Surgical Treatments for Breast Cancer Flashcards
(31 cards)
Describe why breast surgery is the best option for breast cancer?
There are very few people who cannot survive breast surgery, and it usually only takes < 2 hours unless you are reconstructing
What treatment may be used for individuals who have severe cases of breast cancer where surgery is contra-indicated and have a low life expectancy?
Primary hormone therapy
If a person says, “I’ll have a mastectomy to reduce the chances of the cancer coming back” what should you tell them?
You must make sure the patient isn’t making the decision thinking that a mastectomy will stop the cancer from coming back. Systemic treatment is what will stop the person having a recurrence elsewhere.
What are the two main types of surgery for breast cancer?
Breast conserving surgery and mastectomy
What is the main type of breast conserving surgery?
Wide local excision (lumpectomy)
How can breast conserving surgery be done if the cancer is non-palpable?
Wire guided local excision using US preferably and if not mammography (stereotactic)
What are the two types of mastectomy?
Traditional transverse and skin sparing with immediate reconstruction
If a woman is having a mastectomy, when is the best time to do reconstruction surgery and why?
At the same time, as there is more of the woman’s own breast tissue present
What is the preferred surgical management of breast cancer and why?
Breast conserving surgery (with radiotherapy) because it has the same survival benefit as mastectomy and has a better cosmetic outcome
Breast conservation surgery has equivalent disease free and overall survival as mastectomy as long as what applies?
There is adjuvant radiotherapy, there are clear margins (must be > 1mm, ideally > 1cm)
Following wire guided local excision, what should you always do?
Send a sample to pathology to orientate it and check that the margins are clear
Why is skin sparing mastectomy preferred? When is this usually done?
Because it has a better cosmetic outcome, it is usually done when immediate reconstruction is taking place
What is the alternative to breast reconstruction?
External prosthesis
Modified radical mastectomy removes what?
The entire breast, including the overlying skin and the axillary lymph nodes
What is the major modification in modified radical mastectomy? Why?
Preservation of the pectoralis major muscle - facilitates improved wound healing and potentially allows reconstruction
Who are candidates for breast reconstruction? When should this be brought up?
Essentially anyone having a mastectomy is a candidate for reconstruction - you should present this option to patients when they are making their choice
What are some options for breast reconstruction?
Implant only / latissimus dorsi pedicled flap +/- implant / deep inferior epigastric artery perforator free flap / inferior gluteal artery perforator free flap
What are the main issues with breast implants?
Loss of implants due to infection, implant rippling, implant migration
What is oncoplastic breast surgery?
Safe oncological surgery while avoiding tissue deformity
What oncoplastic option is available for women with large breasts?
Therapeutic mammoplasty (breast reduction)
What oncoplastic option is available for women with small breasts?
Volume replacement techniques
What are some finishing touches that can be done after oncoplastic surgery?
Nipple reconstruction, lipomodelling, contralateral symmetrising (reduce or augment)
What chemotherapy regime is used neo-adjuvantly?
Standard FEC100 and taxane +/- herceptin
Assessment of response to neoadjuvant therapy is done radiologically using what modalities?
US, mammography and MRI
