Breast Care Center

1.1 Why Healthy Women Need Preventive Care 
Breast Cancer is the most common cancer amongst women in India. It is estimated that 1:25 Indian women may be at risk of developing breast cancer. Breast Cancer can affect healthy women without a family history and in early stages there are no symptoms of the disease. However breast cancer is curable when diagnosed early and treated appropriately with modern oncological treatments. Early detection of breast cancer enables timely diagnosis and saves lives. It also makes treatments more convenient and less invasive.

1.2 Regular Breast Exams all women should undergo

Annual Clinical exam:All women over the age of 30 should undergo a physical breast exam by a doctor once a year. If the Clinical Breast exams reveals an abnormality, our breast surgeons will guide you about appropriate further investigations.

Annual Mammography:All women over the age of 40 should undergo a “Screening Mammography” once a year.

The Mammography centre at Jupiter Hospital offers advanced breast imaging using Digital Mammography with Tomosynthesis. The technology enables detection of very small cancers and minimises false positives to avoid mastectomy

Monthly Breast Self-Exams:All women over the age of 20 should undergo monthly breast-self exams. Learn the correct technique of breast self-exams from our experts. If you notice a lump or other abnormality on your self-exam- do not panic, as most breast lumps are not cancerous. However symptoms of common benign breast problems can overlap with those of breast cancer, so always seek specialist consultation.Schedule a breast exam with our specialists who can guide you through correct diagnostic steps.

1.3 Genetic Testing for Familial risk
5-10 % of breast cancers are hereditary and caused by genetic mutations that you can inherit from your mother or your father. Most such inherited genetic defects in BRCA1 and BRCA2 genes. If you have close blood relatives breast cancer, ovarian cancer, prostate cancer or other cancers, you should schedule a visit to underdo genetic counselling. During your genetic counselling session our specialists will review your detailed family history, study available reports, evaluate the need for genetic testing and explain the testing process.

We believe that an accurate and confident diagnosis is the key first step in successful treatments for any breast problem. At Jupiter Hospital, all your breast complaints are reviewed by qualified and experienced breast health specialists in breast radiology, breast pathology, breast surgery, and breast cosmetology. Our experts are aided by state-of the art diagnostic technology such as digital mammography with tomosynthesis (3-D mammography), breast ultrasound with elastography, image-guided needle biopsy whereby you can be reassured of a confident diagnosis prior to treatment.
At Jupiter Hospital’s Breast Care Center, we offer a complete and accurate diagnosis for complaints such as

• Breast pain:
• Breast lumps:
• Nipple discharge
• Breast infections
• Breast size concerns
• Male Breast problems
• Lactational Breast Problems
• Other undiagnosed breast problems

3.1 Breast Cysts:
Breast Cysts are a common breast problem. A breast cyst may either be a simple cyst, complicated cyst or a complex cyst. Simple cysts often require no treatment. A complicated or complex cyst may require an ultrasound-guided aspiration. Surgery for breast cysts can often be avoided with minimally invasive outpatient procedures.

3.2 Breast Fibroadenomas:
A fibroadenoma is a common cause of a benign breast lump. Small fibroadenoma often do not need treatment and can be observed. However if they causes pain, discomfort or show rapid growth, our experts use minimally invasive and scar-less techniques to remove them.
A triple test is often required to confidently confirm that any breast lump is in-fact non-cancerous

3.3Granulomatous Mastitis:
A very common cause of recurring breast abscesses and inflammation, Idiopathic Granulomatous Mastitis (IGM) can be confused with breast TB and is often treated with repeated surgery. We specialise in medical treatments for IGM that use minimally invasive approaches and avoid surgery and scarring from this condition.

3.4 Breast Papilloma:
Intraductal Papilloma is a growth arising in the lining of the milk ducts that cause abnormal nipple discharge. Often these growths are not seen on mammography and ultrasound. We offer minimally invasive microdochectomy to perform selective removal of the involved duct and preserve normal ducts when treating this condition.

3.5 Lactational Breast Problems:
Cracked nipples, galactoceles, lactational mastitis, breast abscesses are common problems that arise in mothers who are breast-feeding. Prompt treatment of these conditions is essential to the health of the mother and baby. It is also important to distinguish these problems from a more serious and unusual condition called pregnancy associated breast cancer.

We conduct a weekly breast-plastic surgery OPD where our breast surgeons and plastic surgeons offer combined consultations for concerns of breast size and shape. We specialise in

• Breast augmentation with breast implants to increase breast size
• Fat grafting to increase breast size and correct deformities
• Breast lift or mastopexy for sagging breasts
• Breast reduction surgeries for large breast size causing back and neck pain
• Correction of asymmetry in breast size and shape
• Correction of inverted nipples
• Removal of accessory breast tissue in armpit
• Minimally invasive surgery for gynecomastia
• Breast reconstruction after mastectomy

At Jupiter Hospitals Cancer Institute we offer comprehensive treatment of breast cancer. We pride ourselves in state-of the art technology, an experienced team of oncologists, skilled oncology nursing care and a truly multidisciplinary approach to cancer care.

5.1 Accurate Breast Cancer Diagnostics:
Each breast cancer is different and a complete diagnosis of the breast cancer subtype and stage is essential to making a treatment plan.A diagnosis of breast cancer is first made with imaging such as mammography and ultrasound done in our breast imaging department, followed by a core- needle biopsy done in the breast clinic.Our breast pathology experts then obtain Immunohistochemistry (IHC) studies to determine the subtype of the cancer (ER/ PR/ HER2 status). In-house PET- CT services are available for studying the stage of cancer

5.2 Multidisciplinary Tumour Board:
Our team of Breast Surgeons, Surgical Oncologists, Radiation Oncologists, Medical Oncologists, Plastic Surgeons, Palliative Care Specialists, Radiologists and Onco-Pathologists review our breast cancer cases in a weekly tumour-board meeting. A personalised treatment plan is formulated after multiple specialists have studied the patient reports in detail. Patients benefit from expertise of multiple specialists and their exchange of view-points. Your breast cancer treatment plan may involve surgery, chemotherapy, radiation therapy targeted therapy, endocrine therapy and sometimes immunotherapy.Not every patient needs each of these treatments and the treatment plan is customised for each patient.

5.3 State-of the art Breast Cancer Surgery:
Our Breast Surgical Oncologists specialise in advanced breast surgical techniques
Breast Conservation surgery: In most cases breast cancer can be treated without removal of the breast. Intraoperative ultrasound, specimen mammography and intra-operative frozen section increase accuracy of complete tumor removal and minimise chances of re-operation in cancer surgery.
Oncoplastic Breast Surgery
Oncoplastic techniques help preserve the aesthetic appearance of the breast during cancer operations.
The breast cancer is removed with preservation of the shape and cosmetic appearance of the breast, avoiding deformity and minimising scarring.
Mastectomy withBreast Reconstruction
A complete removal of the breast is occasionally needed to treat the breast cancer. For such patients we offer a nipple and skin sparing mastectomy with immediate reconstruction to replace the breast tissue with an implant or tissue flap.Our breast surgeons and plastic surgeons work together as a team to perform advanced reconstruction surgeries, where the breast reconstruction is performed at the time of the cancer operation itselfFor patients who have undergone mastectomy in the past without reconstruction, we also offer delayed breast reconstruction.
Lymphedema Prevention
Lymph node surgery is an essential component of breast cancer surgery which can be complicated by arm swelling or lymphedema. We offer sentinel lymph node biopsy is a minimally invasive procedure that avoids unnecessary axillary lymph node dissection. Axillary reverse mapping and lympho-vascular anastomoses are other techniques we use to help minimise risk of lymphedema in lymph node surgery.
Enhanced Recovery after Breast Surgery
Minimising post-surgical pain, minimising post surgical nausea-vomiting and early mobilisation help minimise hospital stay and complications from breast surgery. Most breast cancer patients are discharged home within 24 hours of the breast cancer surgery.
Treatment of Rare and Unusual Breast Cancers
Our breast cancer specialists treat unusual cases such as phyllodes tumors, breast lymphomas, occult breast carcinomas, male breast cancers, pregnancy associated breast cancers, young breast cancer, breast cancers in elderly and breast cancer in BRCA gene mutation carriers. If

5.4 Breast Cancer Chemotherapy:
Avoiding Chemotherapy:
Not every breast cancer patient may need chemotherapy. If you have a tumour is small, has not spread to lymph nodes, is ER+ PR+ i.e. hormone receptor positive and HER2 negative, we offer a genomic risk assessment of your tumor.If such testing demonstrates your tumor to be at low risk of recurrence, you may be prescribed endocrine therapy alone for 5-10 years and you may be able to avoid chemotherapy
Day-careChemotherapy Administration: When chemo is required,it is administered in a our Day-Care Chemo center by trained staff who have expertise in oncology nursing. Hospital admissions can be avoided with the convenience of our day-care chemotherapy sessions.
Chemo-port placement
Patients who need chemotherapy are offered chemo-port placement to improve convenience of chemotherapy administration and minimise need for IV sticks.
Neoadjuvant chemotherapy Program
Our medical oncologists and breast surgeons work as a team in neoadjuvant chemotherapy program. This approach uses chemotherapy before surgery to allows downstaging of advanced tumours. Cancers shrink with medications to become smaller, allowing surgery to be become less invasive.
Chemotherapy SupportServices:Support services such as psychological counselling, family and care-giver support, hair-loss management, nutritional counselling, are also provided to our chemotherapy patients.
Fertility preservation in chemotherapy:
We offer a multi-disciplinary approach to fertility preservation for our young patients who wish to plan a family after cancer treatments are completed. Our fertility specialists, breast surgeons and oncologists work together to balance safe oncological treatments with preservation of fertility.

5.5 Breast Cancer Radiation:
With advanced radiation treatment protocols we are able to shorten duration of radiation treatments for breast cancer patients from 5 weeks to 3 weeks. Some patients can complete radiation in a short span of 5 days. CT guided planning, IMRT, Respiratory gating and other technological advances in radiation make feasible precise delivery of radiation the target area sparing the surrounding vital organs.