Breast Reconstruction Flashcards
Minimum margin for breast cancer
1mm
Incidence rates of breast cancer are increasing. T/F?
True
What are the usual neoadjuvant therapy prior to surgery?
Chemotherapy or endocrine therapy
What are the 2 types of mastectomy?
Standard AKA Traditional transverse,
Skin sparing with immediate reconstruction
List 3 types of breast conservation surgery
Wide local excision,
Image guided local excision,
Oncoplastic breast conservation inc therapeutic mammoplasty
Neoadjuvant treatment is often used to try and prevent mastectomy by shrinking cancer. What is the standard treatment when using chemotherapy as adjuvant?
Standard FEC and taxane +/- herceptin
What is herceptin?
Trastuzumab - monoclonal antibody for HER2 positive breast cancers
Neoadjuvant treatment is often used to try and prevent mastectomy by shrinking cancer. What is the standard treatment when using endocrine therapy as adjuvant?
Aromatase inhibitors for postmenopausal women!
Tamoxifen for pre or postmenopausal
Why are aromatase inhibitors not used in premenopausal women?
Because they cannot stop aromatase enzyme and production of oestrogen in the ovaries
What are 3 factors to consider when choosing between breast conservation surgery or mastectomy?
Oncological,
Psychological,
Cosmetic
Having a mastectomy improves survival and decreases chances of cancer coming back when compared to breast conservation therapy. T/F?
False! Breast conservation is at least as safe and may actually have better outcomes
Breast conservation surgery is an option for what two presentations?
When patient presents with lump or when patients cancer was picked up on screening and can be localised
If breast cancer is not palpable, what can be done to localise it?
Wire, Clips put in at biopsy -> wire then put in under local anaesthetic to bracket the area of disease if there are multiple,
Magnetic seed, (placed under local near clip)
Radiofrequency marker placed there and use detection probe
What is oncoplastic surgery?
Safe oncological surgery while avoiding tissue deformity so uses cancer and plastic surgery principles
State which type of oncoplastic breast surgery (simple WLE, volume replacement, therapeutic mastopexy or therapeutic reduction mammaplasty) for each case: Small cancer small breast, Med cancer small breast, Med cancer med breast, Med cancer large breast,
Small cancer small breast -> simple WLE,
Med cancer small breast -> volume replacement,
Med cancer med breast -> therapeutic mastopexy,
Med cancer large breast -> therapeutic reduction mammaplasty
How does therapeutic mastopexy work?
When cancer in bottom can do it, is a Breast lift - basically remove volume below
What is therapeutic reduction mammoplasty?
Cancer on outside in large breasts -> bottom base (pedicle) with nipple kept and tissue up and around triangle at bottom of boob
Basially remove tissue underneath, keep tissue so that you can then pull it around so making boobs smaller so is breast reduction with taking cancer out
Describe volume replacement surgery
Move tissue from nearby e.g. lateral skin flap below axilla and move it over to replace excised cancerous bit
Breast conservation is equivalent to mastectomy in disease free and overall survival as long as treatment is? (3)
Clear margins >1mm PLUS breast radiotherapy,
Surgical wide excision aim for 1cm excision at all margins,
Perform full thickness (all the tissue inside) excision at anterior and posterior margins
Mastectomy cosmetic options?
External prosthesis,
Immediate reconstruction,
Delayed reconstruction
What tissues are removed in a radical mastectomy? Used to be used in the past but has bad cosmetic outcome
All breast tissue, skin, pec major and minor and nodes all removed so ribs visible underneath
List the 7 options for reconstruction
Implant only,
Latissimus dorsi pedicled flap +/- implant,
DIEP free flap - deep inferior epigastric artery perforator,
IGAP free flap - inferior gluteal artery perforator,
SGAP free flap - superior gluteal artery perforator,
TUG free flap - transverse upper gracilis,
PAP free flap - profunda artery perforator,
TRAM
Implant reconstruction accounts for approx ? Of reconstructions in the UK?
1/3
Main complications of implant reconstruction? (6)
Loss of implants e.g. infection (approx.25%),
Capsular contracture,
Implant rippling,
Implant migration,
40% need more surgery,
Small risk of Anaplastic large cell lymphoma
