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20 Cards in this Set
- Front
- Back
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Why do we perform breast surgery?
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Treat breast cancer and establish definitive diagnosis
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Anatomy relevant to the breast
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12-20 lobes- milk ducts. Areola, nipple, tail of spence. - Pectoralis major/minor and Serattus anterior -Lymph drainage into axillary
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risk factors
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sex, age, family history, menstruation history,
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Screening methods
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breast self examination (BSE), clinican mammography (CBE)
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Stage 1 Breast cancer
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Smaller than 2 cm 0 lymph nodes and 0 metastases
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Stage 2 Breast cancer
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2-5 cm 0-1 lymph positive 0 metastases
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Stage 3 Breast cancer
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Larger than 5 cm 0 lymph and 0 metastases
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Stage 4 breast cancer
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Tumor any size w/ positive lymph and metastases
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TMN
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tumor metastases nodes
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Biopsy
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removal of suspicious tissue for pathology exam by core needle biopsy incisional or excisional biopsy. Minor basic tray - wire placment before surgery by radiologist
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Lumpectomy
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With or without sentinel node biopsy. Removal of tumor mass with at least 2.5 cm margin of surrounding tissue. Incision mass removal specimen is marked for orientation with SILK for sentinel node biopsy- nodes are localized with dye- dye put into mass which may to to lymph node p603
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axillary node dissection
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1 incision 2 pectoralis minor muscle is exposed 3 hemostasis of major blood and lymph vessels 4 tissue over axillary vein is cut 5 lymph nodes between pec major and minor muscles are removed 6 drain placed in lymph drainage incision closed
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simple mastectomy
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removal of entire breast without lymph node dissection
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simple mastectomy steps
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elliptical incision 2 skin flaps created - undermine tissue 3 breast tissue is removed 4 drains inserted 5 wound is closed
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modified radical mastectomy
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renewal of involved breast and all axillary content. Done after tissue bio. comes back positive malignancy major basic tray
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modified radical mastectomy steps
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1 oblique elliptical incision 2 Skin under cut with # 10 blade and curved scissors 3 fascia and breast are resected. pectoralis muscle left intact 4 axillary flap is retracted for complete dissection of axilla
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modified radical mastectomy steps 5 fascia s dissected from lateral edge of pectoralis major muscle 6 thoracic & thoracodorsal nerves are presented.
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7 breast and axilla fascia are freed from the latissimus dorsi muscle 8 irrigate wound close wound- place drains
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complications
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swelling of arm if node dissection- drainage- infection
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p 603 I&D if abscess
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incision of an inflamed and puss filled area for drainage -irrigation w/ warm saline and antibiotic med - aerboic & anaerobic culture taken -healing by granulation
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groshong catheter
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-central venous catheter for administration of iv fluids, blood, drugs, nutrition and placed into one of the Lg central veins so the top lies in the superior vena cava above the rt atrium.
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