Flashcards in Breast Cancer Surgery/Reconstruction Deck (15)
What are some types of breast conservation surgery?
Wide local excision
Wire guided local excision
Oncoplastic breast conservation inc therapeutic mammoplasty
What are the types of mastectomy?
Skin sparing with immediate reconstruction
When does breast conservation provide the equivalent disease free and overall survival rates as mastectomy?
Clear margins >=1mm
What should be aimed for in breast conservation?
Surgical wide excision aim for 1cm excision at all margins
Perform “full thickness” excision at anterior and posterior margins
How can an impalpable mass found on imaging be managed?
Localisation wide excision
What chemotherapy can be used as neoadjuvant treatment to achieve breast conservation?
Standard FEC100 and taxane
What oncoplastic surgery will be used in large breasts, or large tumours and reshaping?
What oncoplastic surgery will be used in small breasts?
Volume replacement techniques
What are the options in mastectomy?
Reconstruction: Immediate or delayed
Implant only (+/- autologous cellular matrix)
Latissimus dorsi (LD) pedicled flap +/- implant
Deep inferior epigastric artery perforator (DIEP) free flap
Inferior gluteal artery perforator (IGAP) free flap
What are examples of implant based reconstruction options?
Acellular Dermal Matrix (ADM)/Implant
What are examples of autologous reconstruction options?
Pedicled LD flap
What are the main problems in implant based surgery?
Loss of implants (infection)
40% require revisional surgery
What is the two stage implant reconstruction?
1st: Mastectomy and creation of submuscular pocket with expander insertion
Clinic visits for expansion twice weekly
2nd: Exchange of expander for permanent implant (although can leave some expanders and remove ports only)
What are the advantages of ADM reconstruction?
“One stage” implant reconstruction by providing lower pole coverage
Better lower pole expansion
Reduced postoperative pain
Improved aesthetic outcome
Permanent implant can be used at 1st operation
Also useful for revisional surgery