Breast Surgery

Breast cancer is the most common cancer in females all over the world. Breast cancer can occur in males also. Patients with breast cancer can be present with either breast lump or nipple discharge may be blood-stained or retracted nipple or change in the shape of breast or texture of the breast. Mammography (40years), ultrasound of breast (40 years) and MRI are the investigations to diagnose breast cancer. A biopsy is confirmatory.

The most common type is invasive duct carcinoma (IDC) which arises from the milk ducts of the breast. Rarely cancer can arise from lobules, adipose tissue, and fibrous tissue also. Risk factors for breast cancer include older age, personal history of breast cancer or benign (noncancer) breast disease, inherited risk of breast cancer, dense breast tissue, reproductive history resulting in greater exposure to estrogen, taking hormone therapy for symptoms of menopause, radiation therapy to the breast or chest, obesity and drinking alcohol.

Breast cancer runs in family and passes through genes BRCA1 and BRCA2. If one of your first-degree and two of your second-degree relatives are having breast or ovarian cancer you should get yourself tested for genetic cancer risk.

Treatment of breast cancer depends on stage, type, hormonal receptor positivity. Modified radical mastectomy is the standard surgery performed in carcinoma breast. Breast conservative surgery with axillary dissection is also an option in the early stage with the unifocal disease. Adjuvant chemotherapy, radiation therapy, targeted therapy, and hormone therapy are given after surgery depending on biopsy and IHC report. In locally advanced or metastatic carcinoma breast preoperative chemotherapy is given to reduce the tumor bulk.

Screening for breast cancer includes self-breast examination once a month, clinical breast examination annually, and annual mammography after the age of 40years. Women with a family history of breast cancer with BRCA positive should start screening with ultrasound breast 10years before the index case or after the age of 30years.

Protective factors for breast cancer are reproductive history and breastfeeding resulting in less exposure to estrogen, selective estrogen receptor modulators, or aromatase inhibitors and inactivators.  Risk-reducing or prophylactic mastectomy or ovarian ablation can be offered in patients with a family history of breast cancer with BRCA1or BRCA2 gene positive.