Breast Surgery Flashcards
Name types of breast conservation surgery
Lumpectomy
Wide loacal excision
Wire guided local excision
Oncoplastic breast conservation
Name types of mastectomy
Traditional transverse
Skin sparing with immediate reconstruction
Is there a greater chance of recurrence with a wide local exicision than mastectomy
No - if given clear margins and adjuvant radiotherapy with WLI then the chance of recurrence is comparable to mastectomy
What area of clear surgical margins is aimed for in WLE
1cm clear around all margins
What is neoadjuvant treatment
Treatment given before breast conservation surgery
What options are there for neoadjuvant treatment
Chemotherapy +/- Herceptin
Endocrine - aromatase inhibitors or tamoxifen
Why is neoadjuvant therapy given
Shown to reduce mastectomy rates - preferable cosmetic outcome
Overall survival advantage for younger women to have pre op chemo
What chemotherapy is usually given neoadjuvantely
FEC 100 ( fluorouracil (also called 5FU), epirubicin, cyclophosphamide) and taxane
Name an aromatase inhibitor
letrozole (femara)
In what group women are aromatase inhibitors reserved for
post menopausal
They are more effective than tamoxifen for neoadjuvant treatment
how is response to neoadjuvant treatment assessed
mammography, ultrasound, MRI
what is oncoplastic surgery
safe oncological (cancer) surgery while avoiding tissue deformity
What reconstructive options are available post mastectomy
Implant only +/- autologous cellular matricx
Lat dorsi pedicled flap +/- implant
Deep inferior epigastric artery perforator free flap
Inferior gluteal artery perforator free flap
What other autologous reconsturctions are possible
Pedicled LD flap
Pedical transverse rectus abdominus myocutaneous flap
Free TRAM flap
S-gap flap (superior gluteal artery perforator flap)
I-Gap flap
What are the main problems with implants
Loss of implants (infection) Capsular contracture Implant rippling Implant migration 40 percent require reversal surgery
