Surgical options for the breast

Question 1

What options are there for breast conserving surgery?

Answer 1

‘Lumpectomy’/wide local excision

Wire guided wide local excision

Oncoplastic breast conservation inc therapeutic mammoplasty

Question 2

What treatment must be given in conjunction with wide local excision to ensure effective oncological therapy?

Answer 2

Radiation

Question 3

What mastectomy options are there?

Answer 3

Traditional transverse

Skin sparing with immediate reconstruction

Question 4

What adjuvant treatment is given to try and avoid mastectomy?

Answer 4

Chemotherapy +/- herceptin

Endocrine therapy: tamoxefen and (preferably) aratomatase inhibitors e.g. lamotrizole

Question 5

What is the main reconstruction option for immediate reconstruction following mastectomy?

Answer 5

Implants

Question 6

What is the two step approach to implants in immediate reconstruction?

Answer 6

1. mastectomy and creation of submuscular pocket with insertion of expander
   - clinic visits for expansion 2 weekly
2. replacement of expander with permanent implant

Question 7

How can the latissmus dorsi be used in breast reconstruction?

Answer 7

Can be excised and transferred to breast area to create a myocutaneous flap, +/- implant insertion

Question 8

What are the main problems with implants?

Answer 8

Loss of implants (infection)

Capsular contracture

Implant rippling

Implant migration

40% require revisional surgery

Question 9

Other than latissmus dorsi, what other flaps can be used for breast reconstruction?

Answer 9

Transverse rectus abdominus/deep inferior epigastric artery flap

Inferior gluteal artery perforator flap

Question 10

What is the main complication with axillary clearance?

Answer 10

Lymphoedema