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Flashcards in Breast Surgery Deck (18)
1

Name types of breast conservation surgery

Lumpectomy
Wide loacal excision
Wire guided local excision
Oncoplastic breast conservation

2

Name types of mastectomy

Traditional transverse
Skin sparing with immediate reconstruction

3

Is there a greater chance of recurrence with a wide local exicision than mastectomy

No - if given clear margins and adjuvant radiotherapy with WLI then the chance of recurrence is comparable to mastectomy

4

What area of clear surgical margins is aimed for in WLE

1cm clear around all margins

5

What is neoadjuvant treatment

Treatment given before breast conservation surgery

6

What options are there for neoadjuvant treatment

Chemotherapy +/- Herceptin
Endocrine - aromatase inhibitors or tamoxifen

7

Why is neoadjuvant therapy given

Shown to reduce mastectomy rates - preferable cosmetic outcome
Overall survival advantage for younger women to have pre op chemo

8

What chemotherapy is usually given neoadjuvantely

FEC 100 ( fluorouracil (also called 5FU), epirubicin, cyclophosphamide)
and taxane

9

Name an aromatase inhibitor

letrozole (femara)

10

In what group women are aromatase inhibitors reserved for

post menopausal

They are more effective than tamoxifen for neoadjuvant treatment

11

how is response to neoadjuvant treatment assessed

mammography, ultrasound, MRI

12

what is oncoplastic surgery

safe oncological (cancer) surgery while avoiding tissue deformity

13

What reconstructive options are available post mastectomy

Implant only +/- autologous cellular matricx
Lat dorsi pedicled flap +/- implant
Deep inferior epigastric artery perforator free flap
Inferior gluteal artery perforator free flap

14

What other autologous reconsturctions are possible

Pedicled LD flap
Pedical transverse rectus abdominus myocutaneous flap
Free TRAM flap
S-gap flap (superior gluteal artery perforator flap)
I-Gap flap

15

What are the main problems with implants

Loss of implants (infection)
Capsular contracture
Implant rippling
Implant migration
40 percent require reversal surgery

16

What are the advantages of using a acellular dermal matrices in breast implant surgery

Supplements to pec major muscle
“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

17

What is the 'standard' implant surgery that is performed

“Two stage” implant reconstruction
1st: mastectomy and creation of submuscular pocket with expander insertion
Clinic visits for expansion 2 weekly
2nd: exchange of expander for permanent implant (although can leave some expanders and remove ports only)

18

What is the main complication of axillary clearance surgery

lymphadema