One Stop Clinic

One Stop Comprehensive Breast Health

Orchids Breast Clinic, a Prashanti Cancer Care Mission Initiative.

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Envisioned for serving comprehensive, coordinated & compassionate
care for breast health, Orchids Breast Clinic

One of a kind, in offering One stop center for women for all age groups and breast conditions, in a warm, comfortable & serene ambience.

Equipped with most advanced technologies and medical expertise in Breast care
Offers better diagnostic capability & confidence while dealing challenging diseases

Expert Panel
Dr. Arun Kinare
Senior Consultant Radiodiagnosis and Intervention Radiology
Dr. Beenu Varghese
Senior Consultant Radiodiagnosis and Intervention Radiology
Dr. Chaitanyanand B. Koppiker
Director Orchids Breast Health, Chief Breast Surgery & Oncoplastic Surgery
Dr. Upendra Dhar
Senior Consultant Breast Surgery

Dr. Sachin Hingmire
Medical Oncologist

360° Sphere of Confidence in Comprehensive Breast Health

World Class Technologies in Diagnostics and Therapeutics
  • Advanced Mammography system: offering high quality breast imaging, with more reproducible results and consistent follow ups. This digitized mammography is useful in detecting occult lesions in dense breasts of the young women under 50.
  • Ultra-high quality ACUSON S2000 ultrasound system enhanced with capabilities of
    • ABVS (Automated Breast Volume Scanner),
    • Breast Elastography (strain imaging)
    • ARFI imaging (shear wave mediated tissue stiffness/elasticity quantification)
ABVS
Dense breasts, encountered in nearly 70-75% of the young women under 50 yrs of age in whom the breast cancer peaks, poses a diagnostic challenge and a major risk factor for cancer itself.

Since even digital mammography has known limitations in dense breast, ABVS is the answer to the problem of assessing dense breast tissue in the young; and picking out lesions inconspicuous/occult on even digital mammography & hand held sonography. How it works! Automated breast volume scanner automatically scans both the breasts and converts the images into coronal 3D formats that pick up the smallest breast cancers often missed by mammograms in this age group. Sophisticated software then helps the clinicians post process the images and pick up further hidden lesions. Thus a combination of a digitized mammography along with the ABUS is the best method for early diagnosis in the young woman.


Breast Elastography and ARFI Imaging
  • An objective, real-time and non invasive measure of tissue stiffness
  • Novel clinical information, never available before through any other imaging modality, raises the diagnostic confidence in difficult to diagnose/ambiguous cases
  • Potential reduction in the number of false negative biopsies.
  • Conceptually malignant lesions tend to be harder than benign lesions/normal tissue.
  • Elastography has gained a significant clinical interest in
    1. Differentiating benign/malignant nodule
    2. Differentiating complex cyst from solid lesion
    3. Picking up mammography/ultrasound occult lesions in non palpable mass
    4. Assessing the tumor margins with superior border definition for better insight to the breast surgeon
  • Mammotome facility
  • The Only Mammotome facility in the city has been available with the center for many years.
  • It is The International Gold Standard for sampling sub-centimeter lesions Even 2-3mm lesions can be biopsied with higher degree of precision and diagnostic confidence.
    1. As a rule, Trucut/Vacuum assisted biopsy is recommended over FNA for the suspicious cases at our clinic.
    2. We recommend a large core Trucut biopsy (14G) for lesions >10mm and Vacuum assisted biopsy for sub-centimeter lesions.
  • PACS and Robust Data Backup System for storage and encryption of clinical records: ensures full data protection and fidelity over time for consistent follow ups.
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Figure 2: Mammotome assisted biopsy depicted via sonography

Same Day Walk In Walk Out
  • A provisional diagnosis is made within an hour based on imaging results correlated with clinical profile.
  • Patients are rarely recalled for biopsy, which itself is more often undertaken on the same visit.
Individualized Strategy of Management

By an expert panel consisting of breast, oncoplastic and reconstructive Surgeons, breast Radiologists; breast Pathologists, clinical Onco-psychologists & Social workers

  • After a diagnosis is made, a panel of consultants synthesizes a solution based on clinical, radiological, pathological and socio-psychological factors, after a thorough one on one discussion with individual patient
Day Care Facility
  • The centre has a warm and comfortable day care centre where the patients receive chemotherapy under expert supervision of medical oncologists.
  • The advantage of taking chemotherapy in this environment is that the patients take treatment in a serene surroundings, with less chances of acquiring hospital based deadly infections that can happen in major hospitals
Rehabilitation & Counselling for Cancer Patients
  • Trained Oncology counselors and the care givers of the patients stand by their patients through the entire process like a rock preparing them for a life after it.
  • Other holistic treatments for the healing of the mind, body and soul are also offered such as mind healing techniques, meditation, dance therapies, and music sessions.
  • Trained dieticians counsel about the life style modification for healthier & faster recovery & quality of life
Genetic Counselling

High risk counseling is given to the women with family history of breast cancer. In addition, expert advice on diet, exercise and lifestyle modification is provided for earlier adoption of preventive strategies

Pioneers in Breast Surgery & Oncoplastic Breast Surgery in India
  • Breast oncosurgery has experienced a paradigm shift in practices, amid the last few decades, with the adoption of more advanced, complex, refined and comprehensive approaches, rather than the conventional radical procedures which involved extirpation of the breast, muscle, skin and axillary lymph nodes.
  • The mastectomy of early 19th century left the women mutilated, severely impacting her body image, self-esteem, sexuality and even throwing them into throes of depression.
  • In this regard, the advent of oncoplastic breast surgery has been the major breakthrough, emphasizing not only on long term local control but also a better control of cosmetic outcome and overall quality of life.
  • Oncoplastic surgery involves an amalgamation of the techniques of cancer surgery and plastic surgery, with aim of preserving the aesthetics of breast while obtaining an optimal disease control.
  • It helps impart an intact psycho-social & sexual life to the women post surgery, with even enhanced young looking breasts.
  • As shown in the figure, the tumor – i.e., the red dot in left breast is excised in the reduction specimen and the breast is lifted and enhanced after surgery for breast cancer.
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Figure3: Incorporating Reduction Mammoplasty
Techniques for BCT
  • Various techniques of immediate breast reconstruction, by either using safe breast silicone prosthesis, or using borrowed muscle and skin from the back or abdomen, have evolved where women can feel complete immediately after their surgery where the reconstructed breast mimics a natural breast accurately.
  • The silicone prosthesis available today is compact, cohesive and safe.
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Expertise in Cosmetic Surgery

The centre also offers cosmetic surgery options to women seeking solutions for the ageing breast that droops, or the young breast that needs to be enhanced or augmented.

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Figure 4:
Giant Fibroadenoma – Inferior Pedicle Reduction
Skin Reducing + Implant 250 cc MP

Case Studies Demonstrating Comprehensive Breast Assessment with Unique Advantages of Automated Breast Volume Scanning & Elastography

Case Study1: ABVS picking up an occult carcinoma adjacent to a lipoma

A 45 year old lady presented with a soft lump in right breast, suspicious of a lipoma.

  • Mammography found a well circumscribed radio-lucent lesion, consistent with lipoma; with moderately dense breast parenchyma.
  • A prior hand-held ultrasound, performed at some other center was also consistent with the above findings.
  • ABVS revealed a hidden spiculated density 1.9 x 1.4 cm, just adjacent to the Lipoma
  • The patient underwent a lateral mammoplasty oncoplastic surgery with medialisation of the NAC.
  • Histopathology confirmed it to be a grade-3 intra-ductal carcinoma with margins negative 2.1 x 1.3cm
obh-9Figure 4: Mammogram
showing a lucent mass
suggesting a lipoma
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Impression: ABVS picked up an occult carcinoma which would have been missed otherwise.


Case Study 2: ABVS & adjunct elastography detecting an inconspicuous cancer in large sized
Dense breast

43 year old lady, with family history of breast cancer in a sibling, presented with large breasts and
associated vague pain and lumpishness in upper quadrant of right breast. Clinically, vague nodularity
was found in right breast at 11-12 o’ clock position, with normal axillae.

  • Mammography revealed dense breast parenchyma without any signs of asymmetry or abnormality.
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  • ABVS was followed, revealing an irregular spiculated lesion at 12 o’ clock position in right breast. The precise size (2.5 x 1.7cm) and extent could be delineated by breast volume scanning.

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  • A targeted hand held sonography & elastography done thereafter found the lesion to be stiff. Elastography also showed the tumor to be larger than seen on B grey scale ultrasound (E/B ratio>2), suggesting infiltration.
  • Tru-cut biopsy found an intra-ductal carcinoma and a ductal carcinoma in-situ.
  • Patient underwent excision and reconstruction with reduction mammoplasty.
  • Histopathology confirmed an intra-ductal carcinoma, 2.3×1.8 cm, with DCIS, Stage T2N0MO, and sentinel node negative.


Impression: ABVS & targeted sonoelastography detected cancer in dense breast. It is interesting to note
that the actual size of lesion is larger than B mode and correlated with elastogram.

Case Study 3: ABVS & adjunct elastography picking up multi-centric breast cancer
> changed the course of management

A 40 year old woman, diagnosed with an intra-ductal carcinoma on mammography & excision biopsy, was referred for further management and the prospect of breast conservative surgery. There was no significant family history.

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  • ABVS detected a sub-centimeter lesion in the axillary tail, in addition to the primary lesion. It was found to be stiff on targeted sonoelastography.
  • Impression: Multicentric breast cancer
  • Management approach changed to skin sparing mastectomy with immediate reconstruction; rather than BCT
Case Study 4: ABVS detecting a lobular carcinoma, missed on prior mammography based
screening

A 42 year old woman, asymptomatic, premenstrual, without any significant family history, came for routine screening.

  • Mammography revealed dense breast parenchyma, without any apparent abnormality. ABVS was advised.
  • ABVS detected a spiculated lesion at 2 o’clock in left breast.
  • Elastography found it to be stiff.
  • An ultrasound guided Tru-cut biopsy from the lesion confirmed it to be lobular carcinoma.

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Case Study 5: ABVS in assessing the treatment response of breast tumor post neo-adjuvant
chemotherapy and

A 35 year old woman presented with mass in right breast, around 4.5 cm, seen both on mammography & ultrasound. It was confirmed to be an Intra-ductal carcinoma grade 2 on histopathology, and put on neo-adjuvant chemotherapy.

After completion of four cycles of chemotherapy, the patient is being worked up for surgery.

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  • On clinical and mammographic evaluation, no mass was visible.
  • ABVS showed minimal residual carcinoma at 10 o’clock & presence of necrosis suggesting response to chemotherapy.
  • The mass was found to be stiff and larger than one seen on grey scale ultrasound, suggesting ductal extension.

obh-17Figure12: ABVS depicting the mass lesion
at 10 o’clock
obh-18Figure13: Elastogram revealing the mass lesion
with ductal extension

Impression: ABVS helped in delineating the tumor mass post chemotherapy, & assessing the response; while adjunct elastography showed the tumor extension into surrounding parenchyma, which was not appreciated on B mode. Thus it suggested that the cancer is aggressive, and the surgery needed to be more extensive, like quadrantectomy with excision
upto nipple, or a skin sparing mastectomy.