Combined mastectomy and beating heart coronary artery bypass grafting: a single-session surgical approach

The surgical management of breast cancer in patients with coronary artery disease presents significant challenges, requiring a balance between oncological treatment and cardiovascular stability. A woman in her 70s was diagnosed with breast cancer after imaging identified a right breast lesion confirmed as papillary ductal carcinoma in situ on tru-cut biopsy. Following discussion at the multidisciplinary team (MDT) meeting, the consensus recommendation was mastectomy with sentinel lymph node biopsy. During the preoperative anaesthesia evaluation, cardiology consultation was obtained, and coronary angiography revealed severe stenosis of the left anterior descending and right coronary arteries. Given the patient's cardiovascular status, an MDT decision was made to perform simultaneous off-pump coronary artery bypass grafting and mastectomy using a beating-heart technique. This case highlights the challenges of managing complex comorbidities in patients with cancer and demonstrates the role of MDT collaboration in achieving optimal surgical outcomes.