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Objective: To evaluate the feasibility and impact of fast track discharge in patients undergoing definitive breast cancer surgery., Methods: One hundred six breast cancer patients older than 20 years of age were assigned to undergo definitive breast cancer surgery. It was ensured that enrolled patients had a ready access to hospital, reasonable home circumstances. They were assessed by using post-anesthesia discharge scoring system (PADSS) for fast track discharge. Quality of life both in preoperative and postoperative period was assessed by Functional Assessment of Cancer Therapy-Breast cancer version 4 (FACT-B4) questionnaires., Result: Overall 90 patients (84.9%) were fit for fast track discharge. Eighty-nine patients (83.96%) were successfully discharged within 48 hr. One patient (0.94%) could not be discharged despite being fit as she was of concern that it would put too much responsibility on the family. Mean duration of postoperative hospital stay in patients fit for fast track surgery was 42.27 ± 5.73 hr with a median of 44 hr. All patients undergoing breast conservation could be discharged on fast track basis with a mean postoperative hospital stay of 32.12 hr., Conclusion: Fast track discharges in breast cancer patients after definitive surgery are feasible in Indian setting., (© 2014 Wiley Periodicals, Inc.)

Major mammary duct excision is the standard surgical treatment for patients with periductal mastitis presenting with persistent non-bloody nipple discharge or recurrent subareolar sepsis and mammary duct fistula. The present trial was aimed at comparing outcomes following 1.5-cm ductal cone excision versus conventional 3-cm-long excision, in terms of control of periductal mastitis, occurrence of complications, postoperative pain, and the cosmetic outcome. Patients with non-bloody nipple discharge without imaging suspicious of malignancy and history of lactation in the past 6 months were recruited and randomized into two groups, viz., 1.5-cm ductal cone excision and 3-cm ductal cone excision. After completing triple assessment, patients underwent a procedure under local anesthesia and were followed up at 1, 2, and 4 weeks and 6 months to assess postoperative complications, viz., hematoma, surgical site infection, the nipple–areolar complex (NAC) necrosis, pain, NAC sensation, cosmesis, and recurrence. Sixty patients were recruited in this study. Recurrence of nipple discharge was observed in one patient in each arm. Three patients in the 3-cm duct excision group had a partial necrosis of areola and 2 had complete loss of sensation, whereas none was observed in the 1.5-cm duct excision group. More patients had complained of pain in the former group. A total of 86.67% patients experienced excellent cosmesis in the 1.5-cm duct excision group, whereas only 66.67% reported the same in the 3 cm group. The limited 1.5-cm-long ductal cone excision is a safe and effective procedure in ladies presenting with pathological non-bloody nipple discharge. [ABSTRACT FROM AUTHOR]

Background and Aims: Serratus anterior plane (SAP) blocks can be given either superficial or deep to the serratus anterior muscle to block the branches of intercostal nerves providing analgesia to the anterolateral chest wall. This prospective randomised comparative study aimed to compare the analgesic efficacy of superficial and deep SAP block in breast surgeries. Methods: Forty female patients scheduled to undergo elective modified radical mastectomy under general anaesthesia (GA) were randomly assigned to receive ultrasound guided SAP block with 30 ml 0.375% ropivacaine either superficial (group S, n = 20) or deep (group D, n = 20) to the serratus anterior muscle, before the induction of GA. The primary outcome was post operative fentanyl requirement over 24 hours and secondary outcomes were comparison of numerical rating scale (NRS) scores for pain, sensory block mapping, time to perform the block, number of needle attempts, etc. Results: The post operative 24-hour fentanyl requirement was comparable between group S and D (318.75 ± 80.65 versus 272.5 ± 80.25 μg, P = 0.07). NRS pain scores were comparable between the groups. Sensory block mapping done at various levels showed T3–T7 block in most of the patients with no difference between the groups. Block performance time (6.05 ± 3.27 versus 8.35 ± 3.26 minutes, P = 0.034) and number of needle attempts was significantly lesser in group D. Conclusion: There was no difference in analgesic efficacy when SAP block was given superficial or deep to serratus anterior muscle for modified radical mastectomies. However, deep SAP block required less time and number of attempts to perform than superficial technique. [ABSTRACT FROM AUTHOR]

The modified radical mastectomy is still the standard of care for breast cancer management. While performing mastectomy, it behoves on us to make every effort to extirpate maximum amount of ducto-lobular tissue containing terminal ducto-lobular units (TDLUs) as most cases of breast carcinoma arise from TDLU. This is possible if we follow the concept of premammary fascia. It is a thick white distinct fascia and demarcates the plane between subcutaneous tissue and the actual ducto-lobular breast tissue. The technique described by us stress on elevation of skin flap superficial to the white fascial plane. This technique ensures removal of maximum amount of ducto-lobular tissue. [ABSTRACT FROM AUTHOR]

Phyllodes tumor of the breast is a rare mixed tumor of epithelial and mesenchymal origin with an incidence of less than 1% of all primary breast tumors. This tumor is well known for its high potential for local recurrence ranging in 8–40% of patients. Excision of tumor with a 2-cm margin without raising skin flap along with overlying skin and underlying part of pectoralis major muscle described by our team seems to be a guarantee against local recurrence. It was a prospective cohort study conducted at the Department of Surgical Disciplines, AIIMS, New Delhi, India, from March 2011 to December 2016. Patients with large phyllodes tumor were managed with a "radical mastectomy without axillary lymph node dissection" whereas women with a small lesion were treated with a wide local excision with a 2-cm margin of healthy breast tissue all around the lesion following our surgical technique. Sixty-one women were enrolled in this study. Twenty-nine patients underwent wide local excision, and 32 patients with large, recurrent, or malignant tumors were managed by radical mastectomy without axillary lymph node dissection (ALND) (27 patients) and with ALND in 5 patients with enlarged axillary nodes. None of the patients have developed local recurrence till date with a follow-up period ranging from 2 to 59 months. Excision of tumor with a 2-cm margin without raising skin flap along with overlying skin and underlying part of pectoralis major muscle is a very effective technique to prevent local recurrence. [ABSTRACT FROM AUTHOR]

Phyllodes tumour is a rare benign neoplasm of the breast. It is a mixed tumour of epithelial and mesenchymal origin. The epithelial element is characterized by proliferation of ductolobular units. The fibrous tissue and collagen bundles represent the mesenchymal element. It is also known as 'cystosarcoma' phyllodes to characterize some important features, viz. cyst-like or cleft-like spaces within the mass along with a leaf- or frond-like pattern of the stromal element. The tumour is well known for its high potential for local recurrence. Most patients in developing countries present with very large breast tumours with close proximity to the skin and pectoralis major. In these cases, there is a need to perform a three-dimensional en bloc removal of the mass with overlying skin and underlying muscle(s). If a skin flap is raised in the vicinity of the tumour, there is a risk of cutting close to the tumour, increasing risk of local recurrence. Here, we describe a surgical technique that permits a three-dimensional en bloc removal of phyllodes tumour. [ABSTRACT FROM AUTHOR]