Breast Care Unit

Breast cancer is the most common cancer affecting urban Indian women. The last three decades have seen the numbers of breast cancer patients grow steadily. It is estimated that by 2015-2020, India will be among the world leaders in new breast cancer cases detected every year. We need to be aware of this and gear ourselves up for this. It is important to spread awareness about the disease and also about ways and means of preventing the disease or detecting it early so that cure rates are maximised. Worldwide, there are specialised breast units that deal with patients with breast diseases, including breast cancer.

The Kokilaben Hospital Comprehensive Breast Care Unit is a dedicated service that has been created to specifically diagnose and treat the entire spectrum of conditions affecting the mammary gland. The breast unit has been designed on the guidelines laid down by the European Union Society of Mastology (EUSOMA) and is based on two fundamental principles – evidence-based medicine and multidisciplinary approach.

Evidence Based Medicine

Over the years, a lot of research has been carried out in the field of breast diseases, both benign and malignant, spanning diagnosis to treatment. It is important for all clinicians to keep up with this vast reservoir of knowledge, understand it and translate it into practice guidelines that are applicable in day-to-day clinical practice. This is called evidence-based medicine. At Kokilaben Hospital, we follow the model of evidence-based medicine so that our patients can receive the highest level of care in surgery, chemotherapy or radiotherapy that is prevalent in the world e.g. in the field of breast cancer management, the next step of individualising treatment for each and every patient has already been taken using new molecular predictors of recurrence, by techniques such as microarrays and RT-PCR. Such advances in technology have allowed us to quantify the risk of relapse for an individual patient and tailor her therapy accurately e.g. avoid chemotherapy in patients who are at low risk of relapse as estimated using these new assays. Such advances in management are practiced on a regular basis in the breast unit at Kokilaben Hospital.

Multidisciplinary Approach

The days of surgeons treating breast cancer patients on their own are long gone. Today, centres of excellence all over the world treat their patients using multidisciplinary teams. With a growing awareness about breast cancer, more and more patients are being diagnosed in the early stages and consequently, cure rates have risen to up to 85-90%. This has made post-treatment quality of life and rehabilitation very important and relevant in addition to treatment issues.

Kokilaben Hospital Breast Unit Team

At Kokilaben Hospital, the breast unit multidisciplinary team includes:

• Breast Surgeon (specialising in benign and malignant diseases of the breast) – Dr. Mandar Nadkarni
• Reconstructive Plastic Surgeons – Dr. Charudatta Chaudhari & Dr. Quazi Ahmad
• Medical Oncologists – Dr. Sandeep Goyle & Dr. PSRK Sastry
• Radiation Oncologist – Dr. Kaustava Talapatra
• Breast Radiologists – Dr. Dibya Konger & Dr. Shefali Shah Sardar
• Breast Pathologists – Dr. Bijal Kulkarni & Dr. Nanda Kachare
• Psychologist/Counsellor – Ms. Priyadarshini
• Psychiatrist – Dr. Jalpa Bhuta
• Rehabilitation Physician – Dr. Abhishek Srivastava
• Breast Nurses

Each member of the team is an expert in his/her line of speciality and being a member of the team encourages healthy interaction amongst all members in making and executing therapeutic decisions for individual patients. The main purpose of a multidisciplinary team is to impart the best possible state-of-the-art care to the patient, from diagnosis to treatment and even post-treatment rehabilitation.

At Kokilaben Hospital we have performed more than 425 surgeries in the past 2 years.

Spectrum of Breast Diseases

• Breast Cancer
• Operable Breast Cancer (OBC)
• Locally Advanced Breast Cancer (LABC)
• Metastatic Breast Cancer – Liver, lung, bone, brain metastases
• Axillary Lymph Node Metastases with unknown primary
• DCIS – Impalpable microcalcifications/on screening mammography
• Proliferative breast disorders – LCIS and atypical ductal hyperplasia
• Benign Breast Disease including fibroadenomata, breast cysts, fibrocytic disease (fibroaddenosis/ANDI), cyclical mastalgia (breast pain) etc.
• Significant Nipple Discharge - Blood stained nipple discharge
• Inflammatory conditions of the breast – e.g. breast abscess, granulomatous mastitis etc.

Breast Unit Service

• Screening and early detection of breast cancers – Mammography, breast ultrasound, magnetic resonance imaging (MRI)
• Image-guided hook-wire localisation of impalpable breast abnormalities and excision.
• Surgery for breast cancer – Breast Conservation Surgery or Modified Radical Mastectomy or Radical Mastectomy.
• Oncoplastic Breast Conservation Surgery for breast cancer – Combines the principles of plastic surgery and cancer surgery to facilitate cosmetic surgery in patients with breast cancer. . At Kokilaben Hospital, we consider microvascular reconstruction following cancer surgeries as the standard of care – unless the patient is unfit for such a surgery. Microvascular reconstructions give the best cosmesis and the patient can return to daily activities significantly improving the quality of life. These surgeries also make secondary surgeries unnecessary.
• Partial and Whole Breast Reconstruction – Using pedicled autologous flaps (latissimus dorsi myocutaneous flap or transverse rectus abdominis myocutaneous flap) or free tissue transfer (deep inferior epigastric artery based perforator flap, superior gluteal artery perforator flap, Interolateral thigh flap) with or without silicone implants, followed by reconstruction of nipple and areola.
• Conservative axillary surgical procedures to minimise the side effects of axillary surgery, such as post- operative seroma and lymphedema, using techniques such as sentinel node biopsy and 4 Node Axillary Sampling.
• Counselling the patient and relatives over the histopathology report and discussing therapeutic options regarding adjuvant therapy along with individual risk-benefit ratios and overall risk reduction after adjuvant therapy.
• Placement of indwelling chemotherapy ports with specialised ‘port clinic’ for management of patients with chemo ports.
• Delivery of adjuvant chemotherapy and targeted therapy by a medical oncologist specialised in breast cancer chemotherapy in stat-of-the-art chemotherapy suites. The range of chemotherapy includes both anthracycline and taxane-based chemotherapy, regular and dose-dense regimens.
• Specialised Radiation Therapy (whole breast or chest wall radiotherapy) delivered by experts in the field, using the latest technology. Radiation therapy also includes palliative radiotherapy in metastatic breast cancer for bone and brain metastases e.g. hemi-body irradiation, whole brain radiotherapy, cranio-spinal irradiation for meningeal carcinomatosis etc.
• Detailed instructions on exercise and diet by the respective experts after completion of therapy and follow-up advice.
• Diagnosis, counselling and medical/surgical treatment of benign breast conditions such as cyclical mastalgia (breast pain), breast cysts, fibrocystic disease (ANDI).
• Diagnosis and treatment of significant nipple discharge.
• Management of breast abscess – Conservative treatment (if <3cm) or surgical drainage (if >3 cm).
• Genetic Counselling in patients with a family history of breast cancer or hereditary breast cancer.

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