Breast Surgery
Tjun Tang, Elizabeth O'Riordan, Stewart Walsh in Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Describe implant-based reconstruction in the immediate and delayed settings.Implant-based reconstructions may be one (if adequate skin/muscle cover for desired size is achieved e.g. with a skin-sparing mastectomy) or two stages (gradual expansion and exchange for fixed-volume implant).The implant may be placed in the submuscular (pectoral muscle + partial serratus anterior lifted), subpectoral using synthetic mesh/ADM/dermal sling (if adequate ptosis) for lower pole coverage, or pre-pectoral (using complete implant coverage with mesh/ADM +/- dermal sling) plane.The benefits of implant-based reconstruction include short hospital stay and quicker return to daily living (compared to autologous reconstruction). However, implant-based reconstructions look and feel less natural than an autologous reconstruction and do not move or age like natural tissue.Implant-associated risks/complications include infection, capsular contracture, implant loss (∼10%), ‘animation’ with submuscular techniques, anaplastic large cell lymphoma, need for replacement in future, not advisable if post-mastectomy radiotherapy required due to higher rate of complications.
Lymph Stasis After Lymph Node Dissection
Waldemar L. Olszewski in Lymph Stasis: Pathophysiology, Diagnosis and Treatment, 2019
Lymphedema of the arm after mastectomy and axillary dissection is reported as less than 10% in most series,7 and is fortunately most often mild and decreasing in incidence. Radical mastectomy (which is now less commonly performed) was associated with a higher incidence of severe lymphedema. The addition of radiation therapy to the dissected axilla is often a marked aggravating factor,8 as is wound infection after operation. The discussion of lymphedema after mastectomy would not be complete without mention of lymphangio-sarcoma in the extremity chronically edematous after nodal dissection. First described by Stewart and Treves in 1948,9 the complication is seen an average of 10 years after mastectomy and is difficult to treat and harder to cure.10 Fortunately, with the decreased performance of radical mastectomy in the last 20 years, the incidence of this problem has also decreased.
Radiotherapy
John Melford in Pocket Guide to Cancer, 2017
For patients with early-stage breast cancer, a mastectomy, which involves removal of all breast tissue, is an option for treatment. Another option is breast-conserving surgery in which only the tumor is removed. In cases where the tumor is large, there are multiple tumors, or there is a reluctance or inability to undergo radiation therapy, a mastectomy is preferable. An increasing number of women demonstrate a preference for a mastectomy over radiation therapy as a precaution against tumor recurrence. An increasing number also choose to have both breasts removed. The proportion of women with non-metastatic breast cancer who elect to undergo a double contralateral prophylactic mastectomy increased, from 5% of total mastectomies in 1998 to 30% in 2011. Among women diagnosed with stage I or stage II breast cancer, 61% undergo breast-conserving surgery, while 36% undergo a mastectomy. In contrast, among women diagnosed with stage III breast cancer, 21% undergo breast-conserving surgery, while 72% undergo a mastectomy. Women with stage IV breast cancer often receive radiation therapy alone or in conjunction with chemotherapy.
Treatment of women with BRCA mutation
Published in Climacteric, 2023
HT after RRBSO does not seem to be associated with relevant increases in breast cancer risk according to the available studies.Withholding HT in young women after RRBSO may, however, substantially increase the risk of osteoporosis, cardiovascular disease, Alzheimer’s disease (especially in APOE4 carriers), cognitive disorders and sexual problems.HT should be promoted more liberally after RRBSO in young women.PGD is a well-established treatment to have children without BRCA mutation.Optimal age to plan oophorectomy should be 35–40 years in women with BRCA1 and 40–45 years in women with BRCA2, after childbearing is complete.A prophylactic skin/areola/nipple-sparing mastectomy with immediate breast reconstruction should only be performed after extensive information of all different surgical options. The areola is skin and should be preserved as much as possible during reconstruction.
Mastectomy is a safe procedure in transgender men with a history of breast reduction
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Floyd W. Timmermans, Lian Elfering, Thomas D. Steensma, Mark-Bram Bouman, Wouter B. van der Sluis
Prior to undergoing gender-affirming mastectomy, transgender men may have opted for breast reduction surgery. Reasons to seek breast reduction surgery prior to a mastectomy can be having large breasts, resulting in physical complaints, or more specifically in this population, breast dysphoria as an expression of gender dysphoria. In some clinics, especially in the past, breast reduction was offered as ‘top surgery’, as there was little or no experience with gender-affirming mastectomy. Resultantly, having undergone breast reduction surgery prior to a gender-affirming mastectomy may limit the available mastectomy techniques that are commonly used in transgender individuals. Some concerns are present that performing mastectomy with prior breast reduction surgery, increases the risk of complications and revision surgery [11,12]. Furthermore, the previous use of a NAC-bearing pedicle during breast reduction may endanger NAC vascularization and vitality during pedicled NAC mastectomy [13].
Ultrasound-guided serratus anterior block versus instillation of local anaesthetic through surgical drain in modified radical mastectomy: A randomized controlled study
Published in Egyptian Journal of Anaesthesia, 2022
Rabab S. S. Mahrous, Haytham Awad Fayed, Abdelrahman Mohamed Kamal
Mastectomy is a widely accepted and common procedure for breast cancer management worldwide. Many patients are complaining of side effects from such surgical intervention. Postmastectomy pain is one of the most common complaints during the postoperative time and can be complicated by postmastectomy pain syndrome in an insignificant number of patients if not adequately controlled. The primary objective of our study was to compare the duration of analgesia between both techniques. In the SAPB group, the duration lasted for 1370 min (around 22 hr) while in the local instillation group lasted for 450 min (around 7.5 hr) that could be explained by using ultrasound allows delivery of the precise amount of LA in the exact plan without escaping into the undesired site and also explained by a higher dose of bupivacaine 0.5% used which has a longer duration of action than other types of LA used in other studies. On the other hand, escape of local anesthetic by the effect of gravity and drain malposition may add to the shorter duration of analgesia.
Related Knowledge Centers
- Breast
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- Lumpectomy
- Neoplasm
- Breast Cancer
- Lesion
- Chemotherapy
- Preventive Healthcare
- Wide Local Excision
- Hormonal Therapy