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Max Super Speciality Hospital, Saket
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  • Robotic Urological Surgery: 15 years journey 
    Dr. Rahul Yadav, Dr. Anant Kumar
  • Robotic surgery is the latest in advanced onco surgical procedures 
    Dr. Harit Chaturvedi
  • Percutaneous balloon aortic valvuloplasty & balloon dilatation of aortic coarctation in a 10 year old child 
    Dr. Neeraj Awasthy, Dr. Sushil Shukla
  • Role of CT/MR imaging and echocardiography in evaluation of valsalva sinus aneurysm 
    Dr. Reena Anand, Dr. Raj Kumar, Dr. Divya Malhotra, Dr. Bharat Aggarwal
  • Risk factors for patients undergoing treatment for Breast Cancer
    Ms. Kanika Arora, Ms. Ritika Samaddar
  • Radiology Case of The Month 
    Dr. Nafisa Shakir Batta, Dr. Dhruv Jain
Date: 
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Bio Medical Waste Report For Shalimar Bagh

Month Red Autoclave(Infected Plastic Waste) Yellow- Incineration(AnatomicalWaste & Soiled Waste) Blue Autoclave (Glass- Bottles) Black Cytotoxic- Incineration( Cytotoxic Contaminated Items) White- Sharp Total Bags Total Weight(In KG's)
  No. of Bags Weight (in KG's) No. of Bags Weight (in KG's) No. of Bags Weight (in KG's) No. of Bags Weight (in KG's) No. of Bags Weight (in KG's)    
Apr-17 924 2963.50 954 2994.10 239 1017.30 103 279.20 1645 606.40 3865 7861.00
May-17 1175 4624.12 1028 3498.40 276 1524.34 87 195.01 1803 823.85 4369 10665.71
Jun-17 1060 4511.45 902 2886.66 293 1324.05 76 194.00 2057 1100.69 4388 10016.85
Jul-17                     0 0.00
Aug-17                     0 0.00
Sep-17                     0 0.00
Oct-17                     0 0.00
Nov-17                     0 0.00
Dec-17                     0 0.00
Jan-18                     0 0.00
Feb-18                     0 0.00
Mar-18                     0 0.00
YTD 3159 12099.065 2884 9379.155 808 3865.69 266 668.705 5505 2530.94 12622 28543.555

Breast Cancer

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Breast cancer treatment

January 4, 2021 0 3 minutes, 23 seconds read

With roughly 1 in8women developing breast cancer in their lifetime, the odds are high that nearly every woman is affected by this disease in some way. Whether it’s a personal diagnosis or that of a loved one, finding answers to all the questions and a supportive community of people who understand the experience can make all the difference.

Owing to the advancements in medical treatment for Cancer, 30% of women diagnosed with breast cancer do not need chemotherapy and in coming times this number is going to increase.  

Breast cancer is a curable disease if diagnosed and treated in time. Treatment of breast cancer does not depend only on stage, it also depends on the type of breast cancer. One treatment plan does not fit all. Imaging is very important. Ittells us about the type and extent of breast pathology. Imaging in Breast Cancer includes bilateral mammography and PET CT. 

Clinical examination is significant as well which tells us about the size, involvement of skin, and axillary lymph nodes. After imaging, another important thing to do is a biopsy and there are different ways of doing it. One of the most advanced procedures is Tru-Cut Biopsy which is ultrasound-guided biopsy. It is usually a painless procedure and is done under local anesthesia.

Once the diagnosis of cancer is confirmed, we need to look at Immunohistochemistry markers which include ER, PR, HER2/neu, and Ki 67 index. These markers are important and they tell us the whole story about the aggressiveness of breast cancer. These markers also tell us what therapeutic options can be used depending on the patient. Once the diagnosis and staging are confirmed, treatment should be started immediately without any delay. For locally advanced breast cancer that has spread to lymph nodes, chemotherapy in combination with targeted therapy should be given first and then proceed for surgery.

In the early stage, surgery is the preferred option for most of the patients, but in some patients who are triple-negative or HER2/neu positive, chemotherapy can be given upfront to look for a response. Early-stage hormone receptor-positive breast cancers usually do not require chemotherapy.

After completion of chemotherapy and surgery, radiation therapy to the breast and axillary lymph nodes is advisable depending on the stage of the breast cancer. The tumour which is less than 5 cms does not require radiation.

Once radiation is completed, a patient needs hormonal therapy in the form of a tablet for 5 years, if the hormonal receptor is positive and if it is negative then hormonal therapy will not work for them. Some patients are Her2/Neu positive and require targeted therapy for 1 year. Once the treatment is completed,the patient can live a normal life.

Surgical techniques have also undergone a massive change and in most of the cases, patients’ breast can be preserved. In case there comes a need to remove it, there are umpteen options of getting it reconstructed.

The patient is required to go for a regular mammography (yearly) and clinical examination (every 3 months) as a follow-up.

Bone health remains an issue with hormonal therapy, for which the patient might need bone directed therapy to strengthen their bones. Hence, a multidisciplinary approach to deal with the disease is important.

For a cancer patient, it is very difficult to be strong. However, patient support groups help them regain the confidence, help them empower themselves and start feeling like they have already been cured.

One of my patients, Sarita, was diagnosed with Breast Cancer at the age of 27. As a part of recovery, she gained her strength by getting in touch with women dealing with the same disease, 3 years into remission, she now inspires many young women through wellness, positivity, style, and self-love. Breast cancer support groups help patients to cope up with the disease and get the right treatment.  Long term social, psychological issues are addressed in these support groups.

My advice to all women:

As you turn 45, get in touch with your doctor to discuss and understand the right time to get screened and way forward.

Stay safe and healthy.

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Breast Cancer is the most common affecting Women

December 3, 2020 0 1 minute, 35 seconds read

Breast cancer is the most common cancer affecting women in India and is estimated to affect 1 in 28 women in our country in their lifetime. Although the burden of the disease is huge, the silver lining is that breast cancer has very high cure rates, of more than 90% if detected early. October is celebrated worldwide as Breast Cancer Awareness Month and we, at Max Institute of Cancer Care, Max Super Speciality Hospital, and Saket have pledged to spread the message about the same in our community.

It is important to remember that early detection of breast cancer is simple and quite doable if we spread the message of basic breast health awareness, monthly self-examination and screening mammograms above the age of 40 for our women. Most commonly, breast cancer presents as a painless lump or any change in the look or feel of the nipple or the breast. It is also important to remember that breast cancer can affect women of any age be it 20 years or 90 years and even those, who have no family history of cancer.

Breast cancer treatment has evolved dramatically over the last few decades. It entails a coordinated multidisciplinary team effort of not only breast and oncoplastic surgeons but medical and radiation oncologists, oncofertility experts, radiologists, pathologists, molecular oncologists, psychologists, nursing staff, physiotherapists etc. The decision about the kind of treatment, the sequence of treatment, whether we can avoid chemotherapy for a particular patient, whether to use certain targeted therapy etc. are all tricky ones and need a balanced team of experienced oncologists. Today, most of our patients can undergo treatment with mild morbidity because of availability of better surgical techniques such as sentinel lymph node biopsy, better drugs and radiation techniques.

Another extremely vital message for our society is that the risk of breast cancer can be lowered by adopting a healthy lifestyle, balanced diet, regular exercise, keeping weight in check and avoiding alcohol.

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Dr. Bhuvan Chugh

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Biography

Biographical Sketch: 

Dr Bhuvan Chugh is a Medical Oncologist with rich experience in treatment of solid organ cancers such breast, lung, gastro intestinal, gynae and genitourinary cancers and haematological malignancies such as lymphomas and myelomas. After completing DNB super-speciality in Medical Oncology at Medanta, he joined there as a faculty member and was part of the same for last 3 years.

At present, he is leading the charge of Max Institute of Cancer Care at Max Gurgaon. Have been an active part of the faculty both in terms of clinical and research work. Have co-authored many chapters, papers & abstracts in various national and international journals and conferences.

PROFESSIONAL JOURNEY

Work Experience: 
  • Currently working as Consultant, Medical Oncology at Max Healthcare
  • Worked as Associate Consultant, Department of Medical Oncology & Hematology, Medanta, Gurgaon
  • Worked as Attending Consultant, Department of Medical Oncology & Hematology, Medanta, Gurgaon
Education & Training: 
  • DNB Medical Oncology-2018, Medanta, the Medicity, Gurgaon, Haryana (NBE)
  • DNB General Medicine-2012, (Army Base Hospital, Delhi Cantt, Delhi (NBE)
  • MBBS-2007, Rajiv Gandhi University of Health Sciences, Karnataka
Speciality Interest: 
  • Breast Cancer
  • Thoracic and Esophageal Cancer
  • Gastrointestinal Cancer
  • Gynae Cancer
  • Genitourinary Cancer
Duration Of OPD: 

       Max Super Specialty Hospital, -Gurgaon

  • Monday: 9:30 to 1 PM
  • Tuesday to Thursday: 9:30 to 5 PM
  • Friday: 9:30 to 1 PM
  • Saturday: 9:30 to 4 PM
  • Video Consultation: Tuesday, Wednesday and Friday 3to 5 PM & Saturday 11-12 Noon.

       Max Super Speciality Hospital, -Saket

  • Monday & Friday  - 3 PM to 5 PM
Research & Publication: 
  • Chugh, B. and Vaid, A K. 2020. ‘Key Takeaways from International Guidelines on Gastric Cancer’. Gastric Cancer. Springer Healthcare Education
  • Clinico-hematologic and cytogenetic profile in a rare case of pure erythroid leukaemia; Annals of Haematology 98(3); March 2019.
  • Myelodysplastic syndromes: Where do we stand? Asian Journal of Oncology. April 2016.
  • Outcomes of patients presenting with acute coronary syndrome with vitamin D deficiency. Indian Heart Journal. November 2014.

       PRESENTATIONS

  • Abstract Publication in BTG2018, 9th International Hematologic Malignancies Conference held in Seoul, South Korea from March 29-31, 2018.
  • A Prospective Study of Clinico-pathological features, Prognostic factors, and Response rates in Advanced Non-small Cell Lung Cancer Patients Eligible for Chemotherapy - A Single Centre Experience at 37th ICON New Delhi. 2017
  • A Prospective Observational Study of Clinico-Pathological Features, Prognostic Factors and Treatment Response to Primary Therapy in Multiple Myeloma at a Tertiary Care Centre; Blood 134(Supplement_1):5559-5559; November 2019
  • Speaking engagements in various national level conferences

Do you believe these 10 myths about breast cancer? Debunk them NOW

October 16, 2020 0 2 minutes, 44 seconds read

1. Breast cancer can develop only in the elderly

Although the probability of a breast lump turning out to be cancerous is higher in an elderly woman, it is not zero at any age. Breast cancer is known to occur at all ages and even a young girl should visit a specialist and get herself evaluated if she notices a sudden change in the look or feel of her breast.

2. Breast cancer cannot develop during pregnancy and breastfeeding

Most women tend to ignore subtle breast symptoms during pregnancy or while they are breastfeeding, assuming they are ‘normal’ changes. This often proves to be hazardous and can cause a delay in diagnosis. Although breast feeding and early pregnancy reduces a woman’s lifetime risk, cancer can develop in these phases too.

3. Wearing tight, underwired or black bras can cause breast cancer

This is probably one of the most common fake trivia about breast cancer which is often passed on from one lady to another. Your choice of undergarments is very important for your comfort, but it has nothing to do with your risk of developing breast cancer.

4. Deodorants cause breast cancer

Although it has been proposed that the use of underarm deodorants containing aluminium and parabens may be carcinogenic, there is no definite scientific evidence linking the use of deodorants and antiperspirants with increased risk of developing breast cancer.

5. Physical trauma can cause breast cancer

Often patients attribute their breast lump to a physical injury. More often than not, the injury just brings an underlying breast lump to your notice rather than cause the breast lump. Physical trauma can form a hematoma but never breast cancer.

6. Dairy and sugar intake cause breast cancer

Certain studies have shown that milk may be associated with an increased risk of breast cancer because of the hormone content. However, cutting down sugar or dairy intake to zero is not recommended. It is important to understand that moderation is the key. Any imbalanced diet which may lead to weight gain can cause an increased risk of breast cancer mainly if you are postmenopausal.

7. Pain in the breast is a symptom of breast cancer

Ladies often tend to ignore a lump in the breast or nipple discharge if it is not accompanied with pain. It is probably human nature to ignore something which doesn’t give us discomfort, but is very important to know that cancerous lumps are mostly painless.

 8. If you don’t have family history of breast cancer, you are safe from breast cancer

This is absolutely untrue. Only 5-10% of breast cancers are hereditary or familial, most newly diagnosed patients do not report any family history of breast, ovarian or any other cancer.

9. Mammograms prevent breast cancer

A mammogram is basically an X-ray of the breast tissue. It is useful to detect breast cancer at an early stage and if often recommended for women above the age of 40. However, it does not prevent cancer and in fact, may miss certain cancers in younger women.

10. Men can’t get breast cancer

Last but not the least; men can get breast cancer too. Although the incidence of breast cancer in men is much lower, breast cancer is known to occur in men too and can present with a lump or ulcer on their chest.

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Breast Cancer - It is the Beginning of a Journey rather than the End of the Road

October 12, 2020 0 5 minutes, 26 seconds read

Stage IV Breast Cancer - It’s the Beginning of a Journey rather than the End of the Road

Breast Cancer is the most common cancers in women in India. The numbers are increasing every year. While a part of that can be attributed to increasing life expectancy, a significant blame can be laid upon worsening lifestyle in our population.

When diagnosed in Stages I, II or III, most women with breast cancers can be cured with a combination of treatments that include surgery, radiation, and systemic therapy (chemotherapy, hormonal and in certain cases targeted therapy).

However, the biggest challenge is when a patient is diagnosed with stage IV breast cancer. Stage IV, in simpler terms means that the cancer has already spread from the breast to other organs including liver, lungs, bones, brain etc. There is a limited role for local treatment in this situation. The major back bone of treatment is systemic therapy. Which is chosen as per the breast cancer subtype or disease biology

What to expect when a patient is diagnosed with a Stage IV breast cancer?

The general perception among common people is that stage IV breast cancer is a death sentence with expected life span about a year. There are enough reasons for that to change. There have been tremendous advances in the understanding of the disease leading to emergence of new, more effective treatment options. The average life expectance of these patients is now anywhere between 3 to 4 years. Infact there is a significant percentage of patients who live much longer and succumb to other diseases than cancer.

Are all Stage IV Breast Cancers the same?

All patients diagnosed with breast cancer are subjected to not only a biopsy but also further testing to look at expression of markers like Estrogen Receptor (ER), Progesterone Receptor (PR) and Her 2 receptor. In certain cases, other specialised tests including Next Generation Sequencing (NGS) are also undertaken. This then helps divide breast cancer patients into further subtypes like Hormone Receptor Positive breast Cancers, Her 2 positive Breast cancers and Triple Negative Breast cancers. This means that different treatment options can be offered to patients with Stage IV breast cancer.

How do we treat Hormone Receptor Positive breast Cancers?

These are traditionally the least aggressive subtype of breast cancers.  The thumb rule of treatment is ‘avoid chemotherapy unless absolutely needed”. 

The back bone of treatment is hormonal therapy. Most of the drugs are in the form of oral medications. In the past half a decade or so, at least 5 new medications have emerged showing greater effectiveness in controlling these cancers, with many more in the pipeline. These drugs are not only more effective than the older medications, in many instances they are safer and work for a longer period of time. Typically patients receive a combination of two hormonal drugs in most setting. Chemotherapy is reserved for those patients where there are no further options of hormonal therapy or a very fast response is needed. The average life span is upto 3 to 5 years with the treatment.

How do we treat Her 2 positive Breast Cancers?

The expression of Her 2 Receptors makes these cancers more aggressive. Two decades ago, these patients would generally be treated with chemotherapy alone and results were dismal. It’s the emergence of anti-Her 2 targeted therapy that has brought about a paradigm change in the treatment of these patients. 

What started with one drug called Trastuzumab which showed improvement in survival when combined with traditional chemotherapy, has now expanded into a large portfolio of anti Her 2 drugs that include Trastuzumab, Pertuzumab, Trastuzumab Emtansine, Lapatinib, Neratinib, Tucatinib, Trastuzumab Deruxtecan and others. These drugs, used either alone or in combination with chemotherapy (or now in some cases with oral hormonal therapies) are highly effective and safe. Similar to the Hormone Receptor positive breast cancers , these patient have an average life span of 3 to 4 years.

How do we treat Triple Negative Breast Cancers?

These are the most aggressive subtype of breast cancers being most difficult to control. Traditionally, the only treatment options for these patients have been chemotherapy.

However, that seems to be changing. There is recent data to suggest, that a new class of treatment, called Immunotherapy, has shown promising results for these cancers. These drugs reactivate our body's immune system, own immune cells then kill the cancer cells. Initial studies suggest better outcomes and improvement in survival for selected patients with Triple Negative Breast Cancers.

Another drug that seems to be making waves is the antibody drug conjugate called - Sacituzumab-Govitecan. This drug has shown impressive results in heavily pretreated Triple Negative Breast Cancers and is now being tested in the frontline settings.

There is an impressive array of clinical trials that is evaluating the effectiveness of newer chemotherapy and targeted therapy for these patients.

So what happens when one is diagnosed with stage IV breast Cancer?

The first step is usually a biopsy, with sub typing as discussed earlier, followed in most cases with Whole Body PET CT. On confirmation of diagnosis, subtype and stage, the treating oncologist will typically evaluate the disease pattern, patients’ general condition and fitness and appropriate treatment options are then considered. The case is discussed in a Multi-Disciplinary Tumour Board for optimising treatment choices. Once treatment is started, the first few weeks are spent optimising medications to ensure minimisation of side effects. Most patients undergo a PET CT for disease re evaluation typically 2 to 3 months after initiation of treatment.

Stage IV Breast Cancers are now typically treated like Diabetes or other chronic illnesses. Most patients can expect to be on some medication most of the times. Typically medications are changed when they stop working or give intolerable side effects. Patients can expect to sometimes have a repeat biopsy.

The goals of treatment for Stage IV Breast Cancers are not only longer survival but a good quality of life. That is being achieved not only through more effective medications, but also safer drugs and improvement in supportive care. Most patients will also be under the care of Palliative Care Physician along with a team that comprises of Clinical Psychologist, Dietician, Physiotherapist, Oncology nurse practioner etc.

Conclusions

There have been significant clinically meaningful treatment advances in Stage IV Breast Cancers. The story of these patients now revolves around long survivals, safe and more effective treatments and multi modal team based care. This ensures that the modern patient can go back to her normal life very soon after the diagnosis and treatment initiation. It is indeed, the beginning of a new journey for these patients.

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Dr. Siddharth Kumar Sahai

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Biography

Biographical Sketch: 

Dr. Siddharth Kr. Sahai is a Senior Medical oncologist, trained from all India Institute of medical Sciences (AIIMS), Delhi. He has an experience of 16 + years in managing patients. He has worked and holds teaching experience from most prestigious medical institutions of India like MAMC (Delhi), AIIMS (Delhi) and LHMC (Delhi). Dr. Siddharth Kr. Sahai has rich experience of diagnosing and managing cancer patients. He has in depth knowledge Hormone therapy and Autologus Stem cell Transplant .

PROFESSIONAL JOURNEY

Work Experience: 
  • 16+ years of experience in clinical management of cancer patients
  • 2018 to 2020 – Consultant Medical Oncology , Manipal Hospital , Delhi
  • 2016 to 2018—Senior Consultant , Medical Oncology , Paras Hospital , Gurgaon 
  • 2013 to 2016 – Consultant Medical Oncology FMRI , Gurgaon
Education & Training: 
  • MBBS[MMAMC]
  • MD[MEDICINE]
  • DM[AIIMS]
  • ESMO Certified
Speciality Interest: 
  • Breast Oncology
  • Gynaecological Maligancies (cancer of ovaries, fallopian tubes, uterus, cervix, vagina etc)
  • Head & Neck cancers
  • Targeted Therapy & Immunotherapy
  • Uro-Oncology (Prostate Cancer, Urinary Bladder Cancer, Kidney Cancer etc)
  • Targeted treatment and immunotherapy in lung cancer and sarcoma 
Duration Of OPD: 
  • MAX SUPER SPECIALITY HOSPITAL SHALIMAR BAGH
  • MON TO SATURDAY
  • 9 AM- 5 PM

BREAST CANCER RADIATION THERAPY- JOURNEY FROM 5 WEEKS TO 5 DAYS TREATMENT

October 21, 2019 0 1 minute, 1 second read

Radiation Therapy (RT) for breast cancer has seen a long journey precision and focused therapy. RT is an important part of breast cancer management which improves both local control of cancer as well as patient’s survival.

In earlier times it was a treatment delivered over the span of 5-7 weeks with unavoidable high doses of radiation going to underlying heart and lung.

Now in the era of precision/ focused radiation therapy technique like IGRT and IMRT, in majority patient’s radiation is delivered over 3-4 weeks with much more safety for heart and lung.

In recent years precision of radiation therapy has further improved with several techniques to protect heart and lung with the most important being DIBH (Deep Inspiratory Breath Hold).

In DIBH radiation is delivered in 4D fashion with respiratory gating to keep heart away while delivering radiation therapy.

Further improvement is that in selected patients whole radiation therapy treatment can be delivered over just 4-5 days (rather than weeks) using a technique called APBI (Accelerated Partial Breast Irradiation).

Overall breast cancer radiation therapy has become a much shorter treatment with better safety and precision.

We routinely practice all these advance techniques at department of radiation oncology, Max hospital, Shalimar Bagh.

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Dr. Aditi Chaturvedi

Dr. Aditi Chaturvedi
Associate Consultant Oncology, Max Hospitals
Dr. Aditi Chaturvedi
Memberships: 
  • Indian Society of Oncology (ISO)
  • Indian Association of Surgical Oncology (IASO)
  • European Society of Surgical Oncology (ESSO)
  • Association of Breast Surgeons of India (ABSI)
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PROFESSIONAL JOURNEY

Work Experience: 
  • Specialist Surgical Resident Tata Memorial Hospital, Mumbai
  • Specialist Surgical Resident ACTREC, Navi Mumbai
  • Specialist Surgical Resident Homi Bhabha Cancer Hospital, Varanasi
Education & Training: 
  • MBBS Seth GS Medical College & KEM Hospital, Mumbai
  • MS General Surgery AIIMS, New Delhi
  • MCh Surgical Oncology Tata Memorial Hospital, Mumbai
Awards Information: 
  • Gold Medal in General Surgery AIIMS, New Delhi
  • Vice Chancellor’s Certificate of Merit MUHS, Nashik
Speciality Interest: 
  • Breast and Oncoplastic Surgery
  • Women’s health awareness
  • Cancer survivorship
Duration Of OPD: 

       Max Hospital, Gurgaon

  • Wed  9:00 AM - 11:00 AM
  • Sat: 12:00PM – 01:00PM

       Max Super Speciality Hospital, Saket

  • Mon, Wed & Fri: 02:00PM - 04:00PM
  • Tue, Thu & Sat:  09:00AM - 11:00AM

       Max Institute of Cancer Care-Lajpat Nagar

  • Monday - 9:00 am - 11:00 am

Dr. Neerja Gupta

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PROFESSIONAL JOURNEY

Work Experience: 
  • 5 years of breast surgical oncology( 10 years of surgical oncology)
  • Attending Consultant (Surgical Oncology)- Max Hospital, Saket (Feb 2010-Oct 2014)
  • Specialist (General Surgery) – Jaipur Hospital, Punjab (August 2009-Feb2010)
  • Registrar (General Surgery) – BJRM, Delhi (Oct 2006-August 2009 )
Education & Training: 
  • M.S (General Surgery) -Baroda Medical College
  • P.G. certification (breast oncoplasty) - University of East Anglia, U.K
Awards Information: 
  • Max Sewabhav Award-2017
  • Max Gem Award-2015
Speciality Interest: 
  • Breast Surgical oncology
Duration Of OPD: 

  Max Super Speciality Hospital, Patparganj

  • TUES,THURS,SAT: 11:00 AM - 01:00 PM
  • MON,WED,FRI: 01:00 PM-  02:00 PM 

  Max Multi Speciality Centre, Noida

  • Wednesday 11 am to 1 pm
  • Saturday - 10 am to 11 am
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