Surgery and Reconstruction for Breast Cancer Flashcards
Types of breast surgery?
Breast conservation: • Lumpectomy • Wide local excision • Wire-guided local excision • Oncoplastic breast conservation, inc. therapeutic mammoplasty
Mastectomy:
• Traditional transverse
• Skin sparing, with immediate reconstruction
Does a mastectomy reduce the chances of breast cancer recurrence?
Evidence indicates that there is no difference in survival
Breast conservation has equivalent disease-free and overall survival as mastectomy, as long as:
• Clear margins ≥1mm
• Breast radiotherapy
With surgical wide excision, aim for 1cm excision at all margins
Perform full-thickness excision at the anterior and posterior margins
Issues to cover when considering breast conservation?
Is it feasible?
If not, neoadjuvant treatment be appropriate/ helpful?
Is an oncoplastic approach required?
What does the patient want and why?
What should be done if the disease is impalpable, e.g: it is detected at breast screening?
Specimen X-ray
Options or neoadjuvant treatment alongside breast conservation surgery?
Chemotherapy +/- Herceptin
Endocrine therapies - aromatase inhibitors are more effective than tamoxifen, so it is reserved for post-menopausal women
Uses of neoadjuvant breast cancer chemotherapy?
Currently used to control local disease, as well as systemic
Can allow for less surgery, e.g: breast conservation
How to assess response to neoadjuvant chemo?
Radiological with mammography, USS and MRI
What is oncoplastic surgery?
Safe oncological (cancer) surgery that avoids tissue deformity; principal use is to reshape the breast contours at the time of cancer resection
Methods used in oncoplastic breast conservation?
Therapeutic mammoplasty for:
• Large breast
• Large tumour and reshaping
Volume replacement techniques for:
• Small breasts
Delayed symmetrising, e.g: augment, lipomodelling
What is a mastectomy?
Removal of all breast tissue
Options following a mastectomy?
Use of an external prosthesis
Reconstructions - either immediate or delayed
Implant only +/- autologous cellular matrix
Latissimus dorsi pedicled flap +/- implant
Deep inferior epigastric artery perforator (DIEP) free flap
Inferior gluteal artery perforator (IGAP) free flap
Options for breast reconstruction?
Immediate or delayed
Implant-based or autologous
Options for an implant-based breast reconstruction?
Tissue expander
Acellular dermal matrix (ADM)/implant
De-epithelialised skin/implant
LD/implant
Options for an autologous breast reconstruction?
Many options, e.g: pedicled LD flap, pedicle TRAM, free TRAM, SGAP, IGAP
Main problems with breast implants?
Loss of implants (infection)
Capsular contracture
Implant rippling
Implant migration
NOTE - 40% require revisional surgery
