Breast

Question 1

What are the 4 types of breast procedures?

Answer 1

Mastectomy
Partial Mastectomy (Lumpectomy)
Reconstruction
Reduction (mammoplasty)

Question 2

What two types of surgeon perform mastectomies?

Answer 2

General surgeons (with specialized training) and surgical oncologists

Question 3

What type of surgeon performs reconstructions and reductions?

Answer 3

Plastic

Question 4

What is a mastectomy?

Answer 4

Surgery to remove all breast tissue as a way to treat or prevent cancer

Question 5

What are the 5 types of mastectomies?

Answer 5

Total Simple
Modified Radical
Radical
Skin Sparing Mastectomy (SSM)
Nipple Sparing Mastectomy (NSM)

Question 6

What is a Total Simple Mastectomy?

Answer 6

Removal of the breast tissue, nipple, and areola with large skin incision

Question 7

What is a Modified Radical Mastectomy?

Answer 7

Removal of the breast tissue, nipple, areola, and lymph node bundle in axilla or armpit

Question 8

What is a Radical Mastectomy?

Answer 8

Removal of the breast tissue, nipple, areola, lymph node bundle in axilla or armpit, underlying muscle (minority of mastectomies)

Question 9

What is a Skin Sparing Mastectomy?

Answer 9

removal of breast tissue, nipple, areola, with preservation of vast majority of overlying skin for cosmetic advantage during reconstruction

Question 10

What is a Nipple Sparing Mastectomy?

Answer 10

newer technique performed when cancer is not near nipple or areola and is not of large size – incision is made on edge of breast or around edge of areola and breast is hollowed out, keeping nipple/areola complex intact

Question 11

What are the risks of mastectomy?

Answer 11

pain, infection, bleeding, long term swelling or lymphedema of arm or breast, formation of hard scar tissue at surgical site, shoulder pain and stiffness, numbness under arm from nerve injury during lymph node removal, and hematoma

Question 12

What is another name for Partial Masectomy/Lumpectomy?

Answer 12

Breast conserving or breast sparing surgery

Question 13

What is the margin?

Answer 13

A small amount of normal tissue around the lump is taken to help ensure all of the cancer or other abnormal tissue is removed

Question 14

What is Breast Reconstruction?

Answer 14

A surgery to rebuild chest mound after mastectomy so that it is the same size and shape as it was before - also, nipple and areola can be recreated

Question 15

What are the three types of Breast Reconstruction?

Answer 15

Immediate (one stage), Delayed (two stage), Flap

Question 16

What is an immediate reconstruction?

Answer 16

Implant is placed directly after the mastectomy by plastic surgeon on the same day under pectoralis or above it where breast tissue was removed (sometimes a graft or absorbable mesh to hold in place)

Question 17

What is a Delayed Reconstruction?

Answer 17

Two stage - after mastectomy, a tissue expander similar to a balloon is placed under chest muscle to stretch space and skin above for permanent implant - it is filled over a 4-6 month period with saline over a valve. Carries lower risk of postoperative complications.

Question 18

What are four types of flaps?

Answer 18

Tram Flap, LDM Flap, DIEP Flap, Gluteal Free Flap

Question 19

What is a Tram Flap?

Answer 19

Transverse Rectus Abdominus Myocutaneous uses skin and subcutaneous tissue from the tummy

Question 20

What is a DIEP Flap?

Answer 20

Deep Inferior - uses fat and skin from same area as TRAM flap but does not use muscle, just fat and skin

Question 21

What is an LDM Flap?

Answer 21

Moves muscle and skin from upper back when extra tissue is needed

Question 22

What is a Gluteal Free Flap?

Answer 22

Newer type that uses tissue from buttocks including gluteal muscle

Question 23

What is a breast reduction?

Answer 23

Excess fat, glandular tissue, and skin are removed from breast - also called reduction mammoplasty

Question 24

What are the three reasons a breast reduction is performed?

Answer 24

To address neck and back pain
Under breast rashing (intertrigo)
Cosmesis

Question 25

Where are breast reduction incisions positioned?

Answer 25

Positioned to allow optimal removal of excess tissue and for best cosmetic result - there is tons of dissection up to several pounds of tissue

Question 26

What are the three incision patterns in breast reduction procedures?

Answer 26

Circular patterned, Keyhole Racquet Shaped, Inverted T Anchor Shaped

Question 27

Where are scars in reduction mammoplasty?

Answer 27

On underside of breast

Question 28

What is PB value proposition in mastectomy?

Answer 28

Reduces mean drainage volume and drainage duration

Question 29

What is PB value proposition in lumpectomy?

Answer 29

Decreases thermal injury to surgical margins, improving quality of samples for margin assessment

Question 30

What is the value proposition of PB in breast procedures?

Answer 30

Reduced thermal injury & inflammatory response
No loss of cutting efficiency in local anesthetic (tumescence)
Eliminates sharps injury
Equivalent healing to scalpel
Reduced blood loss
Reduced tissue dissection time

Question 31

Tips to know for breast

Answer 31

During long procedures may need to increase power over time
COAG mode wears device down more
Use right device for right procedures (3.0s for smoke evac and precision, 4.0 for bendable shaft and anatomy with lower visibility)

Question 32

PB Settings for Breast

Answer 32

Cut - Initial Skin Incision - 5, rest 5-8

Coag - 5-8, do not use on skin incision