New operated cases per year (benign and malignant)  1020

Dedicated Breast Surgeons  48

Surgeons with more than 50 surgeries per year  30

Breast Surgery beds  120

Breast Nurse specialists  33

Outpatient surgery

Intra-operative evaluation of sentinel node

Reconstruction performed by Breast Surgeons

Clinical Research

Primary technique for staging the axilla

• Axillary lymph node dissection
• Sentinel lymph node biopsy:
  • Blue dye technique
  • Radio-tracer technique
  • Blue dye + Radio-tracer
• Axillary sampling

Reconstructive/Plastic surgeons  16

Immediate Reconstruction available

Type of breast reconstructive surgery available

• Remodelling after breast-conserving surgery
• Reconstruction after mastectomy:
  • Two-stage reconstruction (tissue expander followed by implant)
  • One-stage reconstruction
  • Autogenous tissue flap
    • Latissimus dorsi flap
    • Transverse rectus abdominis (TRAM)
    • Free-flaps (free TRAM, DIEP, SIEA, gluteal, etc.)
• Surgery on the contralateral breast for symmetry

Dedicated Breast Pathologists  8

Available studies

• Cytology
• Haematoxylin & eosin section (H&E)
  • Surgical specimen
  • Sentinel node
  • Core biopsy
• Frozen section (FS)
  • Surgical specimen
  • Sentinel node
• Immunohistochemistry stain (IHC)
  • Estrogen receptors
  • Progesterone receptors
  • HER-2
  • Ki-67

Other special studies available

• Fluorescence in-situ Hybridization for HER-2 gene (FISH)
• Oncotype Dx (21-gene assay)
• MammaPrint (70-gene microarray)
• Prediction Analysis of Microarray 50-gene set (PAM 50)

Parameters included in the final pathology report

• Pathology stage (pT and pN)
• Tumour size (invasive component in mm)
• Histologic type
• Tumor grade
• ER/PR receptor status
• HER-2/neu receptor status
• Peritumoural/Lymphovascular invasion
• Margin status

Dedicated Breast Medical Oncologists  10

Outpatient systemic therapy

Clinical Research

Dedicated Radiation Oncologists

Clinical Research

Available techniques after breast-conserving surgery (including experimental)

• Whole-Breast RT (WBRT)
• Partial breast irradiation (PBI):
  • External beam PBI
  • Interstitial brachytherapy
  • Targeted brachytherapy (MammoSite, SAVI applicator, other devices)
  • Intra-operative RT (IORT)

Regular MDM/TB for case management discussion

• Twice a week
• Weekly
• Every two weeks
• Other Schedule

Cases discussed at MDM/TB

•  Preoperative cases
•  Postoperative cases

Specialties/services participating in MDM/TB

• Radiology
• Breast Surgery
• Reconstructive/Plastic Surgery
• Pathology
• Medical Oncology
• Radiotherapy
• Genetic Counselling
• Breast Nurse Service
• Psycho-oncology
• Physiotherapy, nutritionist

Nuclear Medicine

• Lymphoscintigraphy
• Bone scan
• Positron Emission Tomography (PET)
• PET/CT scan

Rehabilitation

• Prosthesis service
• Physiotherapy
• Lymph-oedema treatment

Genetic Counselling

• Specialist Providing Genetic Counselling/Risk assessment service:
  • Dedicated Clinical Geneticist
  • Medical Oncologist
  • Breast Surgeon
  • General Surgeon
  • Gynaecologist
• Genetic Testing available
• Surveillance program for high-risk women

Data Management

• Database used for clinical information
• Data manager available