Breast Cancer Surgery and Reconstruction Flashcards
what is happening to the rates of breast cancer
incidence, prevalence and survival increasing
what are the functions of the breast that may need to be preserved after surgery
breast feeding
sexual and aesthetic
what distance of margin is aimed for in breast cancer surgery
1cm clear
what influences survivorship after breast cancer surgery
signs and symptoms of recurrence
improving and wellbeing
relationships and body image
finance and work
what neoadjuvant therapies are available
radio
chemo +/- herceptin
endocrine (aromatase inhibitors more effective than tamoxifen)
what are the types of breast cancer surgeries
breast conservation
- wide local excision
- wire guided local excision
- oncoplastic breast conservation
mastectomy
- traditional transverse
- skin sparing with immediate reconstruction
what is oncoplastic surgery
safe surgery that aims to avoid deformity
reshapes breast via plastic surgery principles- theraputic mastoplexy or volume replacement
does a mastectomy have lower risk of recurrence than brest conserving surgery
no
breast conserving surgery with radiotherapy and >-=1cm margins has slight lower risk of recurrence
is body image reported to be better after breast conserving surgery or mastectomy
BCT
what are the methods of tumour localisation
wires
magnetic clips
radio frequency localisation
what do neoadjuvant therapies reduce the rate of
mastectomy
how does tamoxifen work
oestrogen receptor blocker
how do aromatase inhibitors work
prevent the production of oestrogen
how is the response to neoadjuvant chemo assessed
radiological with mgm, USS and MRI
what oncoplastic techniques for large breasts or large tumour and reshaping
theraputic mammoplasty (reduction in breast size)
what oncoplastic breast techniques for smaller breasts
volume replacement
what delayed oncoplastic techniques exist
delays symmetrising augmentation or lipomodelling
what are the types of mastectomy
(both removal all breast tissue)
standard
skin sparing (usually with immediate reconstruction)
what are the reconstruction options for a mastectomy
external prothesis
reconstruction (immediate or delayed)
-implant
-autologous based:
-latissiumus dorsi pedicled flap +/- implant
-artery free flap (deep inferior epigastric, inferior gluteal, superior gluteal, transverse upper gracilis, profunda)
(free flap= skin and fat, not muscle. only use muscle for transverse upper gracilis and profuna artery perforator)
what are the pros and cons of implant reconstruction
pros- short initial op, no other scars
cons- loss of implants (infection), capsular contracture, implant rippling/ migration)
40% need revisional surgery
small risk of ALC lymphoma (1:25000)
what is the current method for implant reconstruction
two stage:
1st: mastectomy and creation of submuscular pocket with expander insertion
Clinic visits for expansion 2 weekly
2nd: exchange of expander for permanent implant (although can leave some expanders and remove ports only)
what are the ‘finishing touches’ for breast reconstruction
nipple reconstruction
lipomodelling
contralateral symmetrising - reduction or augmentation
what is the pre-op axillary staging
USS axilla +/- core biopsy
what are the axillary treatment options
Sentinel node biopsy- tracer injected into breast , nodes that take up tracer are the ones draining the breast so need to be taken out
Axillary clearance
Axillary radiotherapy
what is the management pathway for axilla disease
USS if suspicious of breast cancer:
if suspicious nodes -> USS guided biopsy:
-if macrometastasis axially lymph node clearance
-if no macrometastases sentinal node biopsy
(if normal nodes on first USS then do sentinal node biopsy)
