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Reproduction and Sexual Health > Breast Surgery and Reconstruction > Flashcards

Breast Surgery and Reconstruction Flashcards

1
Q

What sort of things come under the heading of ‘survivorship’ following breast cancer?

A
  • Signs and symptoms of recurrence – many patients live in crippling fear of reoccurrence
  • Improving wellbeing
  • Relationships and body image
  • Finance and work
  • Mood changes
  • Weight chances
  • Hot flushes
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2
Q

What are the 2 main categories for types of breast cancer surgery?

A
  • Conservative

* Mastectomy

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3
Q

What 4 things come under the heading of breast conservative surgery?

A
  • ‘Lumpectomy’ – basically a wide local excision
  • Wide local excision
  • Wire guided local excision
  • Oncoplastic breast conservation including therapeutic mammoplasty
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4
Q

What is a mastectomy?

A

Removal of the whole breast

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5
Q

What 2 things come under the heading of breast mastectomy?

A
  • Traditional transverse

* Skin sparing with immediate reconstruction

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6
Q

What 2 treatments, when combined, has the same outcome as mastectomy?

A

Breast conserving surgery + radiotherapy = mastectomy

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7
Q

If breast conservation is done, there is equivalent disease free and overall survival compared to mastectomy as long as?

A

There are CLEAR MARGINS OF > 1mm PLUS BREAST RADIOTHERAPY

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8
Q

In surgical wide excision aim for _ cm excision at all margins

A

1cm

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9
Q

What should you do at the anterior and posterior margins of a breast cancer during surgery?

A

Full thickness excision

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10
Q

Why is neoadjuvant therapy done?

A

This is done to achieve breast conservation

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11
Q

What are the different options of neoadjuvant therapy?

A
  • Chemotherapy (standard FEC100 and taxane) +/- Herceptin
  • Endocrine: aromatase inhibitors more effective than tamoxifen, so reserved for postmenopausal women
  • Both methods shown to reduce mastectomy rates
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12
Q

What is chemotherapy used in?

A

Used in the control of local + systemic disease

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13
Q

Why is chemo good?

A

Because less surgery is needed so there is more breast conservation

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14
Q

How is response to chemo assessed?

A

Assessment of response is radiological with mammography, ultrasound and MRI

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15
Q

What is the standard treatment following chemotherapy?

A

Surgical excision

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16
Q

What does oncoplastic breast surgery mean?

A

Aafe oncological (cancer) surgery while avoiding tissue deformity

17
Q

What does oncoplastic breast surgery mean?

A

Safe oncological (cancer) surgery while avoiding tissue deformity

18
Q

What is oncoplastic breast surgery?

A

Uses principles of cancer and plastic surgery to reshape breast contours at time of cancer resection

19
Q

What type of reconstruction is oncoplastic breast surgery?

A

Immediate

20
Q

Outline the different surgical options in oncoplastic breast surgery.

A

Large breast/large tumour - therapeutic mammoplasty

Small breast - volume replacement techniques

21
Q

What is a mastectomy?

A

Removal of all breast tissue

22
Q

What are the 2 different options for a mastectomy?

A
  • Standard

* Skin sparing, usually if immediate reconstruction

23
Q

After mastectomy, various things can be done in terms of conserving breast appearance. Outline some of these.

A
  • External prosthesis
  • Reconstruction - immediate or delayed:
  • Implant only (+/- autologous cellular matrix)
    Latissimus dorsi (LD) pedicled flap +/- implant
    Deep inferior epigastric artery perforator (DIEP) free flap
  • Inferior gluteal artery perforator (IGAP) free flap
24
Q

Outline the 4 different reconstruction options for breasts.

A
  • Implant only (+/- autologous cellular matrix)
  • Latissimus dorsi (LD) pedicled flap +/- implant
  • Deep inferior epigastric artery perforator (DIEP) free flap
  • Inferior gluteal artery perforator (IGAP) free flap
25
Q

Implant based reconstruction accounts for around 37% of all immediate reconstructions done in the UK

A

True

26
Q

What are the main issues with breast implants?

A
  • Loss of implants (infection)
  • Capsular contracture
  • Implant rippling
  • Implant migration
27
Q

__% of people with breast implants require revisional surgery

A

40%

28
Q

How is implant reconstruction carried out?

A

‘Two stage’ implant reconstruction:

1st – mastectomy and creation of submuscular pocket with expander insertion.

  • clinic visits for expansion 2 weekly

2nd – exchange of expander for permanent implant (although can leave some expanders and remove ports only)

29
Q

Outline the advantages of ADM (acellular dermal matrix) Implants.

A
  • “One stage” implant reconstruction by providing lower pole coverage
  • Better lower pole expansion
  • Reduced postoperative pain
  • Improved aesthetic outcome
  • Permanent implant can be used at 1st operation
  • Also useful for revisional surgery
30
Q

Describe latissimus dorsi reconstruction.

A

Myocutaneous flap, standard or extended +/- augmentation

31
Q

Describe TRAM and DIEP flaps.

A

TRAM – transverse rectus abdominus flap

DIEP – deep inferior epigastric artery perforator flap

32
Q

Describe IGAP flaps.

A

Inferior gluteal artery perforatory flap

Note: superior version also available – SGAP

33
Q

What are some finishing touches of breast reconstruction surgery?

A
  • Nipple reconstruction
  • Lipomodelling
  • Contralateral symmetrising: reduction or augment
34
Q

What are the different options for axillary surgery if the cancer has spread?

A
  • Pre-operative axillary staging: USS axilla +/- core biopsy
  • Sentinel node biopsy
  • Axillary clearance
  • Axillary radiotherapy
35
Q

What is ALWAYS done during breast surgery? Why?

A

Axillary surgery

ALWAYS done during breast surgery – either for treatment or staging

36
Q

Why should you not remove ALL lymph nodes?

A

If you take away all the lymph nodes, you get lymphoedema

Avoid removing all lymph nodes

37
Q

What is a sentinel node?

A

The first lymph node which the cancer is likely to have spread to

Reproduction and Sexual Health (51 decks)

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