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Flashcards in Breast surgery and reconstruction Deck (17):
1

types of breast conservation surgery

lumpectomy
wide local excision
wire guided local excision
oncoplastic breast conservation including therapeutic mammoplasty

2

types of mastectomy

traditional transverse
skin sparing with immediate reconstruction

3

what has to be done during surgery - breast conservation

clear margins of >=1mm
breast radiotherapy

surgical wide excision aim for 1cm extension at all margins

4

what is done for impalpable disease

localisation wide excision

5

what is neoadjuvant treatment

chemo +/- perception
endocrine - aromatase inhibitors (for postmenopausal women), tamoxifen

6

chemo (neoadjuvant therapy) used for what
allows for less what
assessment of response

used to control local disease as well as systemic

can allow for less breast surgery - breast conservation

assessment of response - mammography, USS, MRI

7

oncoplastic breast conservation for large breast and large tumour and reshaping

therapeutic mammoplasty

8

oncological breast conservation for small breasts

volume replacement techniques

9

mastectomy options

external prosthesis
reconstruction - immediate/delayed
implant only
latissimus dorsi (LD) pedicled flap +/- implant
deep inferior epigastric artery perforator (DIEP) free flap
inferior gluteal artery perforator (IGAP) free flap

10

what are the two types of reconstruction options

implant based
autologous

11

implant based reconstruction options

tissue expander
acellular dermal matrix implant
de epithelialise skin/implant
LD/implant

12

autologous reconstruction options

peddled LD flap
pedicle TRAM
free TRAM
DIEP flap
S-Gap flap
I-Gap flap

13

problems with implants

loss of implants-infection
capsular contraction
implant rippling
implant migration
40% require revisional surgery

14

current method for implant

1 - mastectomy and creation of submuscular pocket with expander insertion

2 - exchange for expander for permanent implant

15

Acellular dermal matrix implant advantages

one stage implant reconstruction
better lower pole expansion
reduced post op pain
improved aesthetic outcome
perm implant can be used at 1st operation
also useful for revision surgery

16

Finishing touches of IGAP/TRAM/DIEP/LD flaps

nipple reconstruction
lipomodelling
contralateral symmetry - reduction of augment

17

axillary treatment options

pre op axillary staging: USS of axilla +/- core biopsy
sentinel node biopsy
axillary clearance
axillary radiotherapy