Breast Cancer Surgery/Reconstruction Flashcards Preview

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Flashcards in Breast Cancer Surgery/Reconstruction Deck (15):
1

What are some types of breast conservation surgery?

Lumpectomy
Wide local excision
Wire guided local excision
Oncoplastic breast conservation inc therapeutic mammoplasty

2

What are the types of mastectomy?

Traditional transverse
Skin sparing with immediate reconstruction

3

When does breast conservation provide the equivalent disease free and overall survival rates as mastectomy?

Clear margins >=1mm
Breast radiotherapy

4

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

5

How can an impalpable mass found on imaging be managed?

Localisation wide excision
Specimen XR

6

What chemotherapy can be used as neoadjuvant treatment to achieve breast conservation?

Standard FEC100 and taxane
+- Herceptin

7

What oncoplastic surgery will be used in large breasts, or large tumours and reshaping?

Therapeutic mammoplasty

8

What oncoplastic surgery will be used in small breasts?

Volume replacement techniques

9

What are the options in mastectomy?

External prosthesis
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

10

What are examples of implant based reconstruction options?

Tissue Expander
Acellular Dermal Matrix (ADM)/Implant
De-epithelialised skin/Implant
LD/Implant

11

What are examples of autologous reconstruction options?

Pedicled LD flap
Pedicle TRAM
Free TRAM
DIEP Flap
S-Gap Flap
I-Gap Flap

12

What are the main problems in implant based surgery?

Loss of implants (infection)
Capsular contracture
Implant rippling
Implant migration
40% require revisional surgery

13

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)

14

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

15

What are some axillary treatment options?

Pre-operative axillary staging: USS axilla +/- core biopsy
Sentinel node biopsy
Axillary clearance
Axillary radiotherapy