Surgery and Reconstruction Flashcards
What neoadjuvant treatment can be given in breast cancer?
Chemotherapy - standard FEC and taxane +/- herceptin
Endocrine - aromatase inhibitor (post-menopausal)
What factors influence a patient decision regarding breast surgery?
Oncological - cancer, spread, return
Psychological
Cosmetic - body image, scarring
Is breast conservation surgery or mastectomy better?
No overall survival difference - probably breast conservation has better outcomes
Name three types of breast conservation surgery
Wide local excision
Image guided local excision
Oncoplastic
Describe how a tumour is removed
Leave skin unless directly involved, full thickness excision to fascia of pectorals with 1cm margin of normal tissue. Use of wires or magnetic seed.
What is oncoplastic surgery?
Safe surgery while avoiding tissue deformity
Name three types of oncoplastic surgery
Therapeutic mastoplexy
Therapeutic reduction mammoplasty
Volume replacement
What is a therapeutic mastoplexy?
Breast lift
Describe therapeutic reduction mammoplasty
Pedicle kept to maintain blood supply to nipple. Resection of cancer and margins then join up the points with discrete neat scar
Describe volume replacement
Lateral intercostal artery perforator flap - skin and tissue from under armpit used
What are the methods of reconstruction?
External prosthesis
Implant/expander
Lattissimus dorsi flap
Free flap from abdomen, gluteal region, leg
What are the advantages and disadvantages of an implant/expander?
No other body scars
Risk of infection, capsular contractions, rippling, migration, lymphoma
How can a implant be inserted?
Under pecs and slowly inflated
Mesh with pec muscle
Above pec muscle solely mesh (most common now)
Describe a latissimus dorsi flap
Initial weakness, scar along bra line as skin and muscle from back used. Blood supply already present so reduced risk. May twitch when muscle used.
Where can a free flap come from?
Deep inferior epigastric perforator flap
Gluteal
Thigh
