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Surgical Management of Breast Cancer

Surgery is one of the tri-modality therapy used for treatment of Breast cancer, the other two are chemotherapy and radiotherapy. Surgery helps in complete removal of tumor along with proper staging of the cancer. Surgery can be either modified radical mastectomy (MRM) or it could be breast conservation surgery (BCS).

# Modified radical Mastectomy (MRM): MRM entails complete removal of breast tissue along with nipple areola complex and level I and II axillary lymph node. Surgery helps in staging of cancer to guide us the post operative treatment and also for assessing the follow up as to how aggressive and what all test required during follow up. 

# Breast Conservation Surgery (BCS): BCS entails wide local excision of the tumor in the breast with negative margin with axillary level I and II lymph nodal clearance. Negative margins means no tumor at the inked margin. BCS is combined with post operative radiotherapy to the whole breast which is the backbone of Breast Conservation Therapy (BCT). 

BCT has shown equivalent survival as compared to MRM in terms of patient survival. 

Initially breast conservation was done only for early stage tumor but with advent of neo-adjuvant (treatment given before surgery) chemotherapy to down stage the tumor it can be done even in locally advanced tumor.

#Wide Local Excision Only: Elderly female (> 70 years of age) can undergo just wide local excision of tumor with negative margins, if their tumor is ≤ 2cm, is strongly hormonal positive and low grade. No post operative treatment is required in these cases as the tumor at this age is indolent.

# Breast Reconstruction: Women who have undergone MRM have concern of their body image and they are psychologically more disturbed. Reconstruction can be done immediately after MRM or after completion of post operative chemotherapy and radiotherapy. 

There are various options available for reconstruction firstly we can use implant or tissue expander which is kept under the breast skin flap secondly we can utilize plastic surgery flap could be either free flap like the TRAM or DIEP taken from the patients belly area or local flaps like the latissimus dorsi flap which is rotated from back area. 

# Issues after Surgery for Breast Cancer: Certain patients complaints of difficulty in range of movement of the arm after surgery, this can be tackled with adequate physiotherapy and certain light exercises. Sometimes there can be issue of limb swelling of the side where surgery performed but with proper exercise and stockings this can be prevented.



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