[Exam 1] Chapter 58: Assessment and Management of Patients with Breast Disorders Flashcards
1
Q
Ductal Carcinoma in Situ: What is this?
A
Characterized by proliferation of malignant cells inside the milk ducts without invasion to surrounding tissue. Does not metastasize, and woman does not die generally.
2
Q
Ductal Carcinoma in Situ (DCIS): What can cause this to develop into invasive breast cancer?
A
If it is left untreated.
3
Q
Ductal Carcinoma in Situ (DCIS): Frequently manifestated on a mammogram with what appearance?
A
Calcifications and considered breast cancer stage 0
4
Q
Ductal Carcinoma in Situ (DCIS), Medical Mx: Takes what 3 things into account?
A
Assurance of accurate diagnosis, assessment of DCIS size and grade, and careful margin evaluation
5
Q
Ductal Carcinoma in Situ (DCIS), Medical Mx: Grade III vs Grade I ?
A
Grade III tend to grow more quickly than grade 1 and look much more different than normal breast cells.
6
Q
Ductal Carcinoma in Situ (DCIS), Medical Mx: Accurate grading of this is critical why?
A
Because high nuclear grade and presence of necrosis is highly predictive of the inability o achieve adequate margins or borders of healthy tissues around cancer.
7
Q
Invasive Cancer, Infiltrating Ducal Carcinoma: What is this?
A
Most common, 80% of cases. Tumors arise from duct system and invade surrounding tissues. Often form a solid irregular mass in breast
8
Q
Invasive Cancer, Infiltrating Lobular Carcinoma: What is this?
A
10-15%. Tumors arise from lubular epithelium and typically occur as an area of ill-defined thickening in the breast. Multicentric and bilateral.
9
Q
Invasive Cancer, Medullary Carcinoma: What is this?
A
5%, more often in those <50 years. Tumors grow in a capsule inside a duct. Become large and may be mistaken for a fibroadenoma
10
Q
Invasive Cancer, Mucinous Carcinoma: What is this?
A
3%. Those who are postmenopausal and >75 years. A mucin producer and tumor is slow growing.
11
Q
Invasive Cancer, Tubular Ductal Carcinoma: What is this?
A
2%. Prognosis excellent. Micropapillary invasive ductal carcinoma is a rare type of aggressive ductal cancer charancterized by high rate of axillary node.
12
Q
Invasive Cancer, Inflammatory Carcinoma: What is this?
A
Rare. aggressive type of breast cancer with unique symptoms./ Diffuse edema and erythema of skin (peau d’ orange, resmebling orange) are highlight signs of this
13
Q
Invasive Cancer, Inflammatory Carcinoma: What causes this?
A
Maligant cels blocking lymph channels in skin. Mass may be present.
14
Q
Invasive Cancer, Paget Disease: Symptoms incluide?
A
Scaly, erythematous, pruiritic lesion of the nipple. REpresents DCIS of the nipple but may have invasive co mponent.
15
Q
Invasive Cancer, Paget Disease: What does it mean if no lump is felt?
A
This paired with DCIS without invasion shows favorable prognosis.
16
Q
Invasive Cancer, Risk Factors: What may increase risk of development?
A
Combination of genetic, hormonal, and possibly environmental factors
17
Q
Invasive Cancer, Risk Factors: What genes are responsible for this?
A
BRCA1 and BRCA2 are tumor suppressor genes. Mutations here on chromosome 17 responsible for majority of hereditary breast cancer.
18
Q
Invasive Cancer, Risk Factors: What must be done if woman if BRCA positive?
A
Start screening, use mammography once a year than MRI 6 months after yearly mammography by 25.
19
Q
Invasive Cancer, Protective Factors: What are some factors that may be proctective against development of breast cancer?
A
Breast feeding 1 year, moderate physical activity, and maintaining healthy body weight .
20
Q
Breast Cancer Prevention Strategies In High Risk Patient, Long-Term Surveillance: This focuses on what?
A
Early detection. This means additional screening using MRI with yearly mammogram.
21
Q
Breast Cancer Prevention Strategies In High Risk Patient, Chemoprevention: What is this?
A
Main modality that aims to prevent disease. Tamoxifen and Raloxifene are effective.
22
Q
Breast Cancer Prevention Strategies In High Risk Patient, PRopylactic MAstectomy: What is this?
A
Procedure is a total mastectomy (removal of breast tissue) and is usually accompanied by immediate breast reconsutrction
23
Q
Breast Cancer Prevention Strategies In High Risk Patient, PRopylactic MAstectomy: Who would use this?
A
Strong family history, diagnosis of LCIS, mutation in a BRCA gene, annd previous cancer in one breast.
24
Q
Breast Cancer, CMs: What part of the breast is this found on
A
Upper outer quadrant, where most breast tissue located. Lesions nontender, fixed, and hard with irregular borders
25
Breast Cancer, CMs: Complaints include what?
About diffuse breast pain and tenderness with menstruation
26
Breast Cancer, Assessment/Diagnostic: Techniques to determine the diagnosis of breast cancer include?
Various types of biopsy. Tumor staging and additional prognostic factors
27
Breast Cancer, Staging: What does staging involve?
Classifying the cancer by the extent of the disease in the body. Based on where its invasive, size, and how many lymph nodes involved.
28
Breast Cancer, Staging: Most common system used to describe stages of cancer?
American Joiny Committee on Cancer TNM system.
29
Breast Cancer, Staging: What diagnostic tests may be used?
Chest X-Rays, CT Scan, MRI Scan, PET scan, bone scans, and blood work (CBC, comprehensive metabolic panel, and tumor markers)
30
Breast Cancer, Prognosis: Two of the most important factors are ?
Tumor size and whether it has spread to the lymph nodes under teh arm.
31
Breast Cancer, Prognosis: When will a carcinoma become clinically apparent?
When it doubles in sizes 30 times to become 1 cm or larger.
32
Breast Cancer, Prognosis: Most common route of regional spread is to where?
The axillary lymph nodes. Also internal mamary and supraclavicular nodes.
33
Breast Cancer, Prognosis: What other factors can help determine prognosis?
Excessive number of copies of certain genes or excessive amounts of their protein product.
34
Breast Cancer, Surgical Mx: Main goal of surgery?
To gain local control of disease.
35
Surgical Mx and Modified Radical Mastectomy: What is this?
Involves removal of breast tissue, including the nipple-areola complex. Portion of axillary lymph nodes also removed in axillary lymph node dissection (ALND(.
36
Surgical Mx and Modified Radical Mastectomy: What muscles are removed here?
PEctoralis major and pectoralis minor left intact.
37
Surgical Mx, Total Mastectomy: What does this involve?
Removal of breast and nipple-areola complex but does not include ALND.
38
Surgical Mx, Total Mastectomy: Who would get this surgery?
Those with noninvasive breast cancer which does not have a tendency to spread to the lymph nodes.
39
Surgical Mx, Total Mastectomy: What may also be performed for those with invasive breast cancer?
This along with sentinel lymph node biopsy
40
Surgical Mx, Breast Conversation Tx: What is this?
Goal is to excise the tumor in the breast completely and obtain clear margins which achieving acceptable cosmetic result. If noninvasive, lymph node removal not necessary.
41
Surgical Mx, Sentinel Lymph Node Biopsy: Why is SLNB preferred over ALND?
Less invasive. ALND is associated with potential morbidity including lymphedema, cellulitis, decreased arm mobility and sensory changes
42
Surgical Mx, Sentinel Lymph Node Biopsy: What is this lymph node?
This is the first node (or nodes) in the lymphatic basin that receives drainage from the primary tumor in the breast and identified by injecting a radioisotope or blue dye.
43
Surgical Mx, Sentinel Lymph Node Biopsy: What does the surgeon do in this procedure?
Uses a handheld probe to locate the sentinel lymph node, excises it, and sends it for pathologic analysis which is performed immediately
44
Surgical Mx, Sentinel Lymph Node Biopsy: What is done if this is positive?
Surgeon can proceed with an immediate ALND.
45
Surgical Mx, Sentinel Lymph Node Biopsy and Nursing Mx: How long do they stay in hospital?
If SLNB performed in conjunction with breast conservations, discharged same day.
If total mastectomy, usually stay overnight.
46
Surgical Mx, Sentinel Lymph Node Biopsy and Nursing Mx: What discoloration may they notice?
That because of radioisotope and blue dye, they may notice blue-green discoloration in urine or stool.
47
Patient Undergoing Surgery - Potential Complications:
Lymphedema, Hematoma, Infection
48
Patient Undergoing Surgery - Planning and Goals: Major goals may include what
increased knowledge about disease and treatment , reduction of anxiety, and improvement of decision-making abillity
49
Patient Undergoing Surgery - Preop, Providing Education: What surgery type causes a patient to remain overnight?
Breast conservation with ALND or total / modified radical mastectomy remain in hospital overnight.
50
Patient Undergoing Surgery - Preop, Providing Education: For those undergoing ALND, what will be inserted?
Surgical drains in mastectomy incision and in axilla.
51
Patient Undergoing Surgery - Preop, Providing Education: After ALND, they will have a decrease in what?
DEcreased arm and shoulder mobility and needs to be shown range-of-motion exercises.
52
Patient Undergoing Surgery - Preop, Reducing Fear/Anxiety: Fears can include what?
Fears of pain, mutilation, and loss of sexual attractiveness, and concern about inability to care for oneself.
53
Patient Undergoing Surgery - Postop, Relieving Pain/Discomfort: What patient would have the most pain after surgery
After having a modified radical mastectomy with immedicate reconstriction.
54
Patient Undergoing Surgery - Postop, Relieving Pain/Discomfort: Why may pain increase after first couple of days?
Because they begin to regain sensation around surgical site and become more active.
55
Patient Undergoing Surgery - Postop, Relieving Pain/Discomfort: Postop pain may be most common with which patient?
PAtients who have had axillary dissection and correlates with number of nodes removed.
56
Patient Undergoing Surgery - Postop, Managing Postop Sensations: Common sensations include what?
Tenderness, soreness, numbness, tightness and pulling. Occur on chest wall in axilla.
57
Patient Undergoing Surgery - Postop, Lymphedema: What is this?
Complication characterized by chronic swelling of extermity due to interrupted lymphatic circulation. Due to accumulation of protein-rich fluid.
58
Patient Undergoing Surgery - Postop, Lymphedema: What feelings may someone with thi shave?
painful swelling of arms as well as weakness, shoulder pain, and tinglign sesnation in arm and shoulder.
59
Patient Undergoing Surgery - Postop, Lymphedema: When does this happen?
If functioning lymphatic channels are inadequate to ensure a return flow of lymph fluid to general circulation.
60
Patient Undergoing Surgery - Postop, Lymphedema: What is transient edeema?
can be removed by prescribing exercising, elevating arm above heart and gentle muscle . pumping. Occurs after surgery
61
Patient Undergoing Surgery - Postop, Lymphedema: What is the patient taught after ALND?
Patient is taught hand and arm care to prevent injury or trauma to affected extremity, thus decreasing likelihood for development of lymphedema.
62
Patient Undergoing Surgery - Postop, Lymphedema: Treatment for this may consist of ?
A course of antibiotics agents if an infection is present. PT/OT may be necessary.
63
Patient Undergoing Surgery - Postop, Hematoma/Seroma Formation: What is hematoma and when can it occur?
Collection of blood inside a cavity, and may occur after either a mastectomy or breast conservation,
64
Patient Undergoing Surgery - Postop, Hematoma/Seroma Formation: Signs of Hematoma may include what?
Swelling, tightness, pain, and bruising of the skin. Surgeon should be notified immediately. Compression wrap may be applied for 12 hours.
65
Patient Undergoing Surgery - Postop, Hematoma/Seroma Formation: What is a seroma?
Collection of serous fluid that may accumulate under breast incision after mastectomy or breast conservation or in axilla.
66
Patient Undergoing Surgery - Postop, Hematoma/Seroma Formation: Signs of Seroma may include?
Swelling, heaviness, discomfort and a sloshing of fluid., May develop after drain removed.
67
Patient Undergoing Surgery - Postop, Infection: Risk for this may be higher for patients with what comlications
diabetes, immune disorders, and advanced age and those with poor hygiene.
68
Patient Undergoing Surgery - Postop, Infection: Treatment consists of
oral or IV antibviotics for 1-2 weeks
69
Patient Undergoing Surgery - Educating about Self-Care: How does fluid change with ALND and Mastectomy?
Initially it appears bloody, but gradually changes to a serosanguineous and then serous fluid.
70
Patient Undergoing Surgery - Educating about Self-Care: When are drains usually removed?
When the output is less than 30 mL in 24 hour period.
71
Patient Undergoing Surgery - Educating about Self-Care: When should a patient shower?
Some suggest waiting up to 48 hours post
72
Patient Undergoing Surgery - Educating about Self-Care: What must patients do after ALND?
Patients are taught arm exercises on the affected side to restore range of motion. Initiated on second postop day.
73
Patient Undergoing Surgery - Educating about Self-Care: Goals of exercising for someone with ALND?
TO increase circulation and muscle strength, prevent joint stiffness and contractures and restore full range of motion. Perform 3x a day for 20 mins.
74
Patient Undergoing Surgery - Educating about Self-Care: What to do if patient has pain for exercises?
Take analgesic agent 30 mins before beginning exercises and also can take a warm shower.
75
Patient Undergoing Surgery - Educating about Self-Care: Heavy lifting avoided for how long
for 4-6 weeks, but brisk walking is encouraged.
76
Patient Undergoing Surgery - Continuing Transitional Care: How often should follow-up visits occur?
Every 3-6 months for the first several years.
77
Radiation Therapy: Why is this used?
To decrease the chance of a local recurrence in the breast by eradicating residual microscopic cancer cells. Breast conservation treatmetn follows
78
Radiation Therapy: When does external-beam radiation begin?
About 6 weeks after breast conservation to allow surgical site to heal.
79
Radiation Therapy: What is a simulation that parent goes through?
Its a planning session, where antaomic areas to be treated are mapped out and then identified with small permanent ink markings
80
Radiation Therapy: How does external-beam radiation work??
Delivery of high-energy photons from a linear accelerator, given to entire breast region. Lasts only mins and given 5 days a week for 5-6 weeks.
81
Radiation Therapy: Brachytherapy is another option, which is what?
Radiation is delivered by an internal device that is placed close to tumor within breast. Given over 4-5 days instead of weeks.
82
Radiation Therapy, SE: Acute SE of this?
Mild to moderate erythema, breast edema, and fatigue. Skin breakdown may occur and fatigue can be depressing.
83
Radiation Therapy, SE: Rare long term effects of this?
Pneumonitis, rib fracture, heart disease, breast fibrosis and necrosis.
84
Radiation Therapy, Nursing Mx: Self-care advice for those recieivng radiation include
use mild soap with minimal rubbing
avoid perfumed soaps or deodorants
use hydrophilic lotions.
85
Systemic Treatments, Chemotherapy: Adjuvant chemotherapy involves teh use of what?
Anticancer agents in addition to other treatments to delay or prevent recurrent of breast cancer.
86
Systemic Treatments, Chemotherapy: When is this most often initiated?
After breast surgery and before radiation.
87
Systemic Treatments, Chemotherapy: Decisions regarding optimal regimen are based on what factors
tumor characteristics, the patient's age, physical status and existing comorbid conditions.
88
Systemic Treatments, Chemotherapy: Most widely used adjuvant therapy?
Cyclophosphamide, Methotrexate, and Fluorouracil (Known as CMF)
89
Systemic Treatments, Chemotherapy: What is generally incorporated into treatment regimens for patients with larger node-negative cancers and those with posivie axillary lymph nodes
The taxanes.
90
Systemic Treatments, Chemotherapy: What is dose-dense chemotherapy?
Administration of chemotherapeutic agents at standard doses with shorter time intervals between each treatment.
91
Systemic Treatments, Chemotherapy SE: Common physical side effects?
N/V, bone marrow suppression, taste changes, alopecia, mucositis, neuropathy, and fatigue.
92
Systemic Treatments, Chemotherapy SE: What can taxanes cause?
Peripheral neuropathy, arthralgias, and myalgias, particularly at high doses.
93
Systemic Treatments, Chemotherapy SE: Side effect of anthracyclines may be severe and include what?
Cardiotoxicity in addition to N/V, bone marrow suppression and alopecia.
94
Systemic Treatments, Nursing Mx: Instruct the patient about what?
Use of antiemetic agents and reviewing the optimal dosage schedule can help minimize N/V.
95
Systemic Treatments, Nursing Mx: Measures to ease symptoms of mucositis may include
rinsign with normal saline or sodium bicarbonate solution, avoiding hot and spicy foods, and using a soft toothbrush
96
Systemic Treatments, Nursing Mx: What can be given to minimize effects of chemotherapy induced neutropenia and anemia?
Hematopoietic growth factors
97
Systemic Treatments, Nursing Mx: What do granulocyte colony stimulating factors do?
Boost the WBC count, reducing incidence of neutropenic fever.
98
Systemic Treatments, Nursing Mx: Erythropoietin growth factor may be given why?
Production of red blood cells, thus decreasing the symptoms of anemia. Short acting form epoetin alfa (epogen) is given.
99
Systemic Treatments, Nursing Mx: How to help with emotional trauma associated with alopecia?
Often helps for patient to have wig before hair loss occurs.
100
Hormonal Therapy: What is adjuvant hormonal therapy?
Sometimes used with chemotherapy, and is considered in women who have hormone receptor-positive tumors. Can be determined with results of estrogen and progesterone receptor assay.
101
Hormonal Therapy: Breast cancers depend on what for growth?
Estrogen for growth adn express a nuclear receptor that binds to estrogen. Thus estrogen receptor postivie.
102
Hormonal Therapy: Hormonal therapy involves teh use of what?
Synthetic hormones or other medications that compete with estrogen by binding to the reeceptor sites or use the aromatase inhibiors, which block estrogen production.
103
Hormonal Therapy: Which types of tumors have the best likelihood of responding to hormonal therapy?
Those that are ER+ and PR+
104
Hormonal Therapy: What has been the main hormonal agent used in treatment of pre and post menopausal breast cancer?
SERM Taoxifen, and has estrogen blocking and estrogen like effects. . Prevent estrogen from binding tot he receptor sites and preventing tumor growth
105
Hormonal Therapy: How do aromatase inhibitors work?
By blocking the enzyme aromatase from performing the conversion, therby decreasing the level of circulating estrogen.
106
Targeted Therapy: What is Trastuzumab?
A monoclonal antibody that binds specifically to the HER-2/neu protein. This regulates cell growth. This inactivates the HER-2 protein, thus slowing tumor growth
107
Targeted Therapy: Side effects of trastuzumab?
Spares normal cells and includes fevers, chills, n/v, diarrhea, and headache
108
Tx of Recurrent/MEtastatic Breast Cancer: This may recur where?
Locally (on chest wall) , regionally (in remaining lymph nodes) or systemically (in distant organs)
109
Tx of Recurrent/MEtastatic Breast Cancer: In Metastatic disease, what is the most common site of spread?
Bone, usually the hips, spine, ribs, skul or pelvis
110
Tx of Recurrent/MEtastatic Breast Cancer: People with what metastases generally have longer survival?
Those with bone metasteses versus metastases in visceral organs.
111
Tx of Recurrent/MEtastatic Breast Cancer: Local recurrence in the absence of systemic disease is treated how
aggressively with surgery, radiation and hormal therapy.
112
Tx of Recurrent/MEtastatic Breast Cancer: How does treatment for metastatic breast cancer work?
Control disease instead of curing. Tx includes hormoanl therap, chemo, and targeted therapy.
113
Tx of Recurrent/MEtastatic Breast Cancer: With metastatic cancer, woman who are premenopausal and who have hormonally dependent tumors may eliminate the production of estrogen by
the ovaries through oophorectomy (removal of ovaries) or suppression of estrogen production by meds.
114
Tx of Recurrent/MEtastatic Breast Cancer: Patients with advanced breast cancer are studied using baseline studies, that include?
CBC, comprehensive metabolic panel, tumor markers, bone scan, CT of chest and MRI
115
Tissue Expander Followed By Permanent Implant: How is the implant accommodated?
Skin remaining after a mastectomy and the underlying muscle must gradually be stretched using tissue expansion
116
Tissue Expander Followed By Permanent Implant: How does tissue expansion work?
Surgeon places tissue expander through mastectomy incision underneath pectoralis muscle. For 6-8 weeks, ptiet receives additional saline injections through port until fully expanded. Expanded for 6 weeks to allow skin to loosen. Then exchanged for permanent implant.
117
Tissue Expander Followed By Permanent Implant: Women should not participate in what?
Any exercises that will develop the pectoralis muscle, because this can distort the reconstructed breast
118
Tissue Transfer Procedure: Autologous reconstruction is what?
The use of the patient's own tissue to create breast mount. Flap of skin with its blood suply is rotated to the mastectomy site to create mound that stimulates the breast.
119
Tissue Transfer Procedure: DOnor sites may include what?
Transverse rectus abdominal myocutaneous (TRAM) flap, gluteal flap, or the latissimus dorsi flap. Results resemble real breast.
120
Tissue Transfer Procedure: Which one is the most commonly performed procedure?
TRAM flap.
121
Tissue Transfer Procedure: How is a free TRAM performed?
Skin, fat, muscle, and blood supply are completely detached from the body and transplanted to the mastectomy site using microvacular surgery.
122
Tissue Transfer Procedure: Recovery time for TRAM procedure?
6-8 weeks and have incisions both at mastectoym site and donor site.
123
Tissue Transfer Procedure: Other free flap procedures include?
deep inferior epigastric porforator flap (DIEP) and superfiical inferior epigastric artery flap (SIEA)
124
Tissue Transfer Procedure: What is essential to do after the procedure?
Deep breathing and leg exercises, because at greater risk for respiratory complications and deep vein thrombosis.
125
Nipple-Areola Reconstruction: Most common method for creating a nipple?
Is the use of local flaps (skin and fat from center of new breast mound), which are wrapped around each other to create a projecting nuple. Aerola created using skin graft.
126
Nipple-Areola Reconstruction: Most common donor site?
Upper inner thigh, because this skin has darker pigmentation than skin on reconstructed breast.
127
Prosthetics: What is this?
An external form that stimulates a breast. PLaced inside a pocket in a bra.
128
Prosthetics: Prior to discharge, nurse usually provides the patient with what
temporary, lightweight, cotton-filled form that can be worn until surgical incision is well healed (4-6 weeks).
129
Special Issues in Breast Mx, Implications of Genetic Testing: What is the main gene involved here?
BRCA1 and BRCA2
130
Pregnancy and Breast Cancer: This is defined as what?
Breast cancer diagnosed during gestation or within 1 year of childbirth. Due to increased levels of hormones produced during pregnancy, become tender and swollen making it difficult to detect a mass
131
Pregnancy and Breast Cancer: What to do is mass is found?
Ultrasound performemd due to no exposure to radiation.
132
Pregnancy and Breast Cancer: Most common surgicl treatment??
Modified radical mastectomy
133
Pregnancy and Breast Cancer: Is SLNB performed?
Not typically, because of unknown effects of the radioisotope and the blue dye on the fetus.
134
Pregnancy and Breast Cancer: What happens if mass is found while a woman if breast-feeding?
She is urged to stop to allow the breast to involute (return to its baselien state) ebfore any surgery is performed.
135
Quality of Life/Survivorship: Estrogen withdrawal from chemotherapy induced menopause and hormonal treatment can lead to variety of ssymptoms including?
hot flashes, vaginal dryness, UTI, weight gain, decreased sex drive and increased risk of osteoporosis.
136
Quality of Life/Survivorship: How is cognitive functioning affected?
Can have difficulty concentrating (chemo brain).
137
Quality of Life/Survivorship: Rare long term effects of radiation can include
pneumonitis, rib fractures, heart disease, and breast fibrosis.
138
Quality of Life/Survivorship: Long term sequelae after breast surgery may include
lymphedema , pain, and sensory disturbances.
139
Quality of Life/Survivorship: Long-term psychosocial sequelae may include
fears of recurrence, mood changes, increased sense of vulnerability, uncertainity feelings of loss, concerns abut body image, and emotional distress.
140
Breast Women with Disabilities: Possible barriers to use mammography in women with diasbilites includes
physical inaccessibility of ofice space, limited ransportation, and time and assistance constraints associated with undressings.
141
Reconstructive Breast Surgery: This is called what
Mammoplasty
142
Reconstructive Breast Surgery: What is a mammoplasty?
Elective procedure that enhance a womans self-image and sense of well-being.
143
Reduction Mammoplasty: Who is this performed on?
Women who have breast hypertrophy (excessively large breasts).
144
Reduction Mammoplasty: How is the surgery done?
Anchor-shaped incision that circles the areola is made, extending downward and following the natural curve of the of the crease beneath the breast.
145
Reduction Mammoplasty: Drains placed for how long?
For 2-5 days.
146
Reduction Mammoplasty: During preoperative consultation, patient should be informed of what?
Possibility of sensory changes of nipple (numbness) that can ocur.
147
Reduction Mammoplasty: After the surgery , what is the patient instructed to do?
Wear a supportive bra 24 hours a day for 2 weeks to prevent tension on the swollen breast and incision line.
148
Augmentation Mammoplasty: Who is this done on?
Women who desire larger or fuller breasts. BBreast implant placed under pectoralis muscle or under breast tissue.
149
Augmentation Mammoplasty: Incision line can be placed where?
inframmammary fold in the axilla or around the aerola.
150
Augmentation Mammoplasty: What is usually used here?
Saline implants.
151
Augmentation Mammoplasty: What should these women do about mammograms?
Can be difficult to read, so they should seek experienced breast radiologists
152
Mastopexy: When is this done?
When patient is happy with size of breasts but wishes to have the shape improved and a lift performed.
153
Disease of Male Breast, Gynecomastia: How common?
Most common breast condition in the male.
154
Disease of Male Breast, Gynecomastia: Adolescent boys can be affected why
because of hormones secreted by the testes. Benign and resolves in 1-2 years.
155
Disease of Male Breast, Gynecomastia: How does this present in older men?
Presents as firm, tender mass underneath the areola
156
Disease of Male Breast, Gynecomastia: For older men, may be associated with what conditions?
Feminizing testicular tumors , infection of testes, and liver disease resulting from alcohol abuse or parasitic infection.
157
Disease of Male Breast, Gynecomastia: Patients in late 40s presenting with idiopathic (unknown cause) should have what tests
testicular examination and possibly a testicular ultrasound.
158
Disease of Male Breast, Gynecomastia: When are mamography and ultrasound utilized?
If there is a concern about malignancy
159
Disease of Male Breast, Gynecomastia: Best treatment option?
Surgical removal of tissue through a small incision around the areola is the best option
160
Male Breast Cancer: Familial cases in men usually have what mutations?
BRCA2 instead of BRCA1.
161
Male Breast Cancer: Strongest risk factors for this?
Klinefelter syndrome, a chromosomal conditio reflecting decreased testosterone levels.
162
Male Breast Cancer: How is presentation usually?
Painless lump, but is often late.
163
Male Breast Cancer: How common is early detection?
Is uncommon in male breast cancer because of teh rare nature of disease.
164
Male Breast Cancer: Treatment usually consists of what?
Mastectomy with either SLNB or ALND.
165
Male Breast Cancer: What is the most important prognostic indicator?
Involvement of the axillary lymph nodes.
166
Male Breast Cancer: Mainstay of treatment?
Tamoxigen, because they are very likely to be ER+.
