Breast Flashcards
Surveillance Plan SSM
Yearly H&P
-Breast, Chest wall, LN
(no imaging)
-Routine contralateral breast
Complications of NSM
Early:
Nipple/ Skin flap necrosis loss/ exposure/loss of reconstruction
Late:
Asymmetry/ nipple malposition/CC
CI to SSM
NAC involved in CA/ discharge
Locally advanced with skin
Inflammatory
SM/DM/Ob/ Lg ptotic
Aug/Mastopexy Algorithm
Crescent
Circumareolar/Benelli – augmentation primary indication with mild ptosis (Grade I/II)
- ALL of: NAC ≤2cm below IMF + NAC not at most dependent portion breast + ≤3-4cm breast ptosis
Circumvertical – Grade II/III ptosis
- Nipple >2cm below IMF + horizontal skin excess + minimal vertical skin excess
Wise – Grade II/III ptosis
- Nipple >2cm below IMF + horizontal skin excess + vertical skin excess
What is maximum timing of radiation after mastectomy and chemo.
Without chemo?
6mo
1-2mo
When to do delayed
Avoid delay to rads
Compromise delivery
Avoid radiation induced morbidity to otherwise successful flap.
(if immediate recon needed do autologous)
Risk of failure in implant based recon in radiation site.
failure 15-40%
What is the risk of contracture in rads
Infection
10 yr - 17 to 20% vs 8%
Most severe in first 2 years up to 5-7 years.
Infection 25%
Extrusion 15%
Indications for free nipple
Gigantomastia >2500
NAC repositioning >15cm
Very long pedicle >20cm
Co-morbidities.
Why evaluate hematoma?
Pressure on pedicle
Inflamm mediator vasoconstriction
Blood byproduct toxins
Ptosis
Increased SNN
More acute parenchyma to chest wall angle
NAC inferior, gland over IMF
Differential dx of virginal hypertrophy
Fibroadenoma
Cystoscarcoma phyllodes
Hamartoma
Posttraumatic
Tuberous Breast Classification
Tx Principles?
I - Minor - sufficient skin envelope, mild pctisis and enlargement of aerola.
II- Mod - insufficient skin in lower pole, mild ptosis and moderate herniation of aerola.
III - Severe- global skin def, mod ptosis, severe NAC herniation.
Principles: Circim aerola redun, radial scoring, lower IMF, aug/TE
