The report evaluates the effect of coronavirus disease (COVID-19) pandemic on breast cancer treatment and management at a single-surgeon cancer care unit in one of the hotspots of COVID-19 in India. In response to the pandemic, the adjustments were made in the clinical practice to accommodate social distancing. Patient consultations were done over phone call or in-clinic visit with prior appointment to reduce the risk of exposure to COVID-19. Total number of patients that were treated at the clinic and the essential surgeries performed during the pandemic phases are summarized in the report. The methodology adopted here for care and management of the cancer patients can serve as a guiding principle for cancer care units in the country.

Introduction Therapeutic Mammoplasty (TM) is a Oncoplastic Breast Surgery (OBS) technique suitable for medium-to-large breasts with ptosis with large or multifocal/multicentric (MF/MC) tumors. Several studies have indicated that TM expands the scope, extent, and application of breast conservation surgery. This report describes in detail TM outcomes in Indian breast cancer (BC) patients. Methods From our single institutional cohort (n = 211), we present data related to surgical techniques, clinical management, oncological safety, cosmetic and patient reported outcomes (PROMs, based on Breast-Q questionnaire) from BC patients who underwent TM (categorized as simple, complex, extreme and split-reduction type) Results Mean age at diagnosis was 48.7 years. Majority of these patients had advanced stage (II/III) disease. 178 patients consented and 171 completed 1 year follow-up from 3 main groups (a) simple (n=87) (b) complex (n =39) and (c) extreme TM (n = 49). The post-operative complication rates were low (<10%) without any delay in adjuvant treatment. Cosmetic scores were good-to-excellent (n = 154). Post- 1-year PROMs (n =149) revealed good-to-excellent score for satisfaction with breast, cosmetic outcome and psychosocial well-being for all TM types. Conclusion Our study is a first detailed report describing a multi-factorial audit in TM single institutional cohort in Indian BC patients. We propose that our TM technique/s may be optimally suited for BC scenarios common in India namely (a) advanced stage BC patients with moderate-to-large breasts with mild/severe ptosis (b) multifocal, multicentric tumors (c) LABC at initial presentation.

Background: Breast reconstruction with an autologous lower dermal sling (ALDS) is an established one-stage procedure in patients with moderate to large ptotic breasts. However, this technique is difficult to perform in small and non/minimally ptotic breasts. We describe our experiences from a single institution about a novel Advanced Autologous Lower Dermal Sling (A-ALDS) technique for reconstruction in small breasts. Methods: We performed one stage nipple/skin sparing mastectomies in 61 patients with immediate reconstruction either by conventional immediate breast reconstruction surgery or A-ALDS technique. Results: Mean age of study patients was 46.9 years. We observed significantly better cosmetic score and lower immediate complication rate vis-a-vis skin necrosis, implant loss with the A-ALDS technique (i.e., nil versus 3 in Conventional Immediate Breast Reconstruction Surgery -IBRS). 40 patients completed 12 months follow-up. The PROMs- Patient Reported Outcomes Measures (Breast-Q) revealed good to excellent scores for satisfaction with breast, cosmetic outcome and psychosocial well-being in patients operated with both these techniques. However, sexual well-being was significantly better in the A-ALDS group. Conclusion: The A-ALDS is a novel, cost-effective and safe technique for immediate one stage implant-based reconstruction for small breasts. It provides a dermal barrier flap and hence, ensures less complications, excellent cosmetic results and patient satisfaction.