Mastectomy

Question 1

what are the indications of mastectomy?

Answer 1

• BREAST CANCER
• cystosacrcoma phyllodes
• benign virginal hypertrophy
• prophylactic mastectomy (BRCA or P53 mutation)

Question 2

Extended radical mastectomy

Answer 2

skin
breast tissue
nipple 
areola 
axillary lymph nodes
pectoral fascia 
pectoralis major 
pectoralis minor 
thoracotomy 
internal mammary lymph nodes

Question 3

radical mastectomy

Answer 3

skin
nipple and areola 
breast tissue including mass
pectoralis major 
pectoralis minor 
pectoral fascia

Question 4

What is the most common used radical treatment?

Answer 4

modified radical mastectomy

• skin
• nipple and areola
• all breast tissue including mass
• axillary lymph nodes
• preserve pectoralis major
• pectoralis minor could be removed

Question 5

preserving axillary lymph nodes is done in which procedure?

Answer 5

simple mastectomy

Question 6

do internal mammary lymph nodes have a major role in spread of breast cancer?

Answer 6

no

Question 7

which procedures do not involve lymph node removal?

Answer 7

• simple mastectomy

depending on situation

• skin sparing mastectomy
• nipple sparing

Question 8

what is the only indication of radical mastectomy?

Answer 8

invasion of pectoralis major

Question 9

In which procedures do we preform immediate reconstruction of the breast?

Answer 9

skin sparing & nipple sparing mastectomy

Question 10

complications of mastectomy?

Answer 10

• recurrence
• wound infection
• seroma
• skin flap necrosis
• hematoma
• chronic pain
• incisional dog ears
• lymphedema

Question 11

in breast reconstruction, what muscles are used for a myo-cutaneous flap?

Answer 11

• latissimus dorsi flap

- transverse rectus abdominis myocutaneous flap

Question 12

How to apply a silicone implant if we preform a modified radical mastectomy without preserving the skin?

Answer 12

use tissue expander

Question 13

What are the types of conservative breast surgery?

Answer 13

• lumpectomy
• wide local excision
• quadrantectomy
• oncoplastic breast surgery

Question 14

contraindications of breast conservative surgery?

Answer 14

TUMOR

• bilateral or multifocal
• central lesions
• Paget’s disease
• large tumor >4cm
• locally advanced disease or metastasis
• Carcinoma in situ (we cant know the exact margin)
• small breast (tumor to breast ratio)

PATIENT

• pregnant
• contraindications to radiotherapy (SLE)
• previous irradiation

Question 15

When do we remove the axillary lymph nodes in any surgery OTHER than radical surgeries?

Answer 15

if its clinically positive and i can palpate the nodes they should be removed through a separate incision

Question 16

When do we perform a sentinel LN biopsy?

Answer 16

• if we cant palpate the axillary lymph nodes before surgery we should take a biopsy to make sure there is no metastasis
• if its positive we remove them

Question 17

How is the wide local excision preformed?

Answer 17

removal of mass with 2cm safety margin

Question 18

How is oncloplastic breast surgery preformed?

Answer 18

removal of mass with 2cm safety margin + immediate reconstruction of defect with tissue flap