On July 14, 2020, Meghani Yardi, a 42-year-old pre-primary teacher felt an “extra growth” in her left breast. On further investigation, a tumour was confirmed and soon her fear of injections and the idea that “I may not have a breast ruined my peace of mind”.
But that was only till she met oncoplastic breast cancer surgeon Dr C B Koppiker. He explained to her that that she would not lose her breast and that the hollow created by removing the cancerous tumour would be filled up through ‘oncoplastic surgery’.
Now, nearly two years later, Yardi says “I cannot even see the incision on my breast till I specifically look for it.” “Even if I wear a halter neck top, at the most a slight line may be visible,” she smiled.
Breast cancer prevalence has been rising steadily in India, and is presently the most common cancer among females. Of the cases being reported, at least 14% are being detected at a late stage and approximately 50% are “locally advanced” at diagnosis. Mastectomy or breast removal is still performed widely in patients in India and South East Asia. However, the procedure has been associated with several long-term side effects such as body asymmetry, postural instability, depression, loss of self-esteem and poor quality of life.
But no woman should lose her breast to cancer, said Dr C B Koppiker, the director of Oncology Sciences at Jehangir Hospital and Medical Director Orchids Breast Health in Pune.
“The advantage of oncoplastic surgery is that it exterminates cancer safely and provides a cosmetically excellent outcome to a patient of breast cancer,” said Dr Koppikar who is also an honorary associate professor at University of East Anglia in the UK and is on the board of directors of Society of Oncoplastic Surgery (SOS) in the US.
Globally, breast conserving surgery is now the preferred procedure for breast cancer treatment and doctors such as Koppiker are working towards ensuring that oncoplastic conservative breast surgery gets a firm footing in India as well.
In the past, in cases such as Yardi’s, mastectomy along with reconstruction — instead of breast conservation — has been the norm. Dr Koppiker uses a ‘perforator flap’, a volume replacement technique for breast conservation surgery.
“This technique is less invasive and conserves most of the natural breast tissue. Essentially what is done is the patient’s own extra tissue, which is always present on the chest wall, is taken to fill the hollow created in the breast after a large tumour is removed. The ‘perforator’ refers to branched blood vessels arising from the main artery which provides blood to the tissues/flaps to avoid tissue morbidity. These flaps are called ‘perforator flaps’ because they are supplied by a specific blood vessel which robustly ensures viability of this flap or tissue. These flaps can be rotated into the large cavity created by adequate removal of a tumour,” explained Dr Koppiker, who has performed over 2,000 breast surgeries and over 1,000 oncoplastic surgeries.
For women who have very small breasts and need reconstruction after removal of the tumour, there is the option of ‘autologous lower dermal sling (ALDS)’ procedure, an established one-stage procedure for implant-based immediate breast reconstruction surgery (IBRS).
The method is difficult to perform in small breasts because of the non-availability of excess lower tissue for the creation of an appropriately sized dermal sling. Breast reconstruction is also expensive in such situations and is shown to end in sub-optimal cosmetic outcomes. Hence several oncoplastic surgeons routinely use acellular dermal matrices (ADMs) which serve as a sling to hide the implant and provide robust support to the breast. But in developing countries like India, ADMs are not available.
For such cases, Dr Koppiker has developed a unique Advanced Autologous Lower Dermal Sling (A-ALDS) technique, which is a cost-effective and safe alternative to ADM-based reconstruction, and can be performed in a single setting.
“This procedure can be employed in patients with small breasts as it provides a dermal barrier flap, ensures good cosmetic outcome with aesthetic results and an overall positive impact on quality of life,” Dr Koppiker said.
Apart from addressing aesthetic and safety concerns, there is also a reduced rate of depression among patients opting for oncoplastic surgery.
“My patients are happier, not only with the way their breasts look but also with the fact that there no complications and the recovery time is short,” said Dr Koppiker, who also recently presented his ‘perforator flap’ work at the European Society for Medical Oncology (ESMO) Breast Cancer Congress in Berlin, Germany.
“Now, it is important to train the next generation of oncoplastic breast surgeons and bring about the change in quality of treatment for breast cancer patients,” added the doctor, who has so far trained over 500 surgeons from India, Indonesia, Nepal, Maldives, Bangladesh, Sri Lanka and Malaysia in oncoplastic techniques.