1. Breast Surgery in Delhi Breast Cancer Epidemiology Halsted Theory Radical Mastectomy Fisher Theory Modified Radical Mastectomy Goals of Breast Conservation Targeting the Cancer Sentinel Lymph Node Dissection Skin Sparing / Tissue Expander-Implant NSM / Direct to Implant Skin Sparing / Free Flap Cryoablation - Probe Placement Cryoablation - Iceball Formation

2. Breast Cancer Epidemiology Most common type of cancer among women 1 in 8 women will develop breast cancer over her lifetime; 1 in 100 men Second most common cause of cancer deaths among women ~200,000 new cases and ~40,000 deaths per year Risk increases with age

3. HALSTED THEORY LYMPH NODES CANCER BONE LIVER LUNGS

4. Radical Mastectomy

5. FISHER THEORY LYMPH NODES CANCER BON E LIVE R LUNGS BLOOD STREAM

6. Modified Radical Mastectomy

8. Goals of Breast Conservation Minimize local recurrence at the primary site Achieve an acceptable cosmetic result Eradicate microscopic foci of cancer with radiation Minimize risk of complications Maximize benefit in terms of quality of life

9. Targeting the Cancer

10. Sentinel Lymph Node Dissection

11. Skin Sparing / Tissue Expander- Implant

12. The Future Ablative Therapy Majority of patients are candidates for breast conserving lumpectomy Still requires general anesthesia, scarring, potential for cosmetic deformity, and may require multiple operations (literature reports 25-40% re-excision for positive margins) Ablation involves destruction of the tumor without the need for surgery Used for liver, kidney and other cancers

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