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

types of breast conservation surgery

A

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

2
Q

types of mastectomy

A

traditional transverse

skin sparing with immediate reconstruction

3
Q

what has to be done during surgery - breast conservation

A

clear margins of >=1mm
breast radiotherapy

surgical wide excision aim for 1cm extension at all margins

4
Q

what is done for impalpable disease

A

localisation wide excision

5
Q

what is neoadjuvant treatment

A

chemo +/- perception

endocrine - aromatase inhibitors (for postmenopausal women), tamoxifen

6
Q

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

A

used to control local disease as well as systemic

can allow for less breast surgery - breast conservation

assessment of response - mammography, USS, MRI

7
Q

oncoplastic breast conservation for large breast and large tumour and reshaping

A

therapeutic mammoplasty

8
Q

oncological breast conservation for small breasts

A

volume replacement techniques

9
Q

mastectomy options

A

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
Q

what are the two types of reconstruction options

A

implant based

autologous

11
Q

implant based reconstruction options

A

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

12
Q

autologous reconstruction options

A
peddled LD flap
pedicle TRAM
free TRAM
DIEP flap 
S-Gap flap
I-Gap flap
13
Q

problems with implants

A
loss of implants-infection
capsular contraction 
implant rippling
implant migration 
40% require revisional surgery
14
Q

current method for implant

A

1 - mastectomy and creation of submuscular pocket with expander insertion

2 - exchange for expander for permanent implant

15
Q

Acellular dermal matrix implant advantages

A
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
Q

Finishing touches of IGAP/TRAM/DIEP/LD flaps

A

nipple reconstruction
lipomodelling
contralateral symmetry - reduction of augment

17
Q

axillary treatment options

A

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