Week 7 - F - Breast Surgery - Breast conserving Surgery (W.L.E) + radiotherapy or Mastectomy + Breast reconstruction Surgery Flashcards
What are the different types of breast surgery?
Breast conservation - usually always radiation is done with breast conservation surgery Wide local excision - main type Mastectomy is the other option
What is the difference between modified radical and radical mastectomy? What is the modified radical mastectomy also known as?
The modified radical mastectomy is also known as a total mastectomy Modified radical mastectomy - this involves the removal of the whole breast, overlying skin and axillary lymph nodes but pectoralis major is preserved The radical mastectomy does not include the preservation of the pectoralis major muscle
I’ll have a mastectomy to reduce down the chances of the cancer coming back Does having a mastectomy reduce recurrence rates of cancer?
Having a mastectomy reduces cancer occurrence but does not effect the risks of cancer coming back when compared to wide local excision + radiotherapy
When giving a patient breast conservation, it has the equivalent disease free and overall survival as mastectomy, as long as what?
It has the equivalent disease free and overall survival as mastectomy as long as there are clear >/= 1mm margins And breast radiotherapy is carried out afterward
As stated the clear margins are >/=1mm margins in breast conservation surgery along with breast radiotherapy to have the equivalent disease free and overall survival as mastecomy What is the margins aimed for if it is a surgical wide excision carried out and where is the full thickness excision in this procedure? (this is the breast conservation surgery) What is the surgical wide excision also known as?
The margins aimed for when surgical wide excision is carried out is 1cm excision at all margins Full thickness excision is carried out at the anterior and posterior margins - ie from behind skin to pectoral muscle The surgical wide excision is also known as a wide local excision or a lumpectomy
What is the neoadjuvant treatment given to treat breast cancer? (pre and post menopasual)
In pre menopasual women - give chemo and tamoxifen if ER+, and if HER2+ then trastuzamab (herceptin) In post-menopausal women - give chemo and aromatase inhibitor if ER + (first line in post menopasual over tamoxifen), and herceptin if HER2+
Neoadjuvant breast cancer chemotherapy Currently used to control local disease as well as systemic Can allow for less surgery eg breast conservation How is the response to the chemo currently assessed?
Mammograms Ultrasound MRI
In breast conservation surgery, obviously trying to preserve the shape of the breast whilst treating the cancer What has to happen after a mastectomy?
Breast reconstruction surgery
When is sin sparing mastectomy usually carried out?
The skin is usually spared if carrying out immediate reconstruction ie putting in an implant
What are the breast reconstruction mastectomy options?
- An external breast prosthesis - An external silicone breast prosthesis is a weighted prosthesis, made of silicone, which is designed to simulate natural breast tissue. (care home patients have this in their bra remember)
- An implant
- A lattisimus dorsi flap
- A transversus rectus abdominus flap (TRAM)
Pic shows a picture of an external breast prosthesis
The type of reconstruction option differs depending on whether breast reconstruction is immediate or delayed
- Immediate reconstruction is implant based - usually a normal implant or an acellular dermal matrix is inserted
The process of getting an implant differs from getting an acellular dermal matrix What are the different processes?
With the implant It is a two part process
- Need to put in a tissue expander during mastectomy and the creation of the submuscular pocket and come back for a second surgery to exchange the tissue expander for an implant
In the aceullar dermal matrix - only one appointment is required- also reduced post-op pain
How often are the clinic visits after the tissue expander is placed in the submuscular pocket during the 1st appointment after mastectomy?
The clinic visits are two weekly to make the expansion is coming appropriately so the implant can be fitted
What are the advantages of the acellular dermal matrix over the implant? What percentage of patients getting the implant require revisional surgery?
The acellular dermal matrix is one operation - ie at the same time as the mastecotmy It improves aesthetic outcome and reduces post-op pain It is also useful for revisional surgery if required 40% of people getting implants require revisional surgery due to a problem occurring
Apart from the external prosthesis, implant (tissue expander 1st op then exchange for implant 2nd op) and the acellular dermal matrix (ADM), what are other options used as breast reconstruction? Usually used if delayed reconstruction
Have the Lattisimus dorsi flap Transversus rectus abdominus flap (TRAM) Deep inferior epigastric artery perforator (DIEP) free flap Inferior gluteal artery perforator (IGAP) free flap
What are the finsihing touches carried out after the breast reconstruction?
Nipple remodeling Lipomodelling Contralateral symmetrising - reduction or augmentation
