Breast Surgery Flashcards
INdications for Breast Surgery
prophlactic: for cancer risk
biopsy
mastectomy
removal of tumor
Breast anatomy
Lymph Drainage
Four Quadrants
- Right and left upper
- right and left lower
- tail of spence toward axilla
Breast Parenchyma
- alveoli
- lobules
- lobes
- of tissue pockets
Lymph Drainage
- highly lymph area
- for cancer and spread purposes: graded as level I to level III
Level I = the lymph closest to the breast tissue
Level II& III = indicate a spread further out from teh breast origin and a larger METS
Breast Blood Supply
Thoracoacromial arteries
internal mammary perforators (2-5)
lateral thoracic artery
thoracodorsal artery
terminal branches of teh intercostal perforators (3-8)
when doing surgery, alwasy want to preserve the blood supply
Fine Needle Aspiration: Breast
indications
how its done
disadvantages
Indications
- palpabale breast mass
How its done
- +/- imaging needed: can be done accompying teh FNA (mammogram or US depending on the mass)
- prep skin: no anesthesia needed as its one needle
- used 10-20 mL syringe with 23-27 gauge needle
Disadvantages (beind replaced by core needl biopsy)
- cannot distinguish between in situs (started and sitting in duct) or invasive cancer (out of the duct into breast tissue)
- significant rate of non-dx. smaples and false negatveis if not done right
Core Needle Biopsy : breast
indications
procedure
Indications
- breast mass
Procedure
- usually done under imaging guidance of breast radiology: mammogram, US or MR
- local anesthesia
- small skin incision then use 18-9 gauge needle to obtain biopsy
- clip placed in the margins to identify where it was if needed to go back
Surgical Biopsy of Breast
Incisional
Excisional
indications and when theyre performed
Incisional
- removes only a portion of the lesion
- indicated for large masses where if you removed the entire thing to biopsy it would be cosmetically unpleasing
Excisional
- removes the complete lesion
- done when the location of the mass is not able to be reached for a core needle biopsy
- done when there is inconclusive or nondiagnosit evidence of a CNB
- lesion no consistent with imaging
- the size is increasing or cahning despite negative CNB results
Proceudre for a surgical biopsy
- anestheisa: incisional = local, excisional = locoal or general (twilight)
- pt. postion with arms wide
- lesion located via palpation or US
- incision done, dissected and removed with 1cm margins
- pathologic specimen marking of boarders with sutures
- palpate the cavity: could be more of the mass than visable
- hemostasis!!!!!
- closure with deep to superfisical layering
- dressing and post-op bra
Indications for a Lumpectomy
- single or multiple lesions that can be excised to leave satisfactory cosmetic outcomes
- mostly T1 and T2 tumors (smaller)
- considered with neoadj. chemo to shrink it
- can consider T3 tumors in those with large breasts
- (this isnta biopsy, this is removal of a known lump of breast cancer
Surgical Techniques for a Lumpectomy
Surgical Technique
- wide local excision
- goal is to remove entire invasive cancer and any dutacl carcinoma in situ with normal breast tissue margins
- incisions placement: want ellipse for least tension
- hemostasis and closure
what is a Radical Mastectomy (halsted)
what is a modifed radical
Radical Mastecomy: removes the followin g
- breast tissue
- overlaying skin
- pect. major and minor
- entire axillary contents (level I, II and II nodes)
Modified Radical Mastecomy: removing of…
- breast tissue
- undelying fascia of the muscles (but not the muscles themselves)
- level I and II axilla lymph or any biopsy proven METS
SimpleMastectomy
Nipple-Areolar Sparing Mastectomy
Simple Mastectomy
- removes breast tissue
- axillary and chest muscles left
- if there are METS; this cannot be done
- this is most commonly done
Nipple-Areolar Sparing
- preserves the dermis and epidermis of the nipple but removes the ducts within the lumen
- Good procedure for…
- those with small, moderate breasts and noptosis
- those with peripherally located small tumors and not multiple
- prophlyatic removal
Contraindications
- inflammatory BC, clincial involved of the NAC, nipple retraction ,Pagets diease, bloody discahrge or multiple tumors
Indications for Mastectomy
complications
Indications
- cannot get negative margins with lumpectomy
- + sentien LN
- tumoe > 5 cm
- clinically palpable node
- inflammaotry BC
- multiple tumors
Complications
- scarring
- bleeding
- infection
- fluid accumulation (hematoma, seroma)
- delayed healing (necorsis)
- clots
- reoperation
- asymmetry of breasts
- damange to surroudning tissue
- pain!
