Breast Flashcards
The lower pole of the breast can
be constricted in patients with macromastia or mild tuberous breast deformity true or false?.
The lower pole of the breast can
be constricted in patients with micromastia or mild tuberous breast
deformity.
Symmastia occurs more in subglandular or submuscular ?
Symmastia occurs more in subglandular
Different types of selecon rupture can detect with US?
Silicone ruptures with cohesive gel implants can be detected on a mammogram
but more often require MRI to confirm a suspected rupture
Textured devices have lower rates
of capsular contracture, in SUBMASCULAR?
Textured devices have lower rates
of capsular contracture when a textured implant is placed in a subglandular or subfascial
plane
What the percentage of capsular contracture?
Capsular contracture rates from long-term studies
demonstrate variability based on implant manufacturer
what the suitable size of areola to do transareolar approach ?
Good access if diameter of areola is >3.5 cm
what nerve that can injured with transaxlary approach ?
Avoid deep dissection in axilla; intercostobrachial and medial brachial cutaneous nerves are vulnerable
percentage of contracture with breast augmentation ?
Subglandular: 32% contracture rate
Subpectoral: 12% contracture rate
I s there is any change in the sensatin of the nipple after breast implant ?
15% of patients
what the waterfall deformity in breast augmentation? Double-bubble deformity type A
Implant is held high on chest wall by total pectoral coverage or contracture, and loose parenchyma slides off pectoral muscles inferior to axis of the implant
The dual-plane approach helps to prevent this deformity
The biopurden of BIA-ALCL more with smooth or textured Implants?
Textured
Nipple sensation is equally likely to be preserved with submuscular or subglandular implant placement.?????
Nipple sensation is usually preserved following breast augmentation but it is more likely to be preserved
with submuscular placement because the fourth intercostal nerve runs within the pectoralis fascia
Peri areolar mastopexies can be used to elevate the nipple
no more than 2 cm with an eccentrically designed oval.
can we make breast augmentation with SPAIR MASTOPEXY ?
NO but we can use it in hall-findllay technique
mastopexy technique can that reliably leads to
signifi cantly increased upper poll fullness in the long term?
This is because there is no mastopexy technique that reliably leads to significantly increased upper pole fullness in the long term
what is the drawback of Periareolar mastopexies?
Removing skin in a concentric pattern can, however, flatten and reduce breast projection.
Scar widening and eventual widening of the areola can occur If there is circumferential full thickness violation of the
dermis, decreased nipple sensitivity may occur.
vertical mastopexy can used for all grade of breast ptosis?
T
what the primary blood supply to the breast?
The primary blood supply originates from the internal mammary system and its arteries perforate the breast from deep to superficial.
what is the is the lymphatic drainage of the breast ?
cutaneous, internal mammary, posterior intercostal, and axillary routes
After SUCTION-ASSISTED LIPECTOMY the patients alaways need mastopexy?
F may include
mastopexy after successful SAL
keloid scarring is a common complication in breast surgery
keloid scarring is a rare complication in breast surgery
Nipple sensation precerved with submascula approuch better T or F
Nipple sensation is usually preserved following breast augmentation but it is more likely to be preserved with submuscular placement because the fourth intercostal nerve runs within the pectoralis fascia
How many the incidence of revision after augmentation-mastipexy?
Augmentation-mastopexy techniques are associated with high revision rates of up to one in five, although this may be reduced to less than 1 in 10 by staging the procedure
What the indication of tow stage AUGMENTATION-MASTOPEXY
Breast asymetry
Vertical access mor than 6 cm
SN to NAC more than 30
Neurofibromatosis 1 associated with syndromic breast cancer
T
Local recurrence rates after SSM are more than to other forms of mastectomy.
Local recurrence rates after SSM are similar to other forms of mastectomy.
Smoking was found to be an independent risk factor for implant loss in prosthetic reconstruction.5
F large mastectomy specimen weight was found to be an independent risk factor for implant loss in prosthetic reconstruction.5
How much the obese patients develop risk of breast implant reconstruction vs no obese ?
patients with BMI >30 were almost seven times more likely to experience reconstructive failure following prosthetic reconstruction than their nonobese counterparts
Macromastia contraindication for breast prosthetic reconstructions
macromastia is not a contraindication to implant-based reconstruction
The most important parameter in choosing the expander type is the shape of expander?
Among these, base width is the most important parameter for intraoperative device selection
matching the device base mdth to the mdth of the breast footprint on the chest wall eliminates dead space and skin redundancy while optimizing the final expansion pocket
All currently available anatomic-shaped implants are also textured T or F
T All currently available anatomic-shaped implants are also textured to limit unwanted implant movement/ rotation;
capsular contracture and reconstructive failure appear to be two to three times more likely in previously irradiated patients. T or F
T
The ADM can be used before prosthetics reconstraction for irradated tissue to decrease the complication rate?
the use of ADM in previously irradiated patients is not protective against reconstructive failure and may increase the rate of skin flap and infectious complications
Undergoing chemotherapy treatment increase the incidence complication rates in patients undergoing prosthetic reconstruction
there is no clear evidence that either neoadjuvant or adjuvant chemotherapy increases complication rates in patients undergoing prosthetic reconstruction
Preoperative imaging may elucidate vessel anatomy, but is not always critical. in breast autologus reconstraction
T
The need of radiation after mastectomy is absolute contraindication for early reconstruction of the breast?
The need for PMRT, though not an absolute contraindication to immediate reconstruction, tends to be the predominant reason to consider delayed reconstruction
Active smoking would be a absolute contraindication for performing any autologous flap procedure with increased risk for wound dehiscence and delayed wound healing
F. Active smoking would be a relative contraindications
Perfusion of flaps based on the SIEA/SIEV is reliable across the midline.
Perfusion of flaps based on the SIEA/SIEV is not reliable across the midline.
Preoperative imaging may elucidate vessel anatomy, but it is always critical for brest flap reconstruction
Preoperative imaging may elucidate vessel anatomy, but is not always critical
Clinical exam remains the standard for postoperative flap monitoring. T or F
T
history of h ypercoagulable conditions would be a contraindication to performing a free tissue and pedicled flap options ,
history of h ypercoagulable conditions would be a contraindication to performing a free tissue transfer with an increased risk for vessel thrombosis; pedicled flap options would be possible in this context
Studies have shown that CTA may reduce operative time in abdomenal based breast reconstruction T or F
T
the deep inferior epigastric artery system is the more dominant blood supply to the abdominal skin and fat,and muscle
F. the deep inferior epigastric artery system is the more dominant blood supply to the abdominal skin and fat,
Free abdominal based flap for breast has short pedicle with similar caliper for IMA
a long pedicle with similar caliber to recipient vessels
Perfusion of flaps based on the SIEA/SIEV is reliable across the midline.
Perfusion of flaps based on the SIEA/SIEV is not reliable across the midline.
primary closure without mesh is often possible with DIEP flap and free TRAM flap harvests
F. primary closure without mesh is often possible with DIEP flap and free ms-TRAM flap harvests
Free TRAM harvests tend to include wide sections of anterior rectus fascia and always require mesh placement, particularly in cases with bilateral flaps.
F. Free TRAM harvests tend to include wide sections of anterior rectus fascia and may require mesh placement, particularly in cases with bilateral flaps.
Vertical upper gracilis (VUG) has more reliable skin peddle
transverse upper gracilis (TUG) has more reliable skin peddle
The pedicles of upper thigh flap is identified in the interval between the gracilis and adductor magnus muscles
The pedicles of upper thigh flap is identified in the interval between the gracilis and adductor magnus muscles
The pedicles of posterior thigh flap located 10 cm below to the gluteal crease
Perforators from the pedicle are located roughly 5 to 6 cm below the5gluteal crease
The flap is designed as a horizontal ellipse with superior incision at the gluteal crease
The flap is designed as a horizontal ellipse with superior incision at or immediately below the gluteal crease
A contralateral composite nipple graft can be considered for patient who has a nibble projection of 10 to 15 mm
This technique is most effective in patients with a large contralateral nipple where projection exceeds 5 to 6 mm
composite nipple grafting can provide sensation and erectile function in the reconstructed nipple in some cases
T
The breast is not functional after birth to puberty. Is it true or false?
At birth, the neonatal mammary tissue is functional. Seventy percent may secrete colostrum because of rise in prolactin. The nipples evert soon after birth because of proliferation of the underlying mesoderm.
The lactiferous tissue tissue will be completed at eight week. Is it true or false?
True
There is no genetic relationship in bilateral absence of the breast
Genetically inherited bilateral absence of the breast has been described
Mandrekas expanded on this with a ring theory regarding tuberous breast, result from thickening of deep facia of the deep fascia
Fals superficial fascial not deep
How many patients with tuberous breast require breast expansion
8% of total or 30% of Groleau type III tuberous breast required expansion.
Poland syndrome most common in female commonly left side ?
Male 3:1 female commonly right side in female it equal in right and left
how much is the percentage of Poland syndrome in female breast aplasia?
Poland syndrome is involved in 14% of
breast aplasia.
How much the percentage of poland syndrome patients whom has hand anomalies?
The frequency of hand abnormalities with Poland syndrome is 13.5% to 56%; in turn, 10% of syndactyly is a result of Poland syndrome
How many the percentage of chest anamoly in poland syndrom ?
Aplasia of the ribs and cartilage involving rib segments two to five often leads to severe chest depression in 11% to 25% of patients
Percentage of patients whom hase lung hernaition in poland
Eight percent of patients may have lung herniation
Renal ultrasounds are recommended for all patients with aplasia of the pectoralis
T
Breast cancer does not appear in poland syndromes apatients on the effected side ?
breast cancer has been reported to occur in patients with Poland syndrome and therefore standard monitoring is required.
Lipofilling in poland syndrom can be used without any implants with sufficient result
Lipofilling can also be used to camouflage chest abnormalities and may obviate the need for custom silicone devices
There is a role to use ADM with breast implant in poland ?
there have been no descriptions of use of ADM to secure the implant and to reduce the incidence of capsular contracture in Poland syndrome.
The most common form of breast reconstruction in poland syndrom is using prosthetic device?
The pedicled latissimus dorsi flap in combination with a prosthetic device has been the most common form of reconstruction in women with Poland syndrome.
When correction of the infraclavicular territory was necessary, an ipsilateral free gracilis flap was anastomosed to the internal mamary vessel’s
F. When correction of the infraclavicular territory was necessary, an ipsilateral free gracilis flap was anastomosed to the thoracodorsal vessels
No need for imaging modality before operation in free flap reconstruction of poland syndrom
F. Because of the incidence of vascular anomalies in the recipient vessels, preoperative angiography should be strongly considered
Rohrich described the most utilitarian method for classifying gynecomastia, based on the amount and character of breast h yp ertrophy and degree of ptosis
T Rohrich described the most utilitarian method for classifying gynecomastia, based on the amount and character of breast h yp ertrophy and degree of ptosis
The risk of breast cancer increases with gynicomastai patients
The risk of breast cancer in patients with gynecomastia remains equivalent when compared with the normal male population
What is saucer-type deformity in gynicomastia?
Overzealous subareolar resection may lead to a saucer-type deformity under the areola
Augmentation-mastopexy techniques are associated with high revision rates of up to one in five, although this may be reduced to less than 1 in 10 by staging the procedure.
T
what the primary goal of augmentation mastopexy ?
The primary goal of the surgery is to
increase the size of the breast,
now BA can be
performed almost exclusively with silicon implant if desired
now BA can be performed almost exclusively with a patient’s own tissue i
if desired
BA affect the size of
the breast, but also the overall gland shape and position of the NAC.
T
The breast mound should reside
completely or largely above the inframammary fold (IMF) regardless the age of the patients.
The breast mound should reside
completely or largely above the inframammary fold (IMF) although
this can vary with age
What is the Standard measurements before BA?
Standard
measurements before BA include base width (BW), sternal notch
to nipple distance (SN-N), nipple to inframammary fold (N-IMF),
NAC diameter, and internipple distance
2 cm of pinch thickness is considered the minimum necessary for placement of an implant in the subpectoral plane
2 cm of pinch thickness is considered the minimum necessary for placement of an implant in the subglandular or subfacial
why the width of sternum is importent?
width of the sternum is
a nuance that can help the surgeon talk to a patient about expected
superomedial fullness and interbreast distance that will likely persist
after augmentation.
ultrasound (US) or magnetic resonance imaging (MRI) is better than mammogram in monitering of beast augmented patients
T
Patients who seek
BA who have no visible breast skin below the NAC on a frontal view
(grade i ptosis)
Patients who seek
BA who have no visible breast skin below the NAC on a frontal view
(grade III ptosis) ikely need a mastopexy as well to reposition the
NAC on the breast mound
normal positins of IMF atthe middle of humerous?
IMF at the middle of the humerus may be considered “high” breasted
