Breast surgery and reconstruction Flashcards
types of breast conservation surgery
lumpectomy
wide local excision
wire guided local excision
oncoplastic breast conservation including therapeutic mammoplasty
types of mastectomy
traditional transverse
skin sparing with immediate reconstruction
what has to be done during surgery - breast conservation
clear margins of >=1mm
breast radiotherapy
surgical wide excision aim for 1cm extension at all margins
what is done for impalpable disease
localisation wide excision
what is neoadjuvant treatment
chemo +/- perception
endocrine - aromatase inhibitors (for postmenopausal women), tamoxifen
chemo (neoadjuvant therapy) used for what
allows for less what
assessment of response
used to control local disease as well as systemic
can allow for less breast surgery - breast conservation
assessment of response - mammography, USS, MRI
oncoplastic breast conservation for large breast and large tumour and reshaping
therapeutic mammoplasty
oncological breast conservation for small breasts
volume replacement techniques
mastectomy options
external prosthesis
reconstruction - immediate/delayed
implant only
latissimus dorsi (LD) pedicled flap +/- implant
deep inferior epigastric artery perforator (DIEP) free flap
inferior gluteal artery perforator (IGAP) free flap
what are the two types of reconstruction options
implant based
autologous
implant based reconstruction options
tissue expander
acellular dermal matrix implant
de epithelialise skin/implant
LD/implant
autologous reconstruction options
peddled LD flap pedicle TRAM free TRAM DIEP flap S-Gap flap I-Gap flap
problems with implants
loss of implants-infection capsular contraction implant rippling implant migration 40% require revisional surgery
current method for implant
1 - mastectomy and creation of submuscular pocket with expander insertion
2 - exchange for expander for permanent implant
Acellular dermal matrix implant advantages
one stage implant reconstruction better lower pole expansion reduced post op pain improved aesthetic outcome perm implant can be used at 1st operation also useful for revision surgery
