Surgery and Reconstruction Flashcards
What are some neoadjuvant treatments for breast conservation?
Chemotherapy +/- herceptin
Aromatase inhibitors = postmenopausal women
When can chemotherapy offer some survival advantage for younger women?
If given pre-breast conserving surgery
What are the types of breast surgery?
Breast conservation and mastectomy
What are the types of breast conserving surgery?
Wide local excision, wire-guided local excision, oncoplastic breast conservation
What are the types of mastectomy?
Traditional transverse mastectomy, skin sparing mastectomy with immediate reconstruction
Does getting a mastectomy improve survival outcomes?
No = overall survival 19% better with breast conservation, mastectomy also has worse body image outcomes
When does breast conserving surgery have the same disease free and overall survival as mastectomy?
As long as there are clear margins >=1mm plus breast radiotherapy
What kind of margins are left when performing breast conserving surgery?
Surgical wide excision aims for 1cm at all margins
Perform full thickness excision at anterior and posterior margins
When is oncological surgery used?
When disease is non-palpable = safe oncological surgery while avoiding tissue deformity
What are the principles of oncologic surgery?
Uses principles of cancer and plastic surgery to reshape breast contours at time of cancer resection
What may breast reconstruction utilise?
External prosthesis
When can breast reconstruction be done?
Either at the time of cancer resection or at a later date
What are the types of breast reconstruction?
Implant only +/- autologous cellular matrix
Latissimus dorsi pedicled flap +/- implant
Deep inferior epigastric artery perforator free flap
Inferior/superior gluteal artery perforator free flap
Transverse upper gracilis free flap
Profunda artery perforator free flap
How common are implant reconstructions?
37% of all immediate reconstructions in UK
What are the benefits of implant reconstructions?
Short initial operation and no other body scars
