Have you been properly investigated before a breast augmentation??

Breast augmentation has become a very common procedure in India now and more and more ladies are opting for such surgeries. Many surgeons are also luring patients by giving them attractive packages.

In order to save some money, many times, pre-operative imaging of the breast (ultrasound or mammogram) is being avoided and the result is that lesions like cancer are being missed in some of these patients.

I have come across three such patients in the last 6 months. One of them was a 32 year old business executive, who had undergone a breast augmentation 4 months back and she presented with a lump in her left breast. I was surprised to find a 2×3 cm lump in her breast, which had all the features of malignancy. A tru-cut biopsy confirmed her worst fears and she was devastated after the diagnosis. Her initial response was one of disbelief and anger towards the doctor, who had not investigated her properly before the augmentation procedure.

In these patients, the management of cancer also becomes tricky because of the presence of the implant. Therefore, my request to all patients planning to undergo a cosmetic breast procedure, is to  ALWAYS get a pre-operative imaging assessment done and consult a trained breast surgeon, who can guide you properly.

Steps which should be take before deciding on a cosmetic breast procedure:

  1. Consultation with a breast surgeon – understanding the procedure, complications and possible outcome. Discussing your risk of breast cancer with the surgeon
  2. Clinical Examination to rule out any lumps
  3. Radiological investigations – USG, Mammogram, MRI (in certain situations like dense breast tissue in a young patient)
  4. Biopsy of any lesion detected on imaging

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Interesting Mammograms #3

Case 1: 44 year old lady with a rapidly enlarging lump in the right breast of 6 months duration. On examination, she had a 3×3 cm hard lump in the lower half of her right breast. Surprisingly, she had a 5×5 cm hard, fixed axillary lymph node.

Reason of sharing this mammogram: bulky axillary lymphadenopathy with the lymph nodes being larger than the primary.

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Case 2: Patient had a lesion in the left breast, which was biopsied. Wanted to point out the steri-strip (artifact) after biopsy.

Pre- biopsy
IMG_20140910_144444

Post- biopsy
IMG_20140910_144305

 

Information provided by:

Dr. Rohan Khandelwal

Consultant, Breast Oncosurgeon

W Pratiksha Hospital

Interesting Mammogram #2

Case: 45 year old lady that presented with a painless, progressive breast lump on the left side of 7 months duration.

On examination: A10x10 cms firm, mobile lump involving the entire left breast was palpable. There were dilated veins overlying the lump with no palpable axillary lymphadenopathy.

Mammogram is shown below:

image

image

Mammogram was suggestive of an encapsulated lesion with smooth margins, probably a phyllodes tumor.

Tru-cut : Phyllodes tumor
HPE: Benign phyllodes

Learning objective: Benign encapsulated tumor on mammogram suggestive of phyllodes. Capsule is visualized as a radiolucent halo around the lump.

 

Information provided by:

Dr. Rohan Khandelwal

Consultant, Breast Oncosurgeon

W Pratiksha Hospital