Surgery and Reconstruction

Question 1

What are the principles of surgical oncology?

Answer 1

• surgical exision with a clear margin
  
  • assess surgical feasibility
  • assess patient suitability
  • assess potential impact on QOL
• Preserve function
• MDT working

Question 2

What is included within survivorship?

Answer 2

• signs and symptoms of recurrence
• improving wellbeing
• relationships and body image
• finance and work

Question 3

Describe endocrine neoadjuvant therapy

Answer 3

Aromatase inhibitors more effective than tamoxifen, so reserved for postmenopausal women

Question 4

what are the options within BCS?

Answer 4

Wide local excision

Wire guided local excision

oncoplastic brest conservation including therapeutic mammoplasty

Question 5

what are the options within mastectomy?

Answer 5

Traditional transverse

Skin sparing with immediate reconstruction

Question 6

BREAST CONSERVATION AND RADIOTHERAPY IS AT LEAST __ ____ AS MASTECTOMY, AND MAY HAVE _____ ________

Answer 6

BREAST CONSERVATION AND RADIOTHERAPY IS AT LEAST AS SAFE AS MASTECTOMY, AND MAY HAVE BETTER OUTCOMES

Question 7

Cosmesis and satisfaction after breast-conserving surgery correlated with what?

Answer 7

The % of breast volume excised

Question 8

Breast conservation has equivalent disease free and overall survival as mastectomy as long as;

Answer 8

clear margins >/= 1mm PLUS breast radiotherapy

Question 9

What should be performed at anterior and posterior margins of tumour in BCS?

Answer 9

full thickness excision

Question 10

What is oncoplastic surgery?

Answer 10

• safe oncological (cancer) surgery while avoiding tissue deformity
• Uses principles of cancer and plastic surgery to reshape breast contours at time of cancer resection

Question 11

Impants are used in __% of all immediate recons in the UK

What are the benefits and complications?

Answer 11

37%

• benefits
  
  • no other body scars
  • short initial operation
• complications
  
  • loss of implants (infection)
  • capsular contracture
  • implant rippling
  • implant migration
  • 40% require revisional surgery
  • <1:25,000 risk of ALC lymphoma

Question 12

What is used to make implant surgery safer?

Answer 12

Tissue expanders

Question 13

What are the finishing touches of mastectomy?

Answer 13

Nipple reconstruction

Lipomodelling

Contralateral symmetrising: reduction or augment

Question 14

What are the axillary treatment options?

Answer 14

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

Question 15

What is a common complication of axillary node surgery?

Answer 15

Lymphoedema

Question 16

What are the principles of sentinel node biopsy?