Expanding Surgical Choices in Breast Cancer: A Five-Year Experience from a Private Cancer Centre.
Authors: Zaman Ummay Humayra
Institution: Ahsania Mission Cancer & General Hospital
Introduction
Breast cancer surgery now extends beyond mastectomy to include breast-conserving surgery (BCS), oncoplastic reshaping and post-mastectomy reconstruction. In settings where resources, affordability and access to specialist services can constrain treatment choices, patients may not always be aware of the full range of appropriate surgical options. Individualized planning is therefore central to offering care that reflects disease characteristics and patient preferences. The objective of the study was to To describe the range of surgical approaches used in a five-year, single-surgeon series at a private-sector cancer centre in Bangladesh, with particular attention to breast conservation and immediate autologous reconstruction.
Methods
This retrospective descriptive review included 200 patients who underwent surgery for breast cancer at Ahsania Mission Cancer & General Hospital, Dhaka, between July 2020 and June 2025. Procedures were grouped as BCS or mastectomy. Mastectomy cases were further classified by whether immediate reconstruction was performed and by autologous flap type. The BCS cohort also included a range of volume-displacement oncoplastic techniques, for which technique-specific data are available for separate analysis. No implant-based or delayed reconstruction was performed in this series.
Results
Among 200 patients, 68 (34.0%) underwent BCS by several oncoplastic procedures and 132 (66.0%) underwent mastectomy. Of the 132 mastectomy patients, 27 (20.5%) received immediate reconstruction and 105 (79.5%) had no reconstruction. All 27 reconstructions used autologous tissue: 14 TRAM flaps (51.9%), 9 latissimus dorsi flaps (33.3%) and 4 DIEP free flaps (14.8%).
Conclusion
This single-centre experience illustrates a range of surgical options in routine breast cancer practice, including breast conservation and immediate autologous reconstruction. Mastectomy is not the only possible pathway for every patient; careful assessment, informed discussion and multidisciplinary decision-making can help align surgery with each patient's clinical needs and preferences. Wider access to breast-preserving and reconstructive approaches may require continued investment in patient counselling, oncoplastic training, diagnostic and pathology services, coordinated oncology care and affordable treatment pathways. These descriptive data do not establish comparative effectiveness or allow direct comparison between public- and private-sector services. Implant-based and delayed reconstruction remain areas for future service development.