In continuation of the previous session, you can video on important images in surgery (part 2) in this thread.
You can download the PDF of this session by clicking here –
Breastfeeding is a mother’s gift to her child and herself – there are innumerable advantages of breastfeeding to both the mother & child but sometimes mothers can face some difficulties during breastfeeding. One of them is the development of breast lumps during breastfeeding.
Breast lumps during breastfeeding can not only lead to anxiety in the mother but can sometimes be a sign of something as ominous as cancer. The common causes are:
Milk collection (Galactocele) – this is probably the most common cause of breast lumps in breastfeeding mothers. It commonly occurs due to a blocked duct and the patient can feel a painful lump in the breast. It can sometimes also occur, if breast milk is not emptied at regular intervals.
Management of a galactocele/ milk collection can range from emptying of breast milk either by feeding or by using a breast pump. Hot fomentation/ gentle massage also works well in this condition. If the problem occurs frequently, then one should consult a lactation expert/ doctor for further evaluation
Breast abscess/ mastitis – this is inflammation of the breast tissue which can progress to pus formation as well. It is secondary to a bacterial infection and you would be surprised to know that the source of the bacteria is the child’s mouth. These bacteria can enter through the nipple (more common in ladies with cracked/ sore nipples) and lead to infection.
Patient usually develops intense pain in the breast, which can be associated with redness and fever as well. If one notices any such symptoms, they should visit their breast surgeon immediately. In the initial stages, this condition is managed using antibiotics. In case, pus develops, then the surgeon is left with no option but to drain the pus out by performing a minor surgery. If the abscess is very large, your doctor might also recommend stopping breastfeeding using a drug.
Breast cancer – can sometimes be detected during breastfeeding. These lumps can initially be mistaken for a milk collection but unlike milk collections, they don’t respond to simple measures and keep on increasing in size. Sometimes these lumps might even be painless.
Due to these two reasons, cancers can often increase in size before they are detected in breastfeeding mothers.
If a mother notices a lump in the breast during breastfeeding, which does not settle in a few days, she should immediately visit a breast cancer surgeon and get herself evaluated. If the surgeon is suspecting a cancer, they will order an ultrasound followed by a needle biopsy to confirm the diagnosis.
These are some of the common causes of breast lumps during lactation. It is good to be aware of these lumps and one should not delay meeting a doctor in case they notice such problems. Having said this, majority of the mothers have an uneventful lactation period.
Over the last few years it has been seen that mothers are reducing the duration of breastfeeding due to professional commitments. Given all the advantages of breastfeeding for the mother and the child, this world breastfeeding week all ladies should pledge to complete breastfeeding at least for 6-8 months.
This information has been provided by
Principal Consultant, Breast Cancer Surgeon
CK Birla Hospital, Gurgaon
This PDF contains the Surgery Questions which were asked in the recent AIIMS June 2020 exam. The detailed video will soon be uploaded on my youtube channel.
The current COVID19 pandemic has affected the way all doctors practice and oncologists are no exception. Over the last 2-3 months, we have witnessed a lot of changes in treatment protocols, attitude of cancer patients towards their disease and the behavior of newly diagnosed breast cancer patients. Rather than going into technical details regarding the treatment protocols which we are following (which are an Indian modification of American/ European guidelines, most suited for our breast cancer patients at CK Birla Hospital), I will be discussing changes which we have made as doctors and how are our patients coping with the pandemic.
When the lock-down was announced in mid March, fear & panic is what prevailed amongst the patients and they were initially apprehensive in coming to the hospital for their surgery/ chemotherapy. But by early April, it was clear to patients that COVID will persist for a few months and although the world might be in lock-down but the cancer brewing inside their body would continue to grow and they would need to fight it out.
This change in patient attitude coupled with the proactive management at CK Birla Hospital (specially measures taken to improve patient and staff safety), we were able to carry out breast cancer treatment smoothly, even during the lock-down.
During the two months of lock-down, 94% of our breast cancer patients continued their chemotherapy. The ones who skipped some cycles were patients with metastatic disease, who wanted a ‘chemotherapy holiday’. In this period, my unit also operated 22 breast cancer patients. The number of benign (non cancerous) breast surgeries dipped dramatically during this period but we have seen a rebound increase in such cases since the lockdown norms have been eased.
After talking to a lot of friends & colleagues in UK/USA, I realised that I will only be able to take care of my patients if I stay healthy and disease free. To ensure that, in addition to the measures implemented by the hospital, I have also started using extra precaution in the form of a 3M 6200 mask with two p100 filters, which keeps the smoke plumes (thought to be a the leading case of infection in surgeons & anaesthetists) away. Of course, my OCD of hand washing has also served me well during this period 😊.
Our breast cancer patients have also adapted well over the course of the last 2 months. Our unit has a very active cancer support group known as ‘Vijay’ and all the members have devised new methods to keep in touch with each other during these tough times.
In the pre-covid times, old patients used to visit the new patients on the day of their surgery/ first chemotherapy. This is has been replaced by zoom group calls to support newly diagnosed patients. Even our treatment completion celebrations have undergone a lot of change. Earlier, these used to be elaborate affairs where the patient’s family & the treating team would participate actively, but now we have toned it down (but not stopped it, as it is a very important landmark in the patient’s life) to a simple cake cutting with everyone wearing masks.
To summarise, my biggest learnings during this period have been
This article has been written by,
Principal Consultant – Breast Cancer Surgery
CK Birla Hospital, Gurgaon
I clicked this picture a year and a half back and this one moment is associated with a lot of life teachings.
This juvenile tailor bird, while learning how to fly, landed in my balcony. Being an avid bird photographer, I immediately took out my camera and quietly started observing (and clicking) the little one’s repeated attempts to make it over the railing.
In between, the mother kept coming and encouraging the young one but after 30-40 mins of struggle, the little one gave up and found shelter besides a huge pot.
Minutes later, the mother appeared with a treat for the young one and after feeding him, she started coaxing the young one to try once more.
Finally, with the help of the mother, the young one flew from one balcony to the other.
The entire saga lasted for about 1.5 hours (and I skipped my meal) to click at least 200 pictures but this is the one which made my day.
Lessons which I learnt from this moment
At present, almost half the world is in lock-down due to the corona virus outbreak and it is difficult to predict for how long this situation might remain the same. In India, it is almost certain that the lock-down due to COVID 19 will be extended till at least end of April. Even though we are in a state of lock-down but our body is still functioning and that means diseases like cancer might still be growing inside our system. So how does one deal with a problem like breast cancer/ breast lump during this period.
Tips for existing breast cancer patients
Recently detected a breast lump – what should you do during this period?
During the lock-down, lot of ladies are taking out time to carry out breast self examination and they are picking up new breast lumps. If you are one of them, I would advise that you consult a breast lump surgeon immediately. This consultation can either be an online consultation or a physical visit to the hospital. In an online consultation, if the doctor feels the need to carry out a physical examination, he/she would call you to the hospital.
A breast lump should not be ignored because if it is cancerous, it can increase in size during this period. A mammography or an ultrasound should be done after physical examination and if the lump is suspicious, a biopsy/ needle test should be done to confirm the diagnosis. If the breast lump turns out to be non cancerous (benign), then the treatment can be deferred till the time COVI19 situation improves. Your doctor can provide you medicines during this period to deal with the problem/ breast pain associated with the lump.
If the lump turns out to be breast cancer, as I have highlighted above, please consult your doctor and make a treatment plan which is suitable to you.
These are testing times for everyone, including patients. One has to be cautious about not getting infected by the virus as well as make sure that their breast cancer/ breast lump treatment doesn’t suffer. If you follow the tips which I have highlighted above, you can tide over this phase without compromising your health.
This information has been provided by
Breast Cancer Surgeon
CK Birla Hospital, Gurgaon
To book an online consultation with Dr. Rohan Khandelwal, click here
Breast fibroadenomas are the most common cause of breast lumps and they are commonly seen between 15-30 years of age group. We usually see a lot of anxious women presenting to the Breast Centre at CK Birla Hospital, Gurgaon with this complaint and all of them have two common questions:
I will address these two questions in the text below but before that I would just like to give you some information regarding breast fibroadenomas.
Clinical presentation – Breast fibroadenomas usually present as painless (non painful) breast lumps which keep shifting their position within the breast. These lumps can remain the same size for long periods of time but sometimes they can present with pain, rapid increase in size. Approximately 10% women can have multiple fibroadenomas [read about the lady with 39 fibroadenomas in both breasts].
There is no known cause for fibroadenomas and no well defined risk factors.
On examination, these lumps are usually firm in consistency and mobile, which is why jokingly they are also known as a ‘breast mouse’.
Diagnosis of a fibroadenoma can be made out on an ultrasound of the breast (which is the preferred imaging technique in patients less than 40 years of age). If a mammogram is done, you can see a ‘popcorn appearance‘ of the lesion.
Majority of the fibroadenomas can be clearly made out on an ultrasound but if a lesion is showing some atypical changes, then a tru-cut biopsy/ FNAC (needle test) is recommended to confirm the diagnosis. This is also indicated in patients with a family history of breast cancer.
Coming back to the two questions which all patients with breast fibroadenomas have running through their mind during their visit to a breast surgeon:
Surgical removal for fibroadenomas is usually a minor surgery which is done as a day care procedure. The incision for this surgery is usually made around the areola (peri-areolar) as this incision heals with minimal scarring. Sometimes the incision can be made in the skin fold under the breast (infra-mammary crease). Some patients can candidates for scar-less fibroadenoma surgery, in which the lump is removed via a 3-4 mm incision using a special machine.
Those patients who are not candidate for surgical excision are asked to follow-up at regular intervals, usually 6 months to 1 year. In addition to this, they are asked to monitor the size of the lump. In case there is a rapid increase in size of the fibroadenoma, they are asked to return immediately. Unfortunately, there is no credible medical management of fibroadenomas.
Information provided by:
CK Birla Hospital
Dr. Rohan Khandelwal also performs scar-less fibroadenoma surgery at CK Birla Hospital
Ladies commonly present to our Breast Cancer unit with complaints of lumps in the underarm region (axilla) and their first concern is always breast cancer, but not all axillary lumps are a sign of breast cancer. In this article, I will highlight the common causes of under-arm lumps/ swellings, which ladies can develop:
Another common cause of enlargement of these nodes is after shaving/ waxing of underarm hair. This can lead to momentary enlargement of these nodes (reactive lymphadenopathy), which usually settles down with time or with a course of antibiotics.
As I have highlighted above that breast cancer is just one of the causes of axillary lumps. Having said that, it is best that you visit a breast unit whenever you notice a lump in the breast or underarm region. After taking a history and carrying out clinical examination, the breast surgeon will order an imaging test, which would either be a mammogram or ultrasound or both. This would be followed by a tru-cut biopsy/ FNAC to confirm the diagnosis. In some cases a lymph node biopsy might be required to clinch the diagnosis.
For further information or to book an appointment, please contact
CK Birla Hospital, Gurgaon
Lot of times in my Breast Clinic at CK Birla Hospital, Gurgaon, I get patients who come and tell me that they are suffering from stage III breast cancer. When I ask them how do they know about that, the answer which I usually hear is that “my mammogram/ ultrasound report shows BIRADS III.” Not only patients but I have also seen some doctors getting confused with the BIRADS reporting.
BIRADS (Breast Imaging Reporting and Data Systems) is a standardized way of reporting breast radiology reports. This helps radiologists categorize patients from a score of 0-6 and it helps breast cancer surgeons in taking decisions based on this score. Having a uniform reporting system is useful because patients might get their radiology and breast disease treatment done at different places.
The score doesn’t imply the stage of cancer and patients should be aware of this to avoid unnecessary anxiety after seeing the radiology report.
The table below summarizes the BIRADS score and the action which needs to be taken in each category.
So the next time you receive your mammography / breast ultrasound report, don’t be surprised to see the BIRADS score. Discuss the report with your radiologist and breast cancer surgeon and take action accordingly. Remember, that all breast lumps are not cancerous and all of them don’t even require a biopsy/ FNAC test.
This information has been provided by
CK Birla Hospital, Gurugram