Breast Cancer Surgery/Reconstruction Flashcards
What are some types of breast conservation surgery?
Lumpectomy
Wide local excision
Wire guided local excision
Oncoplastic breast conservation inc therapeutic mammoplasty
What are the types of mastectomy?
Traditional transverse
Skin sparing with immediate reconstruction
When does breast conservation provide the equivalent disease free and overall survival rates as mastectomy?
Clear margins >=1mm
Breast radiotherapy
What should be aimed for in breast conservation?
Surgical wide excision aim for 1cm excision at all margins
Perform “full thickness” excision at anterior and posterior margins
How can an impalpable mass found on imaging be managed?
Localisation wide excision
Specimen XR
What chemotherapy can be used as neoadjuvant treatment to achieve breast conservation?
Standard FEC100 and taxane
+- Herceptin
What oncoplastic surgery will be used in large breasts, or large tumours and reshaping?
Therapeutic mammoplasty
What oncoplastic surgery will be used in small breasts?
Volume replacement techniques
What are the options in mastectomy?
External prosthesis
Reconstruction: Immediate or delayed
Implant only (+/- autologous cellular matrix)
Latissimus dorsi (LD) pedicled flap +/- implant
Deep inferior epigastric artery perforator (DIEP) free flap
Inferior gluteal artery perforator (IGAP) free flap
What are examples of implant based reconstruction options?
Tissue Expander
Acellular Dermal Matrix (ADM)/Implant
De-epithelialised skin/Implant
LD/Implant
What are examples of autologous reconstruction options?
Pedicled LD flap Pedicle TRAM Free TRAM DIEP Flap S-Gap Flap I-Gap Flap
What are the main problems in implant based surgery?
Loss of implants (infection) Capsular contracture Implant rippling Implant migration 40% require revisional surgery
What is the two stage implant reconstruction?
1st: Mastectomy and creation of submuscular pocket with expander insertion
Clinic visits for expansion twice weekly
2nd: Exchange of expander for permanent implant (although can leave some expanders and remove ports only)
What are the advantages of ADM reconstruction?
“One stage” implant reconstruction by providing lower pole coverage
Better lower pole expansion
Reduced postoperative pain
Improved aesthetic outcome
Permanent implant can be used at 1st operation
Also useful for revisional surgery
What are some axillary treatment options?
Pre-operative axillary staging: USS axilla +/- core biopsy
Sentinel node biopsy
Axillary clearance
Axillary radiotherapy
