6: Surgery and reconstruction in breast cancer

Question 1

Breast masses are excised leaving a ___ ___.

Answer 1

clear margin

i.e a border in which there definitely isn’t cancer

Question 2

What are the two types of breast surgery?

Answer 2

Breast conserving surgery

Mastectomy

Question 3

What are some forms of breast conserving surgery?

Answer 3

Lumpectomy

Wide local excision

Wire-guided excision

Question 4

Which surgery is most effective for treating breast cancer and preventing recurrence?

Answer 4

Both are equally effective if done correctly and under the right circumstances

e.g proper margins and depth, adjuvant chemo/radio/hormonal therapy

Question 5

Breast cancer patients are offered ___ ___ surgery if possible.

Answer 5

breast conservation

Question 6

Breast conserving surgery is just as effective as mastectomy at reducing recurrence as long as which factors are true?

Answer 6

Clear margins > 1mm

Adjuvant radio, chemo or hormonal therapy / Herceptin

Incision is deep enough

Question 7

What adjuvant treatments can be used after surgery to reduce breast cancer recurrence?

Answer 7

Chemotherapy

Radiotherapy

Hormonal therapy e.g tamoxifen, aromatase inhibitors

Herceptin

Question 8

What is oncoplastic surgery?

Answer 8

Effective cancer surgery without deforming the patient

i.e aesthetics considered in addition to cancer outcome

Question 9

If you’re removing a large area of disease from one breast, what has to be considered?

Answer 9

The other one

Lopsided breasts are a problem aesthetically and in terms of discomfort so often oncoplastic surgery involves breast reduction on the contralateral side

Question 10

Reconstructions following mastectomy often involve taking ___ ___ from other places.

Answer 10

skin grafts

Question 11

Apart from grafts, what else can be inserted during reconstructive breast surgery?

Answer 11

Breast implants

Question 12

What are some complications of using implants in reconstructive surgery?

Answer 12

Infection - foreign material in the body

Double bubble effect - migration of implant causing deformed appearance

Lymphoma - 1 in 25,000 chance

Question 13

What can happen to the connective tissue around a breast implant?

Answer 13

Fibrosis and contracture

Question 14

If fitted improperly, breast implants can ___ elsewhere.

Answer 14

migrate

upwards, downwards etc.

Question 15

Patients going for breast implants must be advised that they may require…?

Answer 15

more than one surgery in their lifetimes due to complications

revision surgeries

Question 16

Which cancer is loosely associated with breast implants?

Answer 16

Lymphoma

Question 17

Patients receiving breast implants must be advised that there is a 1:25,000 chance they could develop ___.

Answer 17

lymphoma

Question 18

Which muscle can be pulled across to the breast (without interrupting its blood supply) to reconstruct the breast?

Answer 18

Latissimus dorsi

Question 19

Which area of skin on the trunk can be used as a graft in reconstructive surgery?

Answer 19

Umbilical skin

Just above the groin, supplied by the inferior epigastric artery

Question 20

Which artery is ‘plumbed into’ umbilical skin when the skin is used as a graft in reconstructive surgery?

Answer 20

Internal mammary artery

Question 21

Which area of skin on the lower limb can be used as a graft in reconstructive surgery?

Answer 21

Inferior gluteal fold

Question 22

Which lymph nodes, found in the axilla, are often operated on in breast cancer surgery?

Answer 22

Sentinel nodes (first axillary nodes to drain the cancer)

Question 23

Which complication occurs secondary to lymph node clearance in breast surgery?

Answer 23

Lymphoedema

Question 24

Are the internal mammary nodes commonly operated on in breast surgery?

Answer 24

Not commonly

You have to manipulate the ribs and sternum to get at them

Question 25

A ___ ___ biopsy is often carried out alongside breast surgery.

Answer 25

sentinel node biopsy

Question 26

In terms of breast cancer surgery, what is meant by a margin?

Answer 26

A rim of healthy tissue around the site of a lumpectomy

Question 27

Bigger margins are more likely to prevent breast cancer recurrence - true or false?

Answer 27

False

1mm is sufficient and just as good as 1cm, so long as no tumour cells are crossing the margin

Question 28

In breast cancer surgery, ALL axillary lymph nodes should be removed - true or false?

Answer 28

False

Even if sentinel node biopsy is positive, studies show this doesn’t improve overall survival rate

It also causes lymphoedema - arm swelling

Question 29

What length of margin is left around excised breast cancers?

Answer 29

1 mm