Breast Surgery Flashcards
What 4 nerves must the surgeon be aware of during an axillary dissection?
long thoracic nerve
thoracodorsal nerve
medial pectoral nerve
lateral pectoral nerve
What nerve courses along the lateral chest wall in the midaxillary line, on the serratus anterior muscle?
What does it innervate?
long thoracic nerve
innervates serratus anterior muscle
What nerve courses lateral to the long thoracic nerve, on the latissimus dorsi muscle? What does it innervate?
thoracodorsal nerve
innervates latissimus dorsi muscle
What nerve runs LATERAL to or through the pectoral minor muscle, actually lateral to the lateral pectoral nerve?
What does it innervate?
medial pectoral nerve
- innervates the pectoral minor and pectoral major muscles
What nerve runs MEDIAL to the medial pectoral nerve? What does it innervate?
lateral pectoral nerve
- innervates the pectoral major
- names describe orientation from the brachial plexus
Damage to which nerve causes “winged scapula”?
long thoracic nerve
“winged scapula” is the name of the deformity if you cut the long thoracic nerve in the axillary
What is the name of the cutaneous nerve that crosses the axilla in a transverse fashion?
intercostobrachial nerve
- Many surgeons try to preserve this nerve.
What is the name of the large vein that marks the upper limit of the axilla?
axillary vein
What nodes are located between the pectoralis major and minor muscles?
Rotter’s nodes
- not usually removed unless they are enlarged or feel suspicious intraoperatively
What are the suspensory breast ligaments called?
Cooper’s ligaments
What is the name of the breast tissue that tapers into the axilla?
“tail of Spence”
What type of biopsy is performed when a nonpalpable breast mass is seen on mammogram?
sterotactic (mammotome) biopsy or needle localization biopsy
What hormone receptors must be checked for in the biopsy specimen of suspected breast CA?
estrogen and progesterone receptors – this is the key for determining adjuvant treatment ***
What staging system is used for breast CA?
TMN (tumor, metastases, nodes)
Why shouldn’t the pt be paralyzed during an axillary dissection?
Bc the nerves (long thoracic/thoracodorsal) are stimulated with resultant muscle contraction to help ID them
They can be stimulated w/ a forceps, which results in contraction of the latissimus dorsi (thoracodorsal nerve) or anterior serratus (long thoracic nerve)
What are common options for breast reconstruction? (3)
TRAM flap (transverse rectus abdominis myocutaneous flap)
implant
latissimus dorsi flap
What is a total (simple) mastectomy?
removal of breast and nipple without removal of axillary nodes
What are the radiographic tests for breast cancer?
Mammography and breast US
MRI
What are the methods for obtaining tissue for pathologic examination?
FNA
Core biopsy (larger needle core sample)
mammotome stereotactic biopsy
open biopsy - can be incisional (cutting a piece of the mass) or excisional (cutting out the entire mass)
What is a “sentinel” node biopsy?
Instead of removing all the axillary lymph nodes, the primary draining or sentinel lymph node is removed
How is the sentinel lymph node found?
Inject blue dye or techetium labeled sufur colloid
