform an upfront surgery employing the following techniques:

Left BCS (Breast Conservation surgery) with SLNB (Sentinel Lymph Node Biopsy)
PBR (Partial breast reconstruction) with a TE (Thoraco-Epigastric flap)

SYMPTOMS

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Lump in the left breast.

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Mastalgia (Breast pain)

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Skin irritation.

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Redness or scaliness.in breast skin

TESTS PERFORMED

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Bilateral Mammogram – suggestive of 2.3*1.9 mass noted at 5 o clock in the left breast (BIRADS 5)

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PET scan – no evidence of metastatic disease

DETAILED DESCRIPTION OF TREATMENT

Left BCS with SLNB

Axillary surgery is an essential part of breast cancer surgery and it helps the oncologists decide the stage of the disease, the chances of recurrence, the need and amount of chemotherapy, and the need for radiotherapy.

Depending on the clinical examination and radiology it is decided what axillary surgery needs to be done. For a clinically node-negative axilla a sentinel lymph node biopsy is advised. In clinically node-positive axilla Axillary Lymph node Dissection (ALND) is recommended which is the removal of all the fibrofatty tissue in the axilla. Anatomically there are three levels of the axilla. The level of dissection may vary from patient to patient and is best decided by the operating surgeon.

PBR with TE

In order to restore the shape and size of the operated breast, Dr. Garvit Chitkara performed a partial breast reconstruction with a Thoraco-Epigastric flap, using a small amount of extra tissue from the patient’s lower chest and upper stomach.

He made an incision in the chest and stomach and then separated the skin and underlying tissues. Once the pocket was created, he placed the flap inside and sewed it into place.

Then he recreated the nipple and areola by making an incision in the skin and using a tattoo or pigmented skin to create the illusion of a nipple and areola.

Finally, he covered the incisions with a dressingfor the stitches to heal.

POST-OPERATIVE ASSESSMENT

Based on the patient and tumor characteristics, she was a candidate for Oncotype DX. With a recurrence score of 9, the patient ended up avoiding chemotherapy and was started on aromatase inhibitors along with locoregional radiation therapy. The patient is currently disease free on follow-up.

PATIENT’S FEEDBACK

The patient said she had been very worried after hearing the diagnosis but Dr. Garvit Chitkara and his team explained to her the condition and treatment procedures.

She is more at ease now and is also happy that the breast reconstruction procedure has filled what otherwise would have been an empty space constantly reminding her of the ordeal she went through.