New operated cases per year (benign and malignant)  400

Dedicated Breast Surgeons  6

Surgeons with more than 50 surgeries per year  3

Breast Surgery beds  14

Breast Nurse specialists  4

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  2

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  1

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  2

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
• Nuclear Medicine

Nuclear Medicine

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

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