The concept of Breast and Endocrine Surgery is established in western countries. In India with the availability of expertise, it is gaining popularity. This department is a one stop solution for any problem related to Breast, Thyroid, Parathyroid, Adrenal and Endocrine pancreas.
Be it medical or surgical, this department provides holistic management to any patient with breast and endocrine related disorders.
What is Breast Surgery ?
Any surgical intervention done on breasts as a part of treatment is termed as Breast surgery. The department provides wide range of treatment options to patients with breast disorders be it cancerous, non-cancerous, cosmetic or infective
Breast cancer surgery
MRM – also known as Modified Radical mastectomy, signifies removal of the whole affected breast with the adjacent axillary lymph nodes as a part of surgical clearance of breast cancer
BCS – also known as Breast Conservation surgery, signifies the removal of the affected part of the breast with a wide cuff of normal margin with adjacent axillary lymph nodes to achieve local cancer control. Breast is saved with profound patient satisfaction, however patient selection is very important and radiation therapy is must to achieve long term results.
Ax LND – also known as axillary lymph nodes dissection, is done for residual or recurrent axillary nodal disease.
Sentinel LN Biopsy – is an intra-op staining and examination technique of axillar lymph nodes to identify the patients with risk of axillary nodal disease and to spare those with low risk of disease of morbid axillar dissection
Oncoplastic Breast Surgery – is a combination of removal of tumor (Onco) along with restoration of Breast mound with the help of native tissues and/or implants (Plasty), with results equivalent to the conventional treatment. It is a much requested, high end technique, gaining popularity with rising awareness.
Benign Breast Lumps
Scarless Breast Lumps Excision (US-VABB)- also known as Ultrasound Guided Vacuum Assisted Breast Biopsy, is a latest technique in the armamentarium of Breast Surgery, where inspite of giving and incision and cutting and retracting the tissues, the lumps are removed via 5 to 7 mm hole. The probe cuts and sucks the tumor tissue under ultrasound guidance with minimal tissue handling. It is most suited for benign, small, multiple lumps and for those who want their lumps to be removed with much precision with minimal tissue handling, less discomfort and no visible scar.
Wide Local Excision – for giant lumps with high tendency for recurrence, it is advisable to undergo wide local excision. The resultant defect can be corrected with oncoplastic breast surgery.
Nipple surgery
Nipple eversion – in certain subsets of females, the nipple remains inverted since development. This leads to periductal mastitis and resultant permanent inversion and many a times recurrent peri-areolar infections. These patients require nipple eversion along with excision of underlying bands and dilated diseased ducts
Breast infection
Breast abscess – breast abscess is a clinical condition with frank pus in the breast. It could be lactation related or non-lactation related. Most of the time, these abscesses requires surgical drainage. Giving antibiotics without draining the infected tissue leads to their organization into a hard lump like lesion, mimicking cancer, known as antibioma. Following drainage, the wound is dressed with Painless Vacuum Assisted Dressing, the single application of which is sufficient to generate healthy granulation to facilitate secondary closure. The results are remarkable.
Breast sinuses – is a clinical condition where due to rupture of a breast abscess through skin, a non-healing opening with a underlying tract remains. Due to the unhealthy tissue, these sinuses keep on causing recurrent infections. The ultimate treatment is the surgical exploration of the sinuses and excision with all its tract and cavity. The results are rewarding.
Aesthetic Breast Surgery
Breast being a secondary sexual organ, any abnormality in the appearance of breasts have a huge impact on the psychology of an individual. Through aesthetic breast surgeries, we boost up the confidence levels by correcting the deformities
Breast Augmentation – It is the enhancement of the breast mound by placing implants. The breasts becomes more prominent and appealing.
Breast Reduction – It signifies reducing the breast sizes in patients with gigantomastia, with significant health issues due to pressure symptoms and size.
Gyanecomastia surgery – sometimes the male breasts get noticeably enlarged, causing profound pshycological issues, and bringing down the confidence levels. Through gyanecomastia surgery, the excess breast tissues in males are taken out surgically, in level with the chest wall. The chances of recurrences are negligible with excellent patient outcome.
Nipple reconstruction – absence of nipples either during development, following surgery or as a part of oncoplastic breast surgery, can be overcome by re-constructing the nipple with the local skin and tattooing it later. Matching with the contra-lateral nipple areola complex.
What is Endocrine Surgery ?
Any surgery on the endocrine glands like thyroid, parathyroid, adrenals, endocrine pancrease, ovaries, pituitary etc is known as Endocrine Surgery.
Endocrine tumours are rare in their occurrence, so are their specialized surgeons. We, at our department are among the few endocrine surgeons in India who are dedicatedly managing Endocrine tumours of all types.
The various endocrine tumors are
Thyroid – Thyroid is one of the most common endocrine gland, with disorders presented in endocrine clinic. The disorders may be related to excessive or low secretions of thyroid hormones, or due to the presence of thyroid swelling- diffuse or nodular. It could be a combination of hormonal dysfunction and swelling. The swelling could be non-cancerous or cancerous.
The hormonal imbalances are usually treated by medicines, however the thyroid swellings, esp the nodular ones usually require surgery.
Scarless Thyroid Surgery – With surgical advancements, we can now remove the thyroid gland without producing any visible scar in the neck, a blessing to those, who wants their thyroid surgery done due to cosmetic reasons. This procedure is done through endoscope and apart from the cosmetic advantage, it also magnifies the vision by 10X , which helps in better identification of the vital structures like nerves and parathyroid glands. With brilliant cosmetic outcome, it has high patient’s satisfaction and recommendation. As a future of thyroid surgery, it is steadily replacing the conventional thyroidectomy for small goitres.
Open Thyroid surgery – it is a conventional thyroid surgery, where through a neck incision the thyroid gland is removed. It could be complete gland removal or total thyroidectomy or a one lobe removal known as hemithyroidectomy, decided on individual level. With the availability of scarless thyroidectomy, the open technique is reserved for huge goitres, or cancers requiring extensive dissections and lymph nodes removal.
Parathyroid – Parathyroids are tiny glands located near the thyroid gland. In majority of population, these are 4 in numbers, located 2 on either side. Their tumors lead to hyper-parathyroidism, with patients developing bone weakness, renal stones, urinary infections, pancreatitis, generalized body weakness, hypertension and cardiomyopathy. The treatment is identification and surgical removal of the offending gland.
Adrenal – Adrenal glands are the endocrine glands located at the superior poles of the kidneys, one on either side. It secretes various hormones, required for the vital functions of the body. Its tumors may lead to clinical features specific for the hormone that is hyper-secreted.
Hyper-cortisolism – it is caused due to cortisol secreting tumor. Patient gradually puts on weight with predominantly truncal obesity and thin limbs. They have characteristic buffalo hump, purple strectch marks, thin and delicate skin, sensitive for infections and generalized body and muscular weakness. Diabetes and hypertension either develops or if already present, becomes uncontrolled despite best medicines following the surgical removal of the tumor, the patient resumes the normal appearance and functions gradually over time.
Hyperandrogenism – Some of the adrenal tumors characteristically secrete androgenic hormones. These hormones causes virilism in females and gyanecomastia in males. Unfortunately most of these tumors have high chances of malignancy and tumor recurrence following surgical excision
Hyperadrenalism – Tumors of adrenal medulla lead to hyper-secretion of catecholamines. It leads to episodic hypertension, headache, sweating, palpitation. If uncontrolled, may lead to complications. Treatment is surgical excision of tumor
Retroperitoneoscopic adrenalectomy – Excision of adrenal tumor with the help of endoscope from the back without opening the abdomen. It is a technically advanced procedure with the advantage of no risk of hernia, no risk of injury to liver, spleen and intestine, early mobilization and weaning and operating both the adrenals in single sitting if indicated.
Trans-peritoneal adrenalectomy – it is the conventional adrenalectomy done from the anterior abdominal wall. The endoscopic advances through the peritoneal cavity. Compared to the Retroperitoneoscopic adrenalectomy, it has higher risk of liver, spleen and intestinal injury, relatively delayed weaning due to gastro-paresis, chances of hernia and difficulty operating both adrenals in single sitting.
Endocrine pancreas – Pancreas is a dual gland having both exocrine and endocrine functions. Endocrine pancreas have cells that secrete hormones like Gastrin and Insulin. Patients with gastrin tumors have severe acid peptic disease, insulinoma tumors have recurrent hypoglycemia . another unique tumors are neuro-endocrine tumors, with clinical manifestations of secretory diarrhoea, and flushing. The treatment is localization and surgical excision of tumor.
Pituitary – Pituitary gland is a tiny gland in the anterior part of the brain. It is the master gland since it regulates the secretion of other endocrine glands. It can develop tumors like prolactinoma, growth hormone tumor etc. the treatment could be medical or surgical depending upon the severity of symptoms
How are we Unique? We are the first and the only Department of Breast and Endocrine Surgery in the Western UP. We provide the one stop solution for all breast and endocrine related problems. Our department is pioneer in Scarless Breast and Endocrine Surgeries along with the retro-peritoneoscopic adrenalectomies. We not only provide the treatment, but also give utmost care to rehabilitate the cancer survivors through various means. We update ourselves with regular academic programmes. We are the ones with difference.
The distinguished state of art services we provide?
- Scarless thyroidectomies
- Scarless breast lumps excision
- Retro-peritoneoscopic adrenalectomies
- Oncoplastic breast Surgeries
- Aesthetic breast Surgeries
- Breast cancer
- Nipple Surgeries
- Breast abscess management through painless dressings
- Thyroid, Parathyroid, Adrenals and Endocrine pancreatic Surgeries