Woman with lines of trans–rectus abdominis muscle (TRAM) reconstruction incisions.
A lines of reconstructed breast incisions
B circle of re–positioned "belly button" incisionC line of abdominal surgery incision
















Woman in process of trans–rectus abdominis muscle (TRAM) reconstruction.
A lines of reconstructed breast incisions
B right trans rectus abdominis muscle
C left TRAM muscle is swung over to re–create the new breast
D incision circle of re–positioned "belly button" incisionE line of abdominal surgery














Woman after mastectomy, showing trans–rectus abdominis muscle (TRAM) and surrounding tissues, in preparation for reconstruction.
A mastectomy site
B right trans rectus abdominis muscle
C left trans rectus abdominal muscleD segment of abdominal tissues: skin and fat, to be transferred along with muscle to create the new breast
















Side view of breast area with filled tissue expander in place lobules.
A tissue expander–filled (silicone gel/saline)
B port
C catheter
D syringe
E ribs
F pectoralis major muscleG Other muscles of the chest wall.

Woman with radical mastectomy.
A pink highlighted area indicates tissue removed at mastectomy
B axillary lymph nodes: levels I
C axillary lymph nodes: levels II
D axillary lymph nodes: levels III
E supraclavicular lymph nodesF internal mammary lymph nodes

Woman with modified radical mastectomy.
A pink highlighted area indicates tissue removed at mastectomy
B axillary lymph nodes: levels I
C axillary lymph nodes: levels IID axillary lymph nodes: levels III

Woman with total (simple) mastectomy.
A pink highlighted area indicates tissue removed at mastectomy
B axillary lymph nodes: levels I
C axillary lymph nodes: levels IID axillary lymph nodes: levels III

Woman with lumpectomy.
A dark area indicates tumourB light pink highlighted area indicates tissue removed at lumpectomy

Breast Cancer- Treatment
(Part-I)

Breast cancer can be cured completely if detected early. When cancer is suspected, generally it includes confirmation of the suspicion by proper diagnosis, evaluation of stages of the disease and proper selection of therapy. The outcome is favourable in the following cases
v Younger the age
v Having disease of Stage I and II
v Cancer limited to the breast
v Favourable pathological features and cell type
v With positive ER-PR status.
For patients other than the above, various treatment modalities are available, but they are more of palliative nature.
Different types of treatment are available for patients with breast Cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials.
A treatment clinical trial is a research study meant to help improve current treatment or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Such trials are freely available in western countries and are comparatively rare in India.
Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team. Usually four types of standard treatments are available. Usually more than one type of treatment is used depending up on the stage and type of the disease.
I. Surgery
Most treatment options in breast cancer will involve some form of surgery. In the past, cancer was thought to spread sequentially from the primary tumour, to regional lymph nodes and finally to distant sites. However, more thinking that is recent recognizes the early metastatic potential of breast cancer and that cancerous cells may have already spread to distant sites by the time the patient presents. Therefore, early diagnosis and/or surgery are important mainly for control of local disease rather than for preventing spread of the disease.
The aim of the surgery is to remove the cancer from the breast as far as possible. Some of the lymph nodes under the arm are usually taken out and looked at under a microscope to see if they contain cancer cells. The following are the standard surgical interventions:
1. Breast conserving surgery: It is an operation to remove the cancer but not the breast itself, includes the following:
v Lumpectomy: A surgical procedure to remove a tumour (lump) and a small amount of normal tissue around it.
v Partial mastectomy: A surgical procedure to remove the part of the breast that contains cancer and some normal tissue around it. This procedure is also called a segmental mastectomy.
Patients who are treated with breast-conserving surgery may also have some of the lymph nodes under the arm removed for biopsy. This procedure is called lymph node dissection. It may be done at the same time as the breast-conserving surgery or after. Lymph node dissection is done through a separate incision. This lymph node dissection is very important to know whether the cancer is restricted to breast alone or spread to distant parts. Knowledge of this is essential to plan further treatment. After the surgery, usually the removed part is sent to study for the presence or absence of Oestrogen receptors (ER) and progesterone receptors (PR). Its presence or absence has a major say in the further plan of treatment.
2. Other types of surgery: They include the following:

v Total mastectomy: A surgical procedure to remove the whole breast that contains cancer. This procedure is also called a simple mastectomy. Some of the lymph nodes under the arm may be removed for biopsy at the same time as the breast surgery or after. This is done through a separate incision.
v Modified radical mastectomy: A surgical procedure to remove the whole breast that contains cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.
v Radical mastectomy: A surgical procedure to remove the breast that contains cancer, chest wall muscles under the breast, and all of the lymph nodes under the arm. This procedure is sometimes called a Halsted radical mastectomy.

Adjuvant therapy:

Even if the doctor removes all of the cancer that can be seen at the time of surgery, the patient may be given further treatment, which depends up on the age, type of cancer, stage of cancer and ER-PR status. This will be in the form of radiation therapy, chemotherapy or hormone therapy. This is essential where we are trying to kill any cancer cells that may be left. This increases the chances of a complete cure.

Brest re-construction surgery:

If a patient is going to have a mastectomy, breast reconstruction (surgery to rebuild a breast’s shape after a mastectomy) may be considered. Breast reconstruction may be done at the time of the mastectomy or at a future time. The reconstructed breast may be made with the patient’s own (nonbreast) tissue or by using implants filled with saline or silicone gel.

II. Radiation therapy:

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

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- Dr.N.Someswara