Surgery and Reconstruction Flashcards
what are the main principles of surgical oncology
surgical excision with a clear margin
preserve function
multidisciplinary team working
what are the types of breast conservation surgery
‘lumpectomy’ - wide local excision
wire guided local excision
oncoplastic breast conservation with therapeutic mammoplasty (eg. to increase size after radio)
what are the types of mastectomy
traditional transverse
skin sparking with immediate reconstruction
what factors are considered when deciding between breast conserving surgery or mastectomy
oncological
psychological
cosmetic
is breast conservation as effective at getting rid of the cancer as mastectomy
yes - equivalent disease free and overall survival as long as:
clear margins (>1mm) Breast radiotherapy
what is an impalpable breast cancer
can’t feel the lump
detected at breast screening
how do you manage impalpable disease
specimen x-ray
wire guided local excision
what is neoadjuvant treatment
treatment given before the surgery
what neoadjuvant treatment is used to achieve breast conservation
chemotherapy (FEC100 and taxmen) +/- Herceptin
Endocrine (aromatase inhibitors - reserved for post menopausal women (letrozole) )
both methods reduce mastectomy rates
theres an overall survival advantage for younger women if chemo is done pre-surgery
how do you asses response to neoadjucant therapy
mammography
ultrasound
MRI
what is oncoplastic surgery
safe cancer surgery while avoiding tissue deformity
uses principles of cancer and plastic surgery to reshape the breast contours at the time of cancer resection
what oncoplastic breast conservation techniques is used for large breasts/large tumour and reshaping
theraputic mammoplasty
what oncoplastic breast conservation techniques are used for small breasts
volume replacement techniques
what is a mastectomy
removal of all breast tissue
can be standard or skin sparing - usually if immediate reconstruction
what are the breast reconstruction options after mastectomy (and where they come from)
external prosthesis (chicken fillets)
Reconstruction (Immediate or delayed)
- implant only (+ autologous cellular matrix)
- latissmus dorsi pedicle flap + implant
- depp inferior epigastric arterator perforator free flap
- inferior plural artery perforator free flap
what is the difference between a pedicled flap and a free flap
pedicled flap stays attached to its blood supply and just swung around to a new position
free flap is detached from its blood supply and reattached to a new one
what are the main complications of reconstruction using prosthetic breast implants
loss of implants (infection)
capsular contracture
implant rippling
implant migration
40% require revision surgery
what are the two stages of implant reconstruction
1- mastectomy and creation of a sub muscular pocked with an expander inserted
(clinic visits for expansion 2 weekly)
2- exchange the expander for permanent implant
what are the advantaged of acellular dermal matrix with the implant
pig skin or cow tissue which holds the implant in place
means theres just one stage implant reconstruction by lowering pole coverage
better pole expansion
reduced post op pain
improved aesthetic outcome
permanent implant can be used at 1st operation
also useful for revision surgery
what finishing touches are done after breast reconstruction
nipple reconstruction lipomodelling contralateral symmetrising (reduction or augmentation)
what treatment options are there for spread to the axillary nodes
pre-op axillary staging
sentinel node biopsy
axillary clearance
axillary radiotherapy
