Lisa Mifsud. Assessment and Management of Surgical Breast Disease.
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Transcript of Lisa Mifsud. Assessment and Management of Surgical Breast Disease.
Lisa Mifsud.
Assessment and Management of Surgical Breast Disease
Anatomy
Anatomy
Internal Thoracic artery
Lateral thoracic artery and lateral mammary branches
Anatomy
Breast disease
• Mastalgia
• Lumps
• Nipple discharge
• Cancer
Risk factors
• Family history• Previous neoplastic
breast changes• Certain breast
conditions• Oestrogen exposure
Assessment
• History and Examination
• Radiography• Cytology/histology
StagingTx Primary tumour cannot be assessed
Tis Carcinoma in situ
T1 Tumour size <2cm
T2 Tumour size 2-5cm
T3 Tumour size > 5cm
T4 Any tumour size with fixation to chest wall or skin
Nx Regional lymph nodes cannot be assessed
N0 Axillary nodes not involved
N1 Ipsilateral axillary node metastases (mobile)
N2 Ipsilateral axillary node metastases (fixed)
N3 Ipsilateral supraclavicular or internal mammary node mets.
Mx Presence of distant mets cannot be assessed
M0 No distant mets
M1 Distant mets
Treatment Guidelines
Surgical options
• Breast:– Conservative– Mastectomy
• Axilla– Sentinal node biopsy– Level 1 dissection– Level 2 dissection– Level 3 dissection
Prognosis
• Invasive versus insitu
• Size and grade
• Histological type
• Number of lymph nodes involved
• Lymphovascular invasion
• Oestrogen/progesterone receptor status
• HER-2 overexpression
Complications• General risks of surgery
– Bleeding– Infection
• Specific risks of breast/axillary surgery– Lymphodema: – Numbness – Seroma– Frozen shoulder– Axillary web syndrome– Skin flap necrosis
• Anaesthetic risks of GA• Risk of immobility