Breast cancer surgery

Question 1

What is breast conservation surgery?

Answer 1

Basically a lumpectomy, where the lump itself is only removed.

Question 2

What is a mastectomy?

Answer 2

The removal of all breast tissue

Question 3

Mastectomy should be offered to most patients. True/false?

Answer 3

False

All patients should be offered BCS (breast conservation surgery) if possible; outcomes better when BCS with radiotherapy.

Question 4

When should a mastectomy be provided?

Answer 4

• Large area of disease relative to breast size
• Avoidance of radiotherapy
• Previous radiotherapy to breast
• Mutation carrier
• Patient wishes

Question 5

What is oncology in treatment of breast cancer?

Answer 5

To remove cancer with clear margins

Question 6

Plastics/aesthetics in breast cancer treatment?

Answer 6

Reshape the breast, avoid deformity, better placement of scar

Question 7

How can risks be reduced during breast surgery treatment?

Answer 7

Allow for greater tissue volume to be taken therefore less risks of margin involvement

Question 8

What are the 2 classifications of oncoplastic breast surgery?

Answer 8

Level 1 and level 2 oncoplastic breast surgery

Question 9

What is level 1 oncoplastic breast surgery?

Answer 9

less than 20% breast tissue removal

Question 10

What is level 2 oncoplastic breast surgery?

Answer 10

more than 20% breast tissue removal and requires volume displacement or replacement techniques

Question 11

What are methods used to fill the defect following breast surgery?

Answer 11

Volume replacement

Volume displacement

Question 12

What is volume replacement in fixing a defect following breast surgery?

Answer 12

Taking volume elsewhere to replace tissue resected e.g. autologous flap e.g. local perforator flaps, implants, or fat grafting

Question 13

What is volume displacement in fixing a defect following breast surgery?

Answer 13

2 types:

• Level I: skin incision, undermining of skin and/or NAC, glandular tissue mobilisation, approximation of tissues and re-positioning of nipple areolar complex
• Level II: therapeutic mammoplasty i.e. nipple repositioned with the use of pedicles

Question 14

What is a sentinel node biopsy?

Answer 14

Removal of the 1st few axillary lymph nodes as part of breast cancer surgery when pre-op USS axilla normal

Radioisotope and blue dye are often used to help stage the axilla and guide treatment.