Sydney Breast Surgeon

Lipofilling — Liquid Gold of breast cancer surgery

Tue, 02 Apr 2024 16:07:06 GMT

Lipofilling, Liquid Gold of breast cancer surgery

What is Autologous Fat Grafting?

Fat grafting, also known as lipofilling or autologous fat grafting, is a minimally invasive reconstructive method that an Oncoplastic Breast Surgeon uses to achieve an excellent outcome after breast cancer surgery. It utilises a patient's own adipose tissue to replenish volume loss resulting from breast cancer treatment or congenital abnormalities. This procedure involves transferring fat from one area of the body, typically the abdomen, thighs, or buttocks, to another area that requires augmentation or reconstruction. Fat injection specifically refers to the process of injecting harvested fat cells into a targeted area.

What is the role of Lipofilling in Breast Cancer Reconstructive Surgery?

Lipofilling plays a crucial role in breast cancer reconstructive surgery, offering a more natural alternative to traditional implant-based reconstruction. It allows for the creation of a soft and natural breast mound using the patient's own tissue, which can improve symmetry and restore confidence following mastectomy. Additionally, lipofilling can address contour irregularities and improve the aesthetic outcome of breast reconstruction. However, it's essential for patients to discuss their goals and expectations with their surgeon to determine if lipofilling is the right option for them, taking into account factors such as previous radiation therapy and the presence of any remaining cancer cells.

What are the breast cancer surgical indications of Fat Grafting?

The indications for fat grafting encompass rectifying and averting defects stemming from surgeries for breast cancer, preempting breast cancer, and rectifying defects related to congenital abnormalities.

Does this procedure benefit patients who have had previous breast reconstruction?

For patients who have previously undergone breast reconstruction, lipofilling can enhance prosthetic coverage and mitigate rippling, contour defects, and the adverse effects of radiotherapy on reconstructed breast skin. Total breast reconstruction via lipofilling necessitates multiple sessions due to the limited amount of tissue transferred per session. Additionally, lipofilling can aid in delayed breast reconstruction by preparing thin or irradiated chest skin flaps before the insertion of a tissue expander or autologous flap surgery. Furthermore, preliminary studies suggest that lipofilling may alleviate chronic pain following breast cancer treatment, although its efficacy can vary, warranting further investigation.

What are the steps of the procedure?

Subsequently, the procedure is conducted under general anaesthesia and encompasses three key components:

Sculpting: After injection, the surgeon may sculpt and shape the treated area to ensure natural-looking results.
Recovery: Patients typically experience mild discomfort, swelling, and bruising following the procedure. Most can return to normal activities within a week or two, although strenuous exercise should be avoided for several weeks.
Compression: A high waisted knee length Spanx type compression garment is applied for compression of donor areas (liposuction areas)

What does the post operative period look like?

Following the procedure, patients are discharged on the same day and scheduled for a follow-up appointment within 10-14 days. Bruising may occur in the recipient area for a few days, and some volume loss may transpire over time due to reabsorption, necessitating repeated procedures for larger volume lipofilling. The donor site may also experience bruising, for which abdominal garments or compression stockings are recommended to alleviate discomfort and minimise bleeding and bruising. Typically, patients resume normal activities within one to two weeks.

What are the outcomes of Lipofilling?

The results of lipofilling are often long-lasting, although some of the injected fat may be reabsorbed by the body over time. Multiple sessions may be required to achieve the desired outcome, particularly in breast reconstruction cases. Patients can expect natural-looking results with minimal scarring compared to traditional surgical techniques. Most patients are delighted with the opportunity to sculpt their breast shape, size and symmetry.

What are the possible complications of this procedure?

While lipofilling is generally considered safe, like any surgical procedure, it carries risks and potential complications, including:

Infection
Fat necrosis (death of injected fat cells)
Seroma (fluid accumulation)
Asymmetry
Overcorrection or undercorrection
Scarring
Changes in sensation

Are there any safety concerns with this procedure?

Concerns regarding the safety of lipofilling in the breast have been dispelled by several studies, affirming its safety profile.

Is it covered by Medicare and Health Insurance?

Medicare and private insurance cover lipofilling for clinically relevant autologous fat grafting services as of November 1, 2021, up to 4 sessions are covered.

Goldilocks Mastectomy

Sun, 04 Feb 2024 12:23:33 GMT

Goldilocks Mastectomy

WHAT IS A GOLDILOCKS MASTECTOMY?

Goldilocks procedure is undertaken subsequent to a mastectomy, aimed at total elimination of all breast tissue. Following bilateral mastectomy, the remaining fatty tissue and skin undergo a transformative process to craft a breast mound, thereby

providing a semblance of shape and definition to the breast. While this procedure is commonly employed for patients with larger and heavier breasts, the applicability extends to some patients with smaller breasts. Without the use of tissue expanders, implants or flap insertion; the Goldilocks mastectomy offers a flexible and patient-centered approach to breast reconstruction.

WHEN WAS IT FIRST DESCRIBED?

Described by Richardson and Ma in 2012, it utilises the redundant inferior mastectomy flap tissue for breast mound construction. After a skin-sparing mastectomy, the de-epithelialized mastectomy flap within the Wise pattern incision boundary is shaped to create breast volume.

WHY IS IT CALLED GOLDILOCKS?

The name "Goldilocks" is fittingly chosen as it signifies a 'middle-of-the-road' option for patients; an option that isn't too extreme one way or the other. It sits comfortably halfway between mastectomy with a flat-closure and full reconstruction with expanders, implants or a body wall flap procedure. This moderate alternative offers patients a fine balance, avoiding the extremes associated with a completely flat-chested appearance or the comprehensive reconstruction involving implants or flaps. They obtain a fantastic breast mound and shape using the locally preserved skin flaps, with or without free nipple grafts.

WHAT IS THE ADVANTAGE OF A GOLDILOCKS MASTECTOMY?

It can prevent potential complications associated with implant reconstruction, without impacting other areas of the body as autologous reconstruction. Excellent option for women who either cannot undergo or choose not to pursue immediate

reconstruction following a mastectomy. Also used in patients with other medical comorbidities who may not be good candidates for immediate breast reconstruction because of the potential complications. It can be a standalone procedure, offering a viable solution for those who may not desire or be suitable for further reconstruction immediately. Moreover, it can act as a foundational step, providing a template or canvas for potential future breast reconstruction if desired.

WHAT ARE THE DISADVANTAGES?

Uncertainty regarding the final size of the breast mound. Complications related to wound healing, particularly at the juncture of breast scars (referred to as the ’T-junction') may arise, necessitating the use of dressings for an extended duration.

WHAT ARE THE PLANNING STEPS FOR THIS SORT OF MASTECTOMY?

Weigh considerations and have comprehensive discussions with healthcare team to make informed decisions about the most suitable surgical approach for individual circumstances.

Collaboration among various healthcare professionals is crucial for the success of the Goldilocks operation. Importance of a team approach, involving surgeons, assistants, and nursing staff. Patient education before surgery, coordination of the operation, and providing support throughout the recovery process.

Close working relationship and regular meetings to discuss treatment options contribute to individualised recommendations based on factors such as patient staging, tumour characteristics, and desired surgical outcomes.

Triple Negative Breast Cancer

Mon, 07 Aug 2023 01:39:01 GMT

Triple Negative Breast Cancer

What is a Triple Negative Breast Cancer?

Triple Negative Breast Cancer, abbreviated to TNBC, is a unique subtype of breast cancer characterised by the absence of these three receptors (hence Triple Negative) on the cancer cells.

Breast cancer is not a singular entity. There are so many variables, and while most breast cancers fit into a particular mould, a smaller percentage are distinct and different. Understanding the characteristics and differences of t between triple-negative breast cancer and other types of breast cancer is crucial for accurate diagnosis and treatment planning.

We determine the specific type of breast cancer based on the presence or absence of receptors, proteins found inside or on the surface of cells that trigger cellular responses. These receptors include the

Oestrogen receptor (ER)
Progesterone Receptor (PR)
Human Epidermal Growth Factor Receptor 2 (HER2)

What is the Implication of Triple Negative Breast Cancer?

Treatment for breast cancers that are Oestrogen receptor-positive, Progesterone receptor-positive, or HER2-positive involves medications that target these receptors to prevent or slow cancer growth.

However, triple-negative breast cancers (TNBC) have no presence of these receptors, making traditional hormone and targeted therapies like Aromatase inhibitors, Tamoxifen and HER2-targeted therapies like Trastuzumab ineffective. Instead, chemotherapy has demonstrated greater efficacy in treating TNBC.

What is a Basal-Like Subtype?

Most TNBC cancers have a genetic pattern known as basal-like, meaning the cancer cells resemble the basal cells that line the breast ducts. Some may refer to triple-negative breast cancer as a basal tumour, basal breast cancer, or basal-like disease. Basal-like breast cancers tend to overexpress certain genes that promote cancer growth. Nevertheless, not all triple-negative breast cancers are basal-like, and not all basal-like breast cancers are triple-negative. Approximately 70 to 90 per cent of triple-negative breast cancers fall into the basal-like category.

What are the Broad Distinctions of Breast Cancer Types?

Some who have experienced breast cancer might not understand the differences between triple-negative breast cancers and hormone receptor-positive or HER2-positive breast cancers.

Others might be familiar with hormonal treatment pills that reduce the risk of recurrence, which may not apply to those with TNBC. Explaining these differences can be challenging, especially for those recently diagnosed. It is important to remember that some chemotherapy medicines used for other breast cancer types may also be employed for TNBC.

There are several myths surrounding TNBC, such as assuming that the same treatments used for other types of breast cancer will work exactly the same for TNBC or believing that TNBC is always challenging to treat. While TNBC can be aggressive, the effectiveness of treatment depends on various factors, including tumour size, lymph node involvement, other cancer factors and overall health.

Who Tends To Develop Triple-Negative Breast Cancer?

Age, Race, or Ethnicity

Several studies indicate that being premenopausal or having African ancestry increases the risk of developing basal-like or triple-negative breast cancer. Among African-American women with breast cancer, there is an estimated 20 to 40 per cent chance of triple-negative cancer. The reasons for the higher rates of triple-negative breast cancer in premenopausal women and specific ethnic groups are not yet fully understood.

Breast Cancer Gene Mutations

BRCA1 and BRCA2 genes are inherited from parents and when intact, typically function to prevent the development of cancers. However, only a small percentage of individuals with breast cancer have mutations in BRCA1 or BRCA2, which alter their DNA. Being born with a BRCA1 mutation increases the risk of developing basal-like breast cancer, though not all breast cancers resulting from BRCA mutations are triple-negative. BRCA2 mutations are more commonly associated with Oestrogen receptor-positive breast cancer.

Are Triple-negative breast cancers always difficult to treat?

While many triple-negative cancers are aggressive, the effectiveness of treatment depends on factors such as tumour size and lymph node involvement, in addition to its triple-negative status. Highly effective treatments, Chemotherapy and Immunotherapy are available for triple-negative breast cancer, and doctors work closely with patients to identify the most suitable approach.

What is a Metaplastic Triple-Negative Breast Cancer?

This is a rare and aggressive subtype, less than 5% of all breast cancers, which accounts for only a small percentage of all breast cancer cases but poses unique challenges in diagnosis, treatment, and prognosis. Like invasive ductal cancer, metaplastic breast cancer begins in the breast's milk duct before spreading to the tissue around the duct. What makes it different is the kinds of cells that make up the cancer. When the cells are examined under a microscope, they may contain some abnormal-looking ductal breast cells, but they also contain cells that look like other tissues of the breast; for example, soft tissue and connective tissue in the breast. It appears that the ductal cells have changed form (metaplasia) to become completely different cells, though it is not known exactly how or why this occurs. Metaplasia refers to a process where cancer cells transform, taking on characteristics of different cell types from the surrounding tissues, making it challenging to classify and diagnose.

Metaplastic TNBC is a rare variant of triple-negative breast cancer, where the cancer cells not only lack the expression of Oestrogen receptors (ER), Progesterone Receptors (PR), and Human epidermal growth factor receptor 2 (HER2) but also exhibit metaplastic features. How to diagnose Metaplastic Triple-Negative Breast Cancer?

Diagnosing metaplastic TNBC. This requires both histological and immunohistochemical analyses. An experienced pathologist looks for histological features in the biopsy specimen, such as squamous or spindle cell differentiation. Immunohistochemistry confirms the absence of ER, PR, and HER2 in the cancer cells.
Clinical Characteristics and Prognosis. Metaplastic TNBC is known for aggressive behaviour, fast growth, and increased local and distant recurrence tendencies. It is associated with a poorer prognosis and overall survival rates compared to the more common breast cancer subtypes.

What Are The Treatment Options For Metaplastic TNBC?

Standard treatment options as for other triple-negative breast cancers. Targeted therapies like hormonal therapies and anti-HER2 agents are not useful. Neoadjuvant chemotherapy is often used to reduce cancer size before surgery, but the response to treatment may be variable. We also use immunotherapies and targeted agents for better treatment strategies. Recent studies have identified potential genomic and molecular alterations that could play a role in the development and progression of this subtype. This might help develop personalised therapies and improve treatment outcomes.

What Advancements In Surgical Techniques For Managing Triple Negative Breast Cancer?

Due to the lack of targeted therapies, surgery remains an essential component of the treatment approach. There have been significant advancements in surgical techniques to improve outcomes and preserve the quality of life for patients with this aggressive breast cancer subtype.

Neoadjuvant Therapy and Surgery: Chemotherapy or targeted therapy is utilised before surgery, shrinking cancer before surgery and potentially increasing the rate of breast-conserving surgery (lumpectomy) rather than mastectomy. It also for a better assessment of treatment response, helping us make more informed decisions on the most appropriate surgical strategy for each patient.
Breast-Conserving Surgery (Lumpectomy) involves removing the tumour along with a margin of surrounding normal tissue. Advances in oncoplastic surgery have enabled us to combine oncological principles with plastic surgical techniques. And we get improved cosmetic outcomes while ensuring complete cancer removal, preserving the patient's breast appearance, body image and self-esteem.
Sentinel Lymph Node Biopsy (SLNB) and Targeted Axillary Dissection(TAD) These are minimally invasive techniques that involve identifying and removing a few lymph nodes, which reduces the need for complete axillary lymph node dissection (ALND), reducing complications such as lymphoedema and improving patient recovery.
Nipple-Sparing Mastectomy (NSM): When prophylactic or therapeutic mastectomy is needed, nipple-sparing mastectomy can be performed without removing the nipple-areola complex, resulting in a more natural breast appearance and improved body image. This technique offers excellent aesthetic outcomes and improved psychological well-being.

Advancements in surgical techniques have significantly transformed the management of triple-negative breast cancer, offering improved treatment outcomes and enhanced quality of life for patients.

Neoadjuvant therapy, oncoplastic surgery, and intraoperative technologies have radically changed the surgical landscape, providing individual solutions to each patient's needs. Surgeons and multidisciplinary teams constantly refine these techniques, creating a way for more personalised and excellent surgical approaches for patients with triple-negative breast cancer.

References:

Lehmann BD, Bauer JA, Chen X, et al. Identification of human triple-negative breast cancer subtypes and preclinical models for selection of targeted therapies. J Clin Invest. 2011 Jul;121(7):2750-67. doi: 10.1172/JCI45014.
Sharma P. Biology and management of patients with triple-negative breast cancer. Oncologist. 2016 Jan;21(1):105-17. doi: 10.1634/theoncologist.2015-0338.
Anders CK, Carey LA. Biology, metastatic patterns, and treatment of patients with triple-negative breast cancer. Clin Breast Cancer. 2009 Dec;9 Suppl 2:S73-81. doi: 10.3816/CBC.2009.s.008.
Pareja F, Geyer FC, Marchiò C, et al. Metastasis-Free Survival Is Associated With Overall Survival in Patients With Metaplastic Breast Cancer. NPJ Breast Cancer. 2020 Feb 14;6:7. doi: 10.1038/s41523-020-0143-5.
Alvarado R, Yi M, Le-Petross H, et al. The role for sentinel lymph node dissection after neoadjuvant chemotherapy in patients who present with node-positive breast cancer. Ann Surg Oncol. 2012 Mar;19(3):317-21. doi: 10.1245/s10434-011-2025-y.
Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomised study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002 Oct 17;347(16):1227-32. doi: 10.1056/NEJMoa020989.

Nipple Discharge

Fri, 05 May 2023 01:34:32 GMT

Nipple Discharge

What is Nipple Discharge?

Nipple discharge refers to the presence of fluid coming out of the nipple. It can be caused by a variety of factors, including hormonal changes, infection, injury, or breast cancer. The discharge can be unilateral (from one breast) or bilateral (from both breasts) and may vary in colour and consistency.

What is normal Milky discharge?

What is the difference between Unilateral or Bilateral nipple discharge?

Nipple discharge can occur from one breast (unilateral) or both breasts (bilateral). Unilateral nipple discharge is more concerning and may indicate the presence of a breast lump or cancer. Bilateral nipple discharge is often due to a benign cause, such as hormonal changes or medication use.

What is Clear Nipple Discharge?

Clear nipple discharge is usually not a cause for concern and is often due to hormonal changes. It may also be caused by medication use, pregnancy, or breastfeeding. However, clear nipple discharge can sometimes be a sign of breast cancer or a benign breast condition, so further evaluation is recommended if it persists.

What is Brown nipple discharge?

Brown nipple discharge can be a sign of a benign breast condition, such as a papilloma or fibrocystic changes. It can also be a sign of breast cancer. Brown nipple discharge is more concerning if it is associated with a breast lump or if it is bloody.

What is Black nipple discharge?

Black nipple discharge is uncommon but can be a sign of a rare condition called mammary duct ectasia. This condition occurs when the milk ducts in the breast become inflamed and clogged. Mammary duct ectasia can cause a thick, black, or greenish discharge from the nipple.

What is Bloody nipple discharge?

Bloody nipple discharge is a concerning symptom and may indicate the presence of breast cancer. It can also be caused by a benign breast condition, such as a papilloma or fibrocystic changes. If the discharge is persistent or occurs spontaneously, further evaluation is necessary.

What if there is an associated with Pain or Breast Lump?

Nipple discharge that is associated with pain or a breast lump is more concerning and may indicate the presence of breast cancer. It is important to seek medical attention if you notice any of these symptoms.

What are the Investigations including Imaging?

Evaluation of nipple discharge typically includes a physical examination, imaging studies (such as a mammogram or breast ultrasound), and possibly a biopsy of the breast tissue. These tests can help determine the underlying cause of the discharge and whether it is benign or malignant.

Management and Surgery:

The management of nipple discharge depends on the underlying cause. If the discharge is due to a benign condition, such as hormonal changes or medication use, it may not require any treatment. If the discharge is persistent or associated with a breast lump or cancer, surgery may be necessary. Surgery may involve removal of the breast tissue (mastectomy) or removal of the milk ducts (microdochectomy).

References:

American Cancer Society. Nipple Discharge. https://www.cancer.org/cancer/breast-cancer/non-cancerous-breast-conditions/nipple-discharge.html
Mayo Clinic. Nipple Discharge. https://www.mayoclinic.org/symptoms/nipple-discharge/basics/causes/sym-20050947
Kessler E, Winters R, Fahey V, et al. Management of nipple discharge and the associated imaging findings. AJR Am J Roentgenol. 2021;216(4):925-935. doi: 10.2214/AJR.20.23918 kjdabv

Gynaecomastia

Mon, 13 Feb 2023 01:34:36 GMT

Gynaecomastia

What is Gynaecomastia?

Gynaecomastia is an increase in the amount of breast gland tissue in boys or men, caused by an imbalance of the hormones oestrogen and testosterone. It can affect one or both breasts, sometimes unevenly. Pseudogynaecomastia refers to an increase in fat but not glandular tissue in male breasts. Newborns, boys going through puberty and older men may develop gynaecomastia as a result of normal changes in hormone levels, though other causes also exist.

Usually, gynaecomastia is not a serious problem, but it can be difficult to cope with the condition. Men and boys with may have pain in their breasts and may feel embarrassed. It may go away on its own, however if persists, medication or surgery may be needed.

What are the symptoms of gynaecomastia?

Most adult men have no symptoms. Signs and symptoms of the condition may include:

Pain, particularly in adolescents
Swollen breast tissue
Breast tenderness
Nipple sensitivity with rubbing against clothes

When to see a doctor for gynaecomastia?

See your doctor if you have:

Swelling
Pain or tenderness
Nipple discharge in one or both breasts

What causes gynaecomastia?

It is triggered by a decrease in the amount of the hormone testosterone compared with Oestrogen. The decrease can be caused by conditions that block the effects of testosterone, reduce testosterone or increase Oestrogen level. Several things can upset the hormone balance, including the following.

What are natural hormone changes in the body during puberty?

The hormones testosterone and oestrogen control sex characteristics in both men and women. Testosterone controls male traits, such as muscle mass and body hair. Oestrogen controls female traits, including the growth of breasts.

Most people think of oestrogen as an exclusively female hormone, but men also produce it, usually in small quantities. Male oestrogen levels that are too high or are out of balance with testosterone levels can cause gynaecomastia.

Gynaecomastia in infants. More than half of male infants are born with enlarged breasts due to the effects of their mother's oestrogen. Generally, the swollen breast tissue goes away within two to three weeks after birth.
Gynaecomastia during puberty. Gynaecomastia caused by hormone changes during puberty is relatively common. In most cases, the swollen breast tissue will go away without treatment within six months to two years.
Gynaecomastia in adults. Researchers have estimated that the prevalence among men ages 50 to 80 is between 24% and 65%.

However, most men with the condition experience no symptoms.

What are medications or substances that can cause gynaecomastia?

A number of medications which include:

Anti-androgens used to treat an enlarged prostate, prostate cancer and other conditions. Examples include flutamide, finasteride and spironolactone.
Anabolic steroids and androgens to treat hormone deficiencies, delayed puberty, or muscle loss from another disease.
AIDS medications. The oestrogen-like properties of some HIV medications can cause gynaecomastia.
ADHD medications that contain amphetamines.
Anti-anxiety medications, such as diazepam.
Tricyclic antidepressants.
Antibiotics.
Ulcer medications, such as the over-the-counter drug cimetidine.
Chemotherapy to treat cancer.
Heart medications, such as digoxin and calcium channel blockers.
Stomach-emptying medications, such as metoclopramide.

Recreational drugs, illicit drugs and alcohol

Substances that can cause gynaecomastia include:

Alcohol
Anabolic steroids used to build muscle and enhance athletic performance
Amphetamines
Marijuana
Heroin
Methadone

What are health conditions that can cause gynaecomastia?

Several health conditions can cause gynaecomastia by affecting the balance of hormones. These include:

Hypogonadism. Conditions that lower testosterone production, such as Klinefelter syndrome or pituitary insufficiency, can be associated with gynaecomastia.
Aging. Hormone changes that occur with aging can cause it, especially in men who are overweight.
Tumours. Some tumours, such as those involving the testes, adrenal glands or pituitary gland, can produce hormones that alter the male-female hormone balance.
Hyperthyroidism. The thyroid gland produces too much of the hormone thyroxine.
Kidney failure. Half the people being treated with dialysis experience it due to hormonal changes.
Liver failure and cirrhosis. Changes in hormone levels related to liver problems and cirrhosis medications are associated with gynaecomastia.
Malnutrition and starvation. When your body is deprived of adequate nutrition, testosterone levels drop while oestrogen levels remain the same, causing a hormonal imbalance. Gynaecomastia can also happen when normal nutrition resumes.

Herbal products

Plant oils, such as tea tree or lavender, used in shampoos, soaps or lotions have been associated with gynaecomastia. This is probably due to their weak oestrogenic activity.

What are risk factors for gynaecomastia?

Risk factors for gynaecomastia include:

Adolescence
Older age
Use of anabolic steroids to enhance athletic performance
Certain health conditions, including liver and kidney disease, thyroid disease, hormonally active tumours, and Klinefelter syndrome

What are complications of gynaecomastia?

Gynaecomastia has few physical complications, but it can cause psychological or emotional problems caused by appearance.

How can gynaecomastia be prevented?

There are a few factors you can control that may reduce the risk of gynaecomastia:

Don't use drugs. Examples include anabolic steroids, amphetamines, heroin and marijuana.
Avoid alcohol. Don't drink alcohol. If you do drink, do so in moderation.

What tests can be done for gynaecomastia?

Your doctor will likely order tests to identify a possible cause of gynaecomastia, to screen for possible breast cancer and to rule out other conditions. These may include:

Blood tests
Mammograms
Computerized tomography (CT) scans
Magnetic resonance imaging (MRI) scans
Testicular ultrasounds
Tissue biopsies

What conditions can cause similar symptoms like gynaecomastia?

Your doctor will want to be sure that your breast swelling is gynaecomastia and not another condition. Other conditions that can cause similar symptoms include:

Fatty breast tissue (pseudogynaecomastia). Some men and boys, especially those with obesity, have breast fat that resembles gynaecomastia. This isn't the same as gynaecomastia and doesn't need additional evaluation.
Breast cancer. Breast cancer is uncommon in men but can occur. Enlargement of one breast or the presence of a firm nodule raises the concern for male breast cancer.
A breast abscess. This is an infection of the breast tissue.

What is the treatment for gynaecomastia?

Most cases of gynaecomastia resolve over time without treatment. However, if gynaecomastia is caused by an underlying condition — such as hypogonadism, malnutrition or cirrhosis — that underlying condition may need treatment.

If you're taking medications that may be the cause of gynaecomastia, your doctor may recommend stopping them or substituting another medication.

In adolescents with no apparent cause of gynaecomastia other than normal hormone changes during puberty, the doctor may recommend periodic reevaluations every three to six months to see if the condition improves on its own. Gynaecomastia in adolescents often goes away without treatment in less than two years.

Treatment may be necessary if gynaecomastia doesn't improve on its own or if it causes significant pain, tenderness or embarrassment.

What medications can be used to treat gynaecomastia?

Medications used to treat breast cancer and other conditions may be helpful for some men with gynaecomastia. They include:

Tamoxifen
Aromatase inhibitors, such as anastrozole

Although these medications are approved by the Food and Drug Administration, they have not been approved specifically for use in people with gynaecomastia.

What is the role of surgery to remove excess breast tissue in gynaecomastia?

If enlarged breasts are significant and bothersome even after initial treatment or observation, your doctor may advise surgery.

Two gynaecomastia surgery options are:

Liposuction . This surgery removes breast fat but not the breast gland tissue itself.
Mastectomy . This type of surgery removes the breast gland tissue. The surgery is often done using only small incisions. This less invasive type of surgery involves less recovery time.

What are measures for coping and support for patients with gynaecomastia?

For men, enlarged breasts can be stressful and embarrassing. Gynaecomastia can be difficult to hide and a challenge to romantic relationships. During puberty, gynaecomastia can make boys a target for teasing from peers. It can make activities such as swimming or changing in the locker room traumatic.

Whatever your age, you may feel like your body has betrayed you and you may feel unhappy with yourself. These feelings are normal, but to help you cope you can:

Get counseling. Talk therapy can help you avoid anxiety and depression caused by gynaecomastia. It can also help you communicate with your partner or family members so that they understand what you're going through.
Reach out to your family and friends. You may feel embarrassed to talk about gynaecomastia with the people you care about. But explaining your situation and asking for support will likely strengthen your relationships and reduce stress.
Connect with others who have gynaecomastia. Talking with men who have had a similar experience can help you cope.

Oncoplastic Breast Surgery — breast cancer oncology and cosmesis

eskaping@gmail.com (Sandra Krishnan) — Mon, 14 Nov 2022 07:27:23 GMT

Oncoplastic Breast Surgery

Combining the principles of oncologic and advanced plastic surgery techniques, to obtain an oncologically sound and aesthetically pleasing outcome.

How will I feel after oncoplastic breast conserving surgical procedures?

Following are the excellent benefits of these techniques

Emotional well being
Faster recovery
Better quality of life
Higher rates of satisfaction

Who is eligible for oncoplastic breast conserving surgery?

Oncoplastic breast conserving surgery is an option for breast cancer patients who can be treated through breast conserving procedures. The breast tissue remaining after the cancer is removed should be adequate to reshape the breast. Some patients are more suited than others to this procedure. The aim is to restore the natural shape of the breast and symmetrise the other side.

Different breast types can be operated on using a wide range of oncoplastic techniques. As there are various breast shapes; particular methods are used to either reshape the breast or add extra volume to reconstruct the defect.

How safe is oncoplastic breast surgery?

One of the ways we measure cancer surgery outcome is by overall survival.

This technique has an excellent high rate of overall survival when the cancer is 3cm or below, but we can also get a good result with a many different cancer sizes and types of cancer.

What is the wound and scar like after oncoplastic breast surgery?

The oncoplastic principles are based on plastic surgery techniques, hence the aim is to provide oncologically sound surgery (clear the cancer) with an outstanding cosmetic result. We place the scars away from the visible areas of the breast and follow the normal lines of the body. This insures that the scar blends in and is as inconspicuous as possible to allow for an excellent body image after the surgery.

How long is the patient’s stay in hospital after the oncoplastic breast surgery?

Some patients may be discharged on the same day and this depends on the extent of the surgery and whether the other breast has been operated on. Sometimes an axillary (armpit) procedure is required like sentinel node biopsy or targeted axillary lymph node dissection. Also if patients have other illnesses, they may have to stay in hospital overnight but patients generally stay no longer than a day.

Lipofilling for breast remodelling

This a technique where fat is extracted from one area of the body and inserted into a different area, where there is mass, volume, or remodelling needed. It is used to help with the breast shape and size both on the affected rest and on the other side to achieve symmetry.

How to summarise oncoplastic breast conservation surgery?

The cancer can removed with a wide margin of surrounding breast tissue, reducing the potential of undetected cancer cells remaining and multiple lesions can be removed from the same breast with a good cosmetic outcome. The cancer removal and reconstructive surgery can be done together in the same sitting. Psychological stress of losing a breast through a mastectomy is avoided, and the aesthetic appearance is maintained for emotional recovery. The surgery is safe and low-risk. Breasts can be rebalanced by displacing or replacing volume as needed. The other side symmetry operation may be required to achieve a final balanced result. As for almost all breast conservation surgery, the patient will need to have breast radiation on the affected breast.

First study the science, and then practice the art which is born of that science — Leonardo da Vinci

Lipoma Surgery

Mon, 11 Apr 2022 00:53:11 GMT

Lipoma - from diagnosis to treatment

Melanoma matters, what you should know

eskaping@gmail.com (Sandra Krishnan) — Sat, 29 Jan 2022 06:27:57 GMT

What is melanoma and why is it important?

What does Melanoma mean?

What are stages of melanoma ?

What is the role of Surgery and the Surgical Oncologist?

The most likely and initial treatment for melanoma, and the extent and role depends on the progress of the cancer.

Early stage melanoma, a biopsy followed by wide local excision is required, where the skin surrounding the melanoma is removed. This is to minimise the risk of recurrence of the melanoma locally.
Later stage melanoma, surgery is a diagnostic tool to assess the spread of the melanoma. You may need invasive surgery to remove lymph nodes.

What can I expect at an appointment with a breast cancer specialist?

eskaping@gmail.com (Sandra Krishnan) — Thu, 23 Dec 2021 01:48:08 GMT

A brief description of what to expect

If you’ve been referred to a breast clinic by your GP or if you’ve been recalled following routine breast screening, it’s natural to feel anxious or worried. The vast majority of people who are seen at a breast clinic will not have breast cancer . However, it’s still important to attend your breast clinic appointment so you can be fully assessed

Being referred to a breast clinic by your GP

GPs decide whether or not to refer you to a breast clinic and how quickly a person should be seen depends on their symptoms. A patient with signs and symptoms that may suggest breast cancer should see a GP within 2 weeks. Optimally, tests should be done within 2 weeks. A positive result on any component of the triple test warrants specialist surgical referral. Ideally, the surgeon should see the patient with proven or suspected cancer within 2 weeks of diagnosis. If necessary, prior discussion should facilitate referral.

How can I prepare for my appointment with a breast surgical oncologist?

Usually, you might have been referred by your GP, occasionally by another Specialist. If you’ve been referred to a breast clinic, keep in mind that the majority of people will not have breast cancer, there are many benign breast conditions that need assessment and management too. It is very important to attend the breast clinic appointment so you can be assessed and examined, and further tests if required can be done. Read all about best breast cancer care here .

When will I get my results?

Your assessment may be done during your visit to the clinic. Some test results may be available later that day, but if you have a core biopsy this will take longer. In some areas, you may be asked to make another appointment to finish your tests or to get your results. If this happens, you may have to wait about a week for your test results.

What about the cost of attending the clinic?

You may have to pay for some appointments, tests, medications, accommodation, travel or parking. Speak with your GP, specialist or private health insurer (if you have one) to understand what is covered and what your out-of-pocket costs may be. If you have concerns about costs talk to your healthcare team or a social worker about:

being bulk-billed or being treated in the public system
help with accommodation during treatment
the possible financial impact of your treatment

Here are some resourc es for further information regarding financial assistance and treatment payments .

Further support

If you’ve been referred to a breast clinic, it is normal to feel worried that you have breast cancer and you may have many concerns. If you have a question about breast health or breast cancer, you can email Dr Krishnan’s Sydney Adventist Hospital NSO clinic at admin@nsogroup.com.au

“The function of freedom is to free someone else.” —Toni Morrison

The Types Of Breast Cancer Surgery | Dr Sandra Krishnan

eskaping@gmail.com (Sandra Krishnan) — Fri, 08 Oct 2021 00:01:55 GMT

What are your options and what should your expectations be?

I remember my first Dragon Boat Race, as part of the Breast Cancer Institute team (the BCI) at Westmead, back in the day, was it 2007? The cold, sparkling water at Darling Harbour, exhilarating paddling with the BCI team, beautiful sun and sky, life putting on a show for us!! Dragon boating, we celebrated breast cancer patients, and we saluted their return to not 'just normal,' but better than normal. In this post, I discuss breast cancer surgery options and what they entail, post operative recovery and beyond.

Surgery for breast cancer has evolved tremendously through the ages. A simple dictum to remember is ‘less is more.’ The tumour is removed along with a cuff of tissue around it (margin) while preserving shape and size of the breast as far as possible. Principles of Oncoplastic Breast Surgery are used to combine oncological and plastic surgery techniques to achieve an outstanding oncological and aesthetic outcome.

Types of breast cancer surgery procedures depend on a few factors — volume of breast tissue excised, the site of the lesion, the spread, and your preference. A Sentinel Node biopsy procedure, to remove and test lymph nodes under the arm is also done. This helps the team plan further treatment after surgery.

Before having surgery for breast cancer, here is a brief explanation of the various procedures. There is a best option for you, discuss this in detail with your surgeon.

Every surgeon is first an anatomist....

eskaping@gmail.com (Sandra Krishnan) — Sat, 14 Aug 2021 23:17:47 GMT

I still remember starting medical school especially Day 1 of Anatomy Dissection....

The feeling did not last long because someone in my batch had 'stolen' the brain. We had started studying brain and head and neck in the last term, and one of the students thought it would be good to take a brain home and keep it in the fridge (simply unbelievable, but true, I promise!) The anatomy faculty came down hard on the entire cohort. They said that unless the perpetrator returned the brain, they would cancel 'prosectorship' for the whole of the batch.

I profess to learn and to teach anatomy not from books but from dissections, not from the tenets of Philosophers but from the fabric of Nature.

— William Harve y De Motu Cordis (1628), The Circulation of the Blood and Other Writings

Pfizer Vaccine second dose

eskaping@gmail.com (Sandra Krishnan) — Sat, 17 Apr 2021 03:18:39 GMT

Do we have a choice?

My first personal encounter with vaccination, I was in a community health posting, an interesting part of my medical studies. One of the things we had to do was help with vaccination in rural areas; mothers would line up with their babies for their scheduled DPT (Diptheria Pertussis Tetanus) and OPV (Oral Polio Vaccine). The lady would hold her baby on her lap and I would vaccinate the babies one by one, there was a method; 1. DPT is an intramuscular 'tiny' injection into the 'tiny' thigh muscle and 2. when the baby cries sneak the drops of OPV into the mouth. The baby got it so quickly, and before you knew it, it was over! This was my experience with my Covid vaccine, decades later as an adult. So much hype, so much drama but it is just another community health initiative, over before I even knew it. And I got a photo for this post!

There are a few things that we can hold on to:

This is not the first time something like this has happened and the world has been brought to it’s knees (and it won’t be the last time.) We know that we can overcome this and we be better than we ever were before.
When something like this happens there is no real border, there is no difference in the economic status, citizenship status, social status of an individual and suddenly we realise that what affects one of us affects all of us. I hope and pray the world heads towards equality in action, and poorer nations get their vaccines too.
We don’t need to have all the answers and we just go with the best current knowledge that we have, fingers crossed, head first, fearless (thank you Taylor Swift!)

Pfizer Vaccine Day 1

Fri, 19 Mar 2021 02:21:32 GMT

I had the best nurse, she told me to relax and flop my arm, managed to get a ‘promo’ photo to promote the vaccine

Pfizer vaccine Day 1 today

Trauma call a minute before vaccination

Obviously was not scared of the shot, more keen on getting my ‘shot (on iPhone!)’ and my morning ahead

Rushed off to Emergency then to theatre for a trauma laparotomy (that’s a whole other story)

Zero side effects btw, still ‘able to leap tall buildings in a single bound’

Hope everyone gets theirs soon, all over the world xx

Breast cancer detection and treatment in two different women | Dr Sandra Krishnan

Fri, 18 Dec 2020 05:40:54 GMT

I am a Breast Cancer Surgeon based in Sydney. My first patient is a lady in her 70s, she noticed a breast lump in November last year. She realised that her breast screening appointment was in July, seven months away and chose to delay seeking advice until her scheduled mammogram. Unfortunately, it had steadily grown into a large, 3 cm lump. She completed the triple test, which includes history with clinical examination and a needle test (breast biopsy) of the lesion, where a high-grade breast cancer was confirmed.

My second patient is a much younger 46-year woman who had felt a small lump in the right breast during her shower during a breast self examination . She decides to check it immediately and presents to her GP, followed by myself for the triple test. R esults come back positive and she is diagnosed with a small, low grade breast cancer.

Both women very quickly and efficiently have their therapy in the same order; the first treatment, almost identical — breast cancer surgery for the lump, wide local excision with sentinel lymph node biopsy of the lymph nodes in the armpit. They have an uneventful post-operative recovery and return for wound inspection, pathology results and further discussion.

Their paths diverge here. The lady with the larger, longer-standing breast cancer is lymph node positive, so she undergoes further axillary surgery where I remove the lymph glands in the armpit. The second lady was lymph node negative, which means no further surgery. Treatment continues, both patients are given adj uvant (after surgery) radiotherapy to the breast and receive adjuvant hormonal therapy. There are two critical points that I would like to make with these case discussions.

1. Interval breast cancer

If a woman notices a lump in between breast cancer screening, she should not wait for her next screening appointment. She must look into it immediately i.e. present for a triple test. The first step in this process is to see your doctor who will then do a clinical examination, followed by the other two components, imaging with mammogram and ultrasound, and biopsy. Early detection of what is hopefully a small, low grade and possibly lymph node negative tumour, allows for less surgery and reduces the aggressiveness of treatment, at the same time almost always means a better outcome. Breast screen is a 'screening' tool, for women with no symptoms. A breast lump is an important symptom , not to be ignored or delayed. Time makes a significant difference.

2. Younger women with breast cancer

Women under the age of 50 who have not received an invitation to Breastscreen should be breast aware, i.e. know their individual risk and perform routine breast self examination. This is a good habit to cultivate, mid cycle, once a month, check your breasts and armpits. Get to know what your body feels like, so you can identify changes early.

There are many 'apps' to help make this a habit, with tips on how to do this better, reminders and additional health awareness articles to read for current information. I have created a few videos on this important 'self health' check, have a look and listen to learn more.

Finally, just as every cancer is different, every breast cancer is different. Surgery is typically the mainstay of breast cancer treatment. However, a patient may require additional treatments, 'adjuvant' such as radiotherapy (local) or chemotherapy, hormonal therapy, targeted immunotherapy (systemic) and occasionally breast cancer trial enrolments. The order in which we administer these therapies differ for each patient; hence it is very important to have a discussion at a multidisciplinary team meeting where many breast cancer specialists come together to discuss each individual patient. We take you right back to the triple test, that point of diagnosis followed by surgery if it has been done and discussion of the pathology results. Finally, a tailored, personalised management plan is created, which might include genetic consideration, fertility, psychological issues and anything else that is relevant for you.

My two patients will recover beautifully in the short term; the advances of modern breast cancer therapies mean that they will both do well and have a systematic surveillance regimen for recurrence. A significant difference is the 5 year survival rate, (% of patients who will be alive five years after diagnosis) a metric to measure effective treatment. Patient 1 has a rate of 80% and patient 2, a much higher number, 96%.

October is breast cancer month, women do so many things on a monthly basis, I feel we should add regular breast self examination to the list, and take back control.

I promise you, it will be worth it.

'You may not control all the events that happen to you, but you can decide not to be reduced by them.'

- Maya Angelou

Breast Cancer in Younger Women | Dr Sandra Krishnan

Fri, 11 Dec 2020 05:25:21 GMT

Youth is strong. It is brave and adventurous. Full of belief and promise. But it is not invincible. I have learned this the hard way, with close friends being diagnosed with cancer, in particular breast cancer. The question is, what can we do?

I am a Sydney Breast Surgeon, and would like to shed some light on this aspect of breast cancer, when it occurs in younger women . I believe that understanding comes from knowledge and through understanding, empowerment. Let me take you through what we know about Breast Cancer, particularly for younger women.

How does Breast Cancer Occur?

When the genes that regulate cell growth change or mutate, cancer occurs. These changes affect the speed of cell division where the cells multiply in an uncontrollably accelerated manner. All the vital organs in the body may be affected, and this includes the breasts.

Breast cancer develops in the breast tissues. The part of the breast that produces milk is the lobules, and the ducts are 'tubes' which allow passages of the milk from the lobules to the nipples. Cancer commonly affects the ducts or lobules of the breast; however, the fatty tissues and other tissues within the breasts may also be a source of malignancy. During the evolution of the disease, the lymph nodes located under the armpits may become involved, and cancer can spread to other vital organs through circulation.

"Who is at Risk of Developing Breast Cancer?"

Because of the increase in the number of young women diagnosed with breast cancer, awareness about risk factors is very important. Here are some of the most common risks in young women that help us in our aim for early detection:

1. Age.

The older a woman gets, the more she is at risk of having breast cancer

2. Being a Female.

Men can develop breast cancer too, but women are 100 times more likely to have the disease

3. Breast Density.

Women who have "mammographically dense breasts" are more likely to have breast cancer according to the American Cancer Society. Dense (looks white on a mammogram) breasts mean that the breast has more connective tissue than fat.

4. Mutation in the genes.

The genes such as the BRCA1 and BRCA2 are responsible for DNA repair in tissues like that of the breasts. However, when there is a mutation, there is an increased risk of developing breast cancer.

5. Breast Cancer Family History.

The risk of having breast cancer is higher if a one has multiple first-degree relatives who have been diagnosed with the disease.

6. Menstrual or Reproductive History.

The earlier a woman has her menarche (first period), the more she is at risk for developing cancer of the breast because of prolonged exposure of her body to hormones like oestrogen and progesterone. This also happens with women who start their menopause at a very late age.

7. Lifestyle Factors.

Young women with poor lifestyle practices like excessive alcohol intake, reduced physical activity and being overweight. These factors are modifiable; we can all do something about them now!

"What are the Early Symptoms of Breast Cancer that I should watch out for?"

These are the most common symptoms of breast cancer:

Thickening of the tissues or a breast lump that has just recently appeared
Pain in the breast/breasts
Appearance of pitted skin over the breast
Swelling in a part or the entire breast
An unusual nipple or blood-like discharge different from breast milk
Skin peeling, flaking, or scaling of the nipple or breast
An unexplained and sudden change in the structure and size of the breast
Pain and swelling under the armpits

Having some of these breast changes or symptoms may not always mean that it is breast cancer, it is essential to remember that not all lumps are cancer. The main thing is to confirm the diagnosis; a professional medical practitioner examines the breasts, a clinical examination. They can then organise further diagnostic procedures where required, i.e. triple test, which includes imaging and needle biopsy.

"What are the challenging situations that young women like me who have breast cancer will possibly be experiencing?"

Young adults diagnosed with breast cancer are an entirely different entity compared to their older counterparts. At this age, they encounter various unique challenges; these may drastically impact their quality of life. Some of the problematic situations faced are:

Sexual dysfunction and the possibility of premature menopause due to breast cancer treatments
Fertility issues because breast cancer treatment regimen may affect their ability to get pregnant
The challenge of raising children while undergoing treatments like chemotherapy or radiation therapy
The risk of developing anxiety disorders and depression seen in occasional breast cancer survivors
Lowered self-esteem due to body image issues especially after surgical removal of a part or the entire breast
Intimacy issues may be a problem with young women who are diagnosed with cancer of the breast
Financial instability due to limited resources, workplace issues like lack or insufficient healthcare benefits, and the increasing cost of cancer treatments

5 Easy At Home Bodyweight Exercises To Reduce The Risk Of Breast Cancer

Fri, 04 Dec 2020 03:19:42 GMT

I laid down my badminton racquet in March 2020. Like its universal effect on everyone and everything, Covid19 had impacted on my favourite "exercise." I was not motivated enough to look for a suitable substitute and had, over the past few months let this part of me down. A couple of weeks ago, I decided that enough is enough, and did some research on how to do a complete workout at home. (Thanks Adrian for your gym junkie expert advice!) For the purpose of this piece, I have related it to breast cancer risk reduction, although we all know that exercise, simply put, is good for everything!

Physical activity is vital to improve your quality of life, but there's more to it — it helps prevent cancer! Medical professionals and researchers worldwide advocate that exercise prevents excess fatty tissue accumulation and helps reduce the risk of breast cancer. According to Cancer Council , Australia physical inactivity is responsible for 14% of colon cancers and 11% of post-menopausal breast cancers - and probably contributes to many other cancers.

In this post, we'll go over the five essential yet straightforward body weight exercises that you can incorporate into your daily routine at home. Before going into it, let's take a look at an important question most people ask when it comes to exercising and prevention of breast cancer.

How Much Exercise Is Enough?

When we talk about exercising, we're not referring to rigorous workout programs. The American Society of Clinical Oncology recommends approximately two and a half hours of physical activity weekly. You don't necessarily have to include intense exercise sessions in your routine; a 30-minute regime daily is more than sufficient.

5 At Home Exercises To Reduce Risk Of Breast Cancer

The following are five significant but easy (gentle start, easing into a routine) types of exercise for breast cancer prevention; you can incorporate these activities into your everyday workout. These are all body-weight exercises, so you don't need to worry about owning weights, dumbbells or any other kind of fancy equipment. Just motivation; that's a whole new post!

1. Cardio

Any movement that raises your heart and breathing rate, while improving the function of our heart, lungs and circulation is Cardio. Cardio helps improve blood flow, boosts hormonal balance, and keeps the overall body healthy. A 10 or 15-minute cardio session is enough for beginners.

This exercise may include running, skipping, boxing, even dancing; anything that involves high aerobic activity.

2. Squats

Several campaigns, such as the 53 Squat Challenge by National Breast Cancer Foundation , have promoted the incorporation of squats in everyday workout routines in their goal of breast cancer awareness 2020.

Squats help strengthen your core and reduce calories. As a beginner, try squatting 12 to 15 times and complete three sets.

3. Push-ups

Push-ups involve shoulders, pectoral muscles, and triceps. These muscles are the most relevant to your chest and have the most significant role as a breast cancer exercise.

E xercising for these muscles every day helps maintain their health, strength, and endurance. Plus, it ensures proper blood flow and improves hormonal imbalance. Performing 5 to 6 sets a day is enough; involve as many repetitions as comfortable.

4. The Plank

The plank is a simple but effective bodyweight exercise; a core exercise that helps build stability and strength throughout your entire body. The plank works out a tremendous number of muscles in your body, which makes them appealing for all sorts of training – strength, endurance, you name it. If you do it everyday, you burn more calories than any other common exercises for abdominal muscles. Planks can be performed by people of pretty much any age, as long as they are physically fit. Kids can start out doing planks and if they continue to do so, they will be able to continue the exercise into old age.

5. The chair dip

Finally, 'chair dips' exercises are excellent for women's health and health in general. It targets the muscles in the back of the upper arms. It is an effective exercise, and can be tough depending on how you position your feet. When the knees are bent, the exercise is easier. Highly recommend this particular exercise when it comes to physical activity and breast cancer prevention.

B eginners should aim for 10 to 12 repetitions to reduce the risk of injury, use a chair that has arms.

How Exercise Helps Reduce The Risk Of Breast Cancer

If you are wondering what the basis of breast cancer and exercise research is, you must first understand the effects of exercising. Physical activity helps improve your immune system, decrease body fat percentage, stimulate positive mental effects, and relieve stress. All these effects directly correlate with reducing the risk of any cancerous growth in your body. When your mental, hormonal, and muscular health is in check, cancers of all sorts stay at bay.

Sydney Breast Surgeon

Lipofilling — Liquid Gold of breast cancer surgery

Lipofilling, Liquid Gold of breast cancer surgery

What is Autologous Fat Grafting?

What is the role of Lipofilling in Breast Cancer Reconstructive Surgery?

What are the breast cancer surgical indications of Fat Grafting?

Does this procedure benefit patients who have had previous breast reconstruction?

What are the steps of the procedure?

What does the post operative period look like?

What are the outcomes of Lipofilling?

What are the possible complications of this procedure?

Are there any safety concerns with this procedure?

Is it covered by Medicare and Health Insurance?

Goldilocks Mastectomy

Goldilocks Mastectomy

WHAT IS A GOLDILOCKS MASTECTOMY?

WHEN WAS IT FIRST DESCRIBED?

WHY IS IT CALLED GOLDILOCKS?

WHAT IS THE ADVANTAGE OF A GOLDILOCKS MASTECTOMY?

WHAT ARE THE DISADVANTAGES?

WHAT ARE THE PLANNING STEPS FOR THIS SORT OF MASTECTOMY?

Triple Negative Breast Cancer

Triple Negative Breast Cancer

What is a Triple Negative Breast Cancer?

What is the Implication of Triple Negative Breast Cancer?

What is a Basal-Like Subtype?

What are the Broad Distinctions of Breast Cancer Types?

Who Tends To Develop Triple-Negative Breast Cancer?

Age, Race, or Ethnicity

Breast Cancer Gene Mutations

Are Triple-negative breast cancers always difficult to treat?

What is a Metaplastic Triple-Negative Breast Cancer?

What Are The Treatment Options For Metaplastic TNBC?

What Advancements In Surgical Techniques For Managing Triple Negative Breast Cancer?

References:

Nipple Discharge

Nipple Discharge

What is Nipple Discharge?

What is normal Milky discharge?

What is the difference between Unilateral or Bilateral nipple discharge?

What is Clear Nipple Discharge?

What is Brown nipple discharge?

What is Black nipple discharge?

What is Bloody nipple discharge?

What if there is an associated with Pain or Breast Lump?

What are the Investigations including Imaging? ﻿

Management and Surgery: ﻿

References:

Gynaecomastia

Gynaecomastia

What is Gynaecomastia?

What are the symptoms of gynaecomastia?

When to see a doctor for gynaecomastia?

What causes gynaecomastia?

What are natural hormone changes in the body during puberty?

What are medications or substances that can cause gynaecomastia?

Recreational drugs, illicit drugs and alcohol

What are health conditions that can cause gynaecomastia?

Herbal products

What are risk factors for gynaecomastia?

What are complications of gynaecomastia?

How can gynaecomastia be prevented?

What tests can be done for gynaecomastia?

What conditions can cause similar symptoms like gynaecomastia?

What is the treatment for gynaecomastia?

What medications can be used to treat gynaecomastia?

What is the role of surgery to remove excess breast tissue in gynaecomastia?

What are measures for coping and support for patients with gynaecomastia?

Oncoplastic Breast Surgery — breast cancer oncology and cosmesis

Oncoplastic Breast Surgery

Combining the principles of oncologic and advanced plastic surgery techniques, to obtain an oncologically sound and aesthetically pleasing outcome.

Lipoma Surgery

Lipoma - from diagnosis to treatment

Melanoma matters, what you should know

What is melanoma and why is it important?

What does Melanoma mean?

What are stages of melanoma ?

What is the role of Surgery and the Surgical Oncologist?

What can I expect at an appointment with a breast cancer specialist?

A brief description of what to expect

What are the Investigations including Imaging?

Management and Surgery: