Optimal treatment of breast cancer in BRCA gene mutations
Brief History
Mrs. Sarika Navale (name changed) is a 33 year old, lady working as a nurse in a reputed hospital. She is married for 10 years and has two children, the youngest child is 4 years of age. She came to us with a lump in the left armpit over a month.
An excisional biopsy was done and it was diagnosed to be a lymph node with cancer that has spread from breast. Since there were no palpable lesions in the left breast and mammogram did not show any abnormality either, breast MRI was done. MRI of the breast showed a 2 cm lump near the nipple.
The immunohistochemistry done on the biopsy specimen showed it was a triple negative breast cancer (No ER, PR or HER 2neu receptors). A PET scan was done, which ruled out metastases (distant spread of the disease). In view of lymph node positivity, triple negative status, she was started on neoadjuvant (before surgery) chemotherapy and referred for genetic counseling.
Her genetic testing came positive for BRCA 1 mutation. Due to this mutation, she was at high risk for developing breast cancer in the opposite (right) breast and ovaries in future.
After Mrs. Sarika finished her chemotherapy, these risks were discussed in detail with her. She was advised to consider the removal of both breasts and both ovaries to prevent the appearance of new cancers in those organs, in future.
Patient’s Concern
Patient was concerned about her appearance after removal of both the breasts. She was also worried about the impact of removal of both ovaries on her health.
Treatments We Offered
We planned,
- Bilateral Skin-Sparing Mastectomy (removal of the entire breast with nipple while preserving the skin covering the breast) with Axillary Clearance (removal of the nodes in the arm pit where the breast cancer usually spreads) for the affected left breast which had cancer
- A Simple Skin Sparing Mastectomy ( removal of the entire breast along with nipple) for the normal right breast
- Bilateral Saphingo-Oophorectomy (removal of both ovaries and tubes).
- We also planned reconstruction of both her breasts using her own abdominal fat. This is called as a DIEP Flap (deep inferior epigastric perforator flap). The abdominal fat along with overlying skin and blood vessel is used to reconstruct a new breast.
Results
Patient underwent surgery, received breast reconstruction for both sides.
Her post-operative recovery was uneventful and she was discharged after 7 days. Patient took additional chemotherapy. She also received radiation to the left side.
After the completion of the treatment, she is back to work at her hospital. She has the freedom to do all her routine activities which she used to do earlier.
With breast reconstruction, she does not get reminded of the cancer she faced whenever she has to choose what kind of clothes to wear.
Core Message
Diagnosing BRCA mutations in breast cancer patients is important to offer optimal treatment. Breast cancer patients with BRCA gene mutations have a high risk of developing cancer in the opposite breast and ovaries.
Addressing this future risk is also essential while treating the present breast cancer. This is usually done by removal of the normal breast and normal ovaries at the time of surgery for breast cancer.
Removal of both breasts is a devastating experience for a lady. Breast reconstructions offer a chance to live a life with dignity and self-respect, even after mutilating breast surgeries.
Another case study you may want to know : 55 year old lady 3*3 cm lump in her right breast, which increased to 7*7 cm treated successfully.
About Author
Dr. Jay Rashmi Anam
Surgical Oncologists
15+
Year Of Experience
Dr. Jay Anam is one of the best surgical oncologists & breast cancer specialist in Mumbai.
Dr. Jay Anam has Completed his M.Ch. Surgical Oncology training from Tata Memorial Centre. He did his Fellowship in Breast Oncology from Centre Oscar Lambret, Lille, France.
As a breast cancer specialist, he believes in world-class cancer care for all patients.
Let’s Fight Like A Girl!
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Facing breast cancer surgery is a brave step, and we know the recovery process may feel overwhelming at times. One aspect of recovery many patients encounter is managing surgical drains.
While these medical devices play a crucial role in your healing, they can be intimidating at first. But don’t worry. With the right knowledge and tools, you can manage them confidently and focus on feeling better.
This guide is here to walk patients and caregivers through every step of drain care—from the basics to troubleshooting to emotional support. By the end, you'll feel prepared to tackle this part of your recovery with ease.
Author
Dr. Jay Anam
Breast Cancer Surgeon and Oncoplasty specialist in Mumbai
Introduction
Why are surgical drains important after breast cancer surgery? These small, plastic tubes help remove excess fluids that can build up in your body as you heal. Getting rid of this fluid reduces swelling, prevents complications like infections, and helps your body recover faster.
We’ll cover everything you need to know, including how to empty and clean your drains, spot signs of infection, manage discomfort, and return to daily life with confidence.
Understanding Surgical Drains
To start, it’s helpful to understand what surgical drains are and why they’re used.
What Are Surgical Drains and Why Are They Necessary?
After surgery, your body produces fluid as part of its natural healing process. Sometimes, this fluid needs help draining so it won’t pool under the skin. That's where surgical drains come in.
Types of Drains
There are a few kinds of surgical drains commonly used:
- Jackson-Pratt (JP) drain – Often shaped like a small bulb, this popular option collects fluid that you can measure and empty.
- Hemovac drain – A slightly larger round container, often used for higher drainage needs.
Your surgeon will determine the best type for you based on your surgery.
How Long Will They Stay in Place?
The timeline varies. Most patients have their drains for 7 to 14 days, but it depends on how much fluid they produce. Don’t worry; your doctor will remove them once output slows down.
Step-by-Step Drain Care Guide
Drain care is manageable if broken down into steps. Let's cover the essentials.
How to Empty the Drain Properly
- Wash your hands thoroughly with soap before touching the drain.
- Unplug the bulb or container, holding it upright.
- Carefully pour the fluid into a measuring cup.
- Record the amount and time in a log to share with your doctor.
- Squeeze the bulb to reset the suction before plugging it back in.
💡 Tip: Empty the drains 2-3 times a day, or whenever they’re about half full.
Cleaning & Infection Prevention
- Gently clean around the drain site with soap and water or antibacterial wipes. Avoid tugging or rubbing the area.
- Watch for signs of infection, such as:
- Redness or swelling around the site
- Fever above 100.4°F
- Foul odor or colored drainage
If you notice these, call your doctor.
Best Sleeping Positions
Finding a comfortable position can be tricky. Try:
- Sleeping on your back with pillows under your arms for support.
- If you’re a side sleeper, place a small cushion around the drains for padding and avoid putting pressure on them.
💡 Tip: A drain-friendly post-surgery pillow with built-in pockets can make rest easier.
Showering & Hygiene Tips
Ask your surgeon if showers are allowed. If so:
- Cover your drains with a waterproof dressing or use a surgical drain belt.
- Limit water exposure to avoid infections.
If showering isn’t an option, stick to sponge baths until your doctor gives the green light.
Recognizing and Managing Complications
Sometimes, issues arise. Here’s what to keep an eye on:
When to Call Your Doctor
- Drainage suddenly increases or stops altogether
- Severe pain or swelling
- Fever or signs of infection
Dealing with a Clogged Drain
A frequent issue is a clogged drain. If you notice reduced suction:
- Milk the tube by gently squeezing it to dislodge the blockage.
- If this doesn’t help, notify your healthcare provider promptly.
Signs of Seroma (Fluid Buildup)
Once drains are removed, some patients develop a seroma. Symptoms include swelling, tenderness, or a feeling of liquid under the skin. While many seromas go away on their own, consult your doctor for advice.
Pain & Discomfort Management
-
Pain is part of recovery, but you don’t have to suffer unnecessarily.
Medication vs. Non-Drug Relief
- Use prescribed painkillers as directed.
- Non-medical options, like a cold compress or heating pad (with your doctor’s approval), can help with aches and stiffness.
Gentle Exercises
Simple arm stretches or shoulder rolls can prevent tightness, but avoid anything strenuous. A physical therapist can provide guidance.
Relaxation Techniques
Practice deep breathing or try mindfulness exercises to cope with discomfort.
Diet & Nutrition for Faster Healing
Fueling your body helps tissues heal faster. Focus on:
- Protein-rich foods, like lean meats, tofu, beans, and eggs.
- Anti-inflammatory options, like berries, leafy greens, and nuts.
- Drink plenty of water every day.
- Consider supplements, like zinc or vitamin C, but check with your doctor first.
Physical Activity & Movement Guidelines
Movement helps, but balance is key:
- Begin with light stretches or short walks to prevent stiffness.
- Avoid lifting anything heavier than a few pounds in the first week.
- Your doctor will guide you on when you can resume driving or house chores.
💡 Tip: Use a supportive bra to minimize any strain during recovery.
Emotional & Psychological Support
Caring for drains can feel isolating. It’s okay to have mixed emotions.
Coping with Anxiety
Deep breathing, journaling, or talking to a friend can help manage stress.
Find Support Groups
Connect with others who’ve been in your shoes. Online breast cancer recovery forums or local groups can make you feel less alone.
Mental Health Resources
Don’t hesitate to reach out to a counselor or therapist to process emotions during your recovery.
Emotional & Psychological Support
Caring for drains can feel isolating. It’s okay to have mixed emotions.
Coping with Anxiety
Deep breathing, journaling, or talking to a friend can help manage stress.
Find Support Groups
Connect with others who’ve been in your shoes. Online breast cancer recovery forums or local groups can make you feel less alone.
Mental Health Resources
Don’t hesitate to reach out to a counselor or therapist to process emotions during your recovery.