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Plastics 1 Flashcards

1
Q

Breast Reduction Symptoms

5

A
  1. Neck, back, and shoulder pain
  2. Headaches
  3. Difficulty sleeping
  4. Intertrigo
  5. Difficulty exercising
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2
Q

Physical Findings

for breast reduction 4

A
  1. Normal nipple position at 21 cm from sternal notch
  2. Can be 40 cm or greater
  3. Deep shoulder grooves
  4. Intertrigo
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3
Q

Workup for BR? 5

A
  1. Screen for medical illnesses
  2. Good diabetic control
  3. Smokers take a hike
  4. Usual screens for medical illness
  5. Mammogram
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4
Q

Indications for BR

4

A
  1. Lots of variation in insurance coverage
  2. Most require resections of 350-500 grams of tissue per breast
  3. Primary care referral, orthopedics, chiropractor
  4. BMI may be an issue
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5
Q

Patient Education

4

A
  1. Patients must understand that there is a trade-off of a better size and shape for scars
  2. Nipple sensitivity may be effected
  3. Breast feeding is 50 50
  4. Breasts can get bigger again with weight gain
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6
Q

Procedure for BR:

  1. Takes about how long?
  2. Inpatient or Outpatient?
  3. Anesthetic?
  4. What is needed for a few days?
  5. What is the shape like initially and then what does it do after?
A
  1. Takes about 3 hours
  2. Outpatient
  3. General anesthesia
  4. Drainage for a couple of days
  5. Shape boxy at first, later softens
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7
Q

Complications for BR?

5

A
  1. Healing problems–skin loss
  2. Nipple problems–loss, sensitivity
  3. Breast feeding problems
  4. Scars
  5. Fat necrosis
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8
Q

Post Mastectomy Reconstruction: Who may need this?

5

A
  1. Breast Cancer
  2. BRCA Gene
  3. Severe Fibrocystic Disease
  4. Breast never develops
  5. Trauma, cosmetic disaster
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9
Q

Considerations in Reconstruction

6

A
  1. Do it or don’t do it
  2. Immediate or delayed
  3. Chances of chemo or radiation
  4. Tissue reconstruction or implant based
  5. Body type
  6. How much do you want to put into breast reconstruction?
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10
Q

For reduction of gynectomastia what do you need to do before surgery?

A

testicular exam

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11
Q

Immediate versus Delayed
1. Advanatges? 2

  1. Unexpected findings could do what?
  2. Slightly higher risk of what?
A
    • Immediate reconstruction avoids the postmastectomy defect
    • Consolidates operations
  2. compromise reconstruction (radiation)
  3. infection
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12
Q

Delayed Reconstruction
1. Advantages? 2

  1. Disadvanatges? 2
A
    • Chance to let therapeutic options get sorted out
    • lower risk of infection
    • Skin flaps are delayed and thus a little tougher
    • More tissue contraction though
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13
Q

Assessing Chances of Chemo or Radiation

4

A
  1. Size of tumor
  2. Skin changes
  3. Presence of nodes
  4. Histology
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14
Q

Single versus Double
1. What leans toward bilateral?

  1. What may influence decision? 2
  2. Things to take into consideration? 2
A
  1. BRCA gene or malignant family history
  2. DCIS or lobular
    • Symmetry
    • Long term risks
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15
Q

Body Type

Considerations?

A
  1. Slim versus non slim
  2. Available tissue for reconstruction
  3. History of other incisions or procedures
  4. Radiation history
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16
Q

Preop Visit

6

A
  1. Establish rapport–very charged subject
  2. Gentle education
  3. Stress the positive
  4. Realistic expectations
  5. Exam and measurements
  6. Careful history
17
Q

Expander Implant Method
1. Procedure involves placing a what where?

  1. HOw long after surgery begin expanding muscle and skin?
    - Adjust expansion to desired size
  2. Replace expanders with what?
A
  1. tissue expander under the pectoral muscle and an acellular dermal matrix sling (Alloderm)
  2. Three weeks
  3. implants
18
Q

Latissimus Dorsi Flap

  1. Used when?
  2. Adds what to the reconstruction?
  3. Advantages? 3
  4. Where is the scar?
  5. Drainage from where?
A
  1. Useful when radiation is anticipated
  2. Adds skin and muscle volume to reconstruction
    • Hearty Flap,
    • rarely dies,
    • usually donor site not a problem
  4. Scar on back

5 .Drainage from harvest site

19
Q

What are the different kinds of tissue flaps?

5

A
  1. TRAM
  2. DIEP
  3. SGAP
  4. SIEP
  5. Abdominal and sometimes buttock tissue flaps used for breast reconstruction
20
Q

Tissue Flaps

  1. Advanatge? 1
  2. Disadvanatges? 4
A
    • Advantage of no implants
    • Donor site defects can be a problem
    • Flaps can die or lose volume
    • Reimbursement is poor
    • Requires microsurgical team and instruments, lots of time
21
Q

Modifying the Other Breast
1. Other breast may be too big, too small, too saggy: What are our options for this? 3

  1. What procedures are covered by law?
A
  1. Options are
    - breast reduction,
    - breast augmentation,
    - breast lift
  2. Symmetry procedures are covered by law
22
Q

Typical areas for excess skin? 5

A

Typical areas are

  1. arms,
  2. neck,
  3. breasts,
  4. abdomen,
  5. thighs
23
Q

What do you need to know:
before body contouring?
4

A
  1. Good to have stable weight for best results
  2. Nutritional and physical condition need to be good
  3. Lots of inches to heal, so proteins need to be up and the cardiovascular output good
  4. Good medical condition otherwise—this is elective surgery and has to go well
24
Q

Complications

of body contouring? 5

A
  1. Don’t get talked into doing too much at one time
  2. Complications are heavily related to length of procedure
  3. I don’t go over four hours
  4. Bleeding and infection aren’t common, maybe 5% if conservative approach used
  5. Small wound breakdowns are not uncommon
25
Q

Abdominoplasty/Panniculectomy

  1. Incision where?
  2. Takes how long?
  3. Blood loss?
  4. Pain control?
  5. Sutures?
  6. Scars take how long to fade?
A
  1. Incision from hip to hip
  2. Takes about 2-3 hours
  3. Usually little blood loss
  4. We use long acting injectable pain killers
  5. No outside stitches usually
  6. Scars take 6-12 months to fade
26
Q

Arm Reduction/Brachioplasty

  1. Incision from where?
  2. Sometimes just where?
  3. Scars?
  4. Healing?
A
  1. Incision from elbow to armpit
  2. Sometimes just in armpit
  3. Scars aren’t the greatest
  4. Can be slow healing
27
Q

Breast lift

  1. Incsions where? 3
  2. Takes how long?
  3. Usually back to work when?
  4. Sometimes some open areas that take how long to heal?
  5. Satisfaction rate?
A
  1. Incisions around areola, vertical from the areola, and in the fold under the breast
  2. Takes about 2.25 hours
  3. Usually back to work in 1-2 weeks
  4. Sometimes some open areas that heal in 2-3 weeks
  5. Very high satisfaction rate
28
Q

Thigh lift

  1. Incision where?
  2. What dictates the incision?
  3. Higher rate of what?
  4. When should we decide to do this surgery?
A
  1. Incision either down the inside of the thigh or in the groin
  2. Amount of excess thigh skin dictates the incision
  3. Higher rate of wound breakdown
  4. Patients are happy if they have a lot of excess skin
    - Minor excess—probably not worth it

Surgery (20 decks)

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