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...SURGERY FOR BREAST CANCER IS NOT ABOUT REMOVING BREASTS, ALWAYS…(contd.) The treatment of breast cancer has undergone major improvements and this has been reflected in how the outcomes have changed dramatically for the better. While curing the disease is a priority, maintaining quality of life is as important. The journey that has been covered before us is no less fascinating and the constant endeavor to make it better for the patient has driven the change. Mutilating surgeries in the form of amputation of the breast and then radical mastectomy (removal of the breast, muscles of the chest and the lymph nodes in the armpit ) or the extended radical mastectomy( same as radical mastectomy but with the additional removal of lymph nodes inside the chest) remained in vogue for a larger part of the 20th century. ...to be continued.....More history in the next update
Never too old to make choices Last week, I met this lovely lady, pushing 80 years. I’m reluctant to call her old for her lively demeanour would put the chronologically young to shame. How I met her was because she had been diagnosed with breast cancer. Fortunately for her, she had early breast cancer. This is a delight for a breast surgeon like me, who is used to seeing advanced breast cancer. After going through the investigations, it was decided that she should have surgery. I started discussing the surgical options and just as I would do with all my patients amenable to all the options, I discussed breast conservation surgery, mastectomy ( surgical removal of the breast)and mastectomy with reconstruction. She was quick in making her decision and said she wanted to have a breast conservation surgery. I liked her firmness but her daughter was not so sure. When the time came for her to be admitted, the daughter came up to me and said that she and her brother thought it would be better if she went ahead with mastectomy. It was surely concern for their mother. They wanted her to be disease free and also thought that at her age, it did not matter if she lost her breast. At the same time, they were not sure that breast conservation and mastectomy yielded the same results. I spoke to her again and said that her mother had made a choice, which was scientifically tenable .Ten years ago, my warped mind might have encouraged her to go for mastectomy. Now I know, choice has nothing to do with age.The instances when husbands, brothers, parents, relatives and anyone else( read neighbors!) influencing surgical decisions have been too many and every time, my heart has gone out, especially, to the young ladies who have had no say in the choices imposed on them.Losing a breast is a self esteem, body image issue- the loss and its impact is borne only by the one who loses it.The lovely dame stood by her choice and it was executed. Choices are not about being right or wrong. Choices are about the freedom to make a decision and stick by it. The comfort of having made one’s choice is a confidence booster and can bring about unexpected results. I do know that, for a fact!
SURGERY FOR BREAST CANCER IS NOT ABOUT REMOVING BREASTS, ALWAYS… In the 1960’s, the conviction that breast cancer was a systemic disease at inception and not a local disease, prompted trials to address one question- ‘Are we doing too much?’ Radical mastectomy was replaced by modified radical mastectomy- a procedure not as mutilating as radical mastectomy ( the chest muscles were preserved)but still one, which involved loss of an organ. Moreover, to a woman, it meant much more than the loss of an organ. It probably entailed a huge psychological blow besides casting a shadow on her feminity. She, being the woman she was, in those days, came to terms with this loss, in the best manner possible. All that mattered to her was her getting well, on her feet and ready to discharge the duties of a wife, mother, daughter and more. And there was really no choice then because the doctors treating her were also convinced that sacrificing the breast was the only chance of getting well. More tomorrow.....on Evolution of treatment
SMALL BUT SIGNIFICANT!! I recently operated upon my colleague’s aunt for breast cancer. She was discharged uneventfully and went home in a baby pink tunic with her drain in a floral pink sling bag, that goes with each patient after breast surgery. That is when my colleague pointed out that the film ‘Sui Dhaaga’ was based on a concept I had created 8 years ago.I was taken aback! I had not seen the film. So, he explained to me how that film was based on creating comfort and practical clothing for patients after surgery.That idea catches on and goes on to become a successful business venture, in the movie. I had seen my patients after surgery for breast cancer, especially those with mastectomy (breast removal) struggle with their clothes to expose the wound while at the same time struggling harder to cover their loss.It was not easy to carry their drain( tube) boxes around and they were always scared of the drains being pulled at and dislodged. I wanted to come up with a solution. My dear friend, Mamta Goenka, had already worked on a pink bag with a smiley ball, peppermint, Vaseline and a soft pillow. I wanted to add something to this and that is when I set about designing a baby pink or floral post mastectomy knee length tunic with Velcro tapes holding the front and Velcro tapes on the sides to allow the drain to slip imperceptibly into the sling bag. To this was added bras with pockets to hold the external prostheses and restore body image, even as the lady walked out of the hospital. I got a vendor to design it and it was welcomed by all patients. Like in the movie, there was a potential business opportunity in this thought.However, I am no businesswoman but the idea caught on with the vendors.Now, there are many vendors in the fray and this kit is being supplied by them to most of the large corporate hospitals in Delhi. For me, patients’ positive feedback is my reward. I am happy that I have been able to make a difference in the lives of those who have had a brush with breast cancer, in a small but significant way!
SURGERY FOR BREAST CANCER IS NOT ABOUT REMOVING BREASTS, ALWAYS… When 32 year old Neena, an HR consultant in an MNC, walked into my clinic, accompanied by her husband and parents, I could sense an air of hopelessness surrounding this good looking young lady. The papers that were laid in front of me carried a needle biopsy report, which confirmed the diagnosis of breast cancer. Fortunately, for her, the size of the lump was about 2cms and there were no lymph nodes that I could feel in the armpit. There was no evidence of spread to the other organs on imaging. I soon realized she had been through the discussion of surgery and she had come to me for a second opinion. I soon found out why she had decided to come for a second opinion. She had been advised a modified radical mastectomy (complete removal of the breast along with the lymph nodes in the armpit). She was a successful career woman with everything going for her till yesterday and today she was grappling with this tough predicament- losing an organ, an integral part of her feminity to cancer- it was almost cruel!.......... ....To be continued.....watch this space for more.......
SURGERY FOR BREAST CANCER IS NOT ABOUT REMOVING BREASTS, ALWAYS… While all this continued as the standard of care for the first 65 years of the 20th century, some smart minds in the medical field started questioning the necessity of performing such radical surgeries to get optimum results. Trials got underway to compare mastectomy versus breast conservation surgery in the 1970s. A pathologist turned surgeon, Dr Umberto Veronesi, pioneered the most convincing trial in Milan. He was able to show that breast conservation surgery (removal of the lump with a surrounding 1 cm margin of normal breast tissue) followed by radiation therapy to the rest of the breast in properly selected patients yielded the same results as a complete removal of the breast. I am quite convinced that it is the pathologist in this surgeon who urged him to go for this trial. He had probably seen while looking at the breast as a pathologist that far too much was being done to address small cancers in the breast. Finally, women with breast cancer had a choice…. For more information on breast cancer, please contact Dr Geeta Kadayaprath, Breast Surgeon, Max Cancer Centre, Delhi, India
One of the first decisions you may have to make is which type of operation you'll have. You may be offered a choice of breast-conserving surgery, (usually referred to as lumpectomy or wide local excision) or a total mastectomy (removal of all the breast tissue including the nipple area). Sometimes it can be helpful to talk through your choices with your breast care nurse and discuss how each would affect you. Dr. Geeta Kadayaprath - Breast Cancer Treatment in Delhi
Many women with Breast Cancer are candidates for Breast-Conserving Surgery, also called Lumpectomy, Partial Mastectomy or Quadrantectomy. In this type of operation, your Surgeon selectively removes the tumor and leaves the remaining Breast intact. Dr. Geeta Kadayaprath - Oncoplastic Breast Surgeon in Delhi
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