Surgery and Reconstruction in Breast Cancer Flashcards
what are the 2 different kinds 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
when would a breast conservation be performed?
equivalent disease free and overall survival as mastectomy as long as
- clear margins >1mm
- breast radiotherapy
what neoadjuvant treatment can be used to achieve breast conservation?
chemotherapy (standard FEC100 and taxane) +/- herceptin
*aromatase inhibitors more effective than tamoxifen so reserved for post menopausal women
what is oncoplastic surgery?
oncoplastic - safe oncological (cancer) surgery while avoiding tissue deformity
uses principles of cancer and plastic surgery to reshape breast contours at time of cancer resection
what is a mastectomy?
removal of all breast tissue
what are the options post mastectomy?
external prosthesis
reconstruction
- implant only
- latissmus dorsi (LD) pedicled flap +/- implant
- deep inferior epigastric artery perforator (DIEP) free flap
- inferior gluteal artery perforator (IGAP) free flap
what are the two different types of breast reconstruction options?
implant based
- tissue expander
- ADM / implant
- de-epithelialised skin / implant
- LD / implant
autologous
- pedicled LD flap
- pedicle TRAM
- free TRAM
- DIEP flap
- S-GAP flap
- I-Gap flap
what is the current method of implant reconstruction?
1st: mastectomy and creation of submuscular pocket with expander insertion
clinic visits for expansion 2 weekly
2nd: exchange of expander for permanent implant (although can leave some expanders and remove ports only)
what are the advantages of “one stage” implant reconstruction by providing lower pole coverage?
better lower pole expansion reduce postoperative pain improved aesthetic outcome permanent implant can be used at 1st operation also useful for revisional surgery
what axillary treatment options can take place?
sentinel node biopsy
axillary clearance
axillary radiotherapy
what is herception?
human epidermal growth factor receptor 2 monoclonal antibody trastuzamad
