Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
19 Cards in this Set
- Front
- Back
|
Amastia |
Common in males Arrest of developme at 6th week Poland syndrome (Abscence of sternal portion of pec major) |
|
|
Blood supply of breast |
Medially : Perforating branches of internal thoracic aa (2nd to 4th)
Laterally : Superior thoracic aa, Pectorial branch of thiraco acromial aa, Lateral thoracic aa and lateral branches of posterior intercostal aa. |
|
|
Posterior intercostal veins |
Baston plexus - Vertebral Mets |
|
|
Nerve supply of breast |
Lateral cutanious branch of 2nd-6th intercostal nerves Intercostobrachial nerve : lateral cutanious branch of 2nd intercostal nerve - Loss of sensation of medial aspect of upper arm. |
|
|
Nerves in the axilla |
Long thoracic nerve - Serratus anterior - Winged scapula Thoracodorsl nerve - LD - Shoulder abduction and internal rotation. Intercostobrachial nerve - Sensory (medial upper arm and postrior acilla) : Expenible nerve (Pectorial Neurovascular bundle) Medial & Lateral pectorial nerves - To pec minor & Major and Minor - very significant |
|
|
LCIS |
35% risk for Ca (Ductal) in bilateral breast - Not anatomic precursor Only in female breast Mx - Risk reduction stratagies
|
|
|
DCIS |
25-70% Risk for Ca on ipsilateral breast. Calcifications are common Symptoms present Bilateral only in 20% unlike LCIS Mets - 2% |
|
|
Stewart classification |
8 types Pagets disease Invasive ductal ca Invasive lobular ca Medullary ca Mucinous /Colloid ca Papillary Tubular Rare types - squamous, adenoid cystic |
|
|
Signs of axillary LN ca |
Size ›1cm Cortical thickening Abscence of fatty hilum Change of shape in to circular Hypoecoic internal echos |
|
|
Contra indications for radiotherapy |
Pregnancy Scleroderma,SLE Cardiac/pulmonary disease Li-Fraumani syndrome Previous radiation to chest wall |
|
|
Outcomes of different surgeries |
Axillary dissection - immidiate / delayed / No with radiotherapy has equal OS & DFS Mastectomy Vs Breast conserving surgery : equal survival given that BCS undergo intensive surveillance and radiotherapy post op. (Selection - size of tumor, Multicentricity) |
|
|
Indications for oncoplastic surgery during BCS |
Significant skin removal >20-30% Large volume resection Tumor in the lower hemisphere If resection causes nipple malposition |
|
|
Indications for mastectomy over BCS |
Tumor large relative to the breast Extensive calcification on Mmg Clear margin can't be obtained Radiation is contraindicated Pt. Prefference |
|
|
Breast reconstruction options |
Immidiate / Delayed Options Implants, Expanders Flaps - TRAM, LD flap, Muscle preserving perforator abdominal flaps |
|
|
MRM |
Stewart / Modified stewart incision Breast + Nipple & areola + ALND Nipple spearing surgery - in |
|
|
SLND Vs Standard ALND |
No difference in OS, DFS or Regional control rate. Low morbidity, out pt. Surgery, rapid recovery in SLND +VE SLN - Only 50% will hv another involved LN |
|
|
Mandatory ALND |
Locally advanced Inflammatory ca If mastectomy is planned in +Ve SLN cases +Ve SLN after neoadjuvant CT
|
|
|
Indications for adjuvant radiotherapy |
Stage III & above 4 or more LN envolved Stage II + (Extracapsular extension/ LV invasion/ Age <40 / Less than standard level I & II axillary dissection) |
|
|
Indication for neoadjuvant |
Locally advanced cases >5cm, Chest wall involvement, Skin involved Inflamatory ca, Bulky and fixed axillary LN Internal mammary / level III LAP |
