breast cancer surgery 2004 william a. barber, m.d. piedmont hospital
TRANSCRIPT
![Page 1: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/1.jpg)
Breast Cancer Surgery 2004
William A. Barber, M.D.Piedmont Hospital
![Page 2: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/2.jpg)
Breast Cancer Screening
![Page 3: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/3.jpg)
Case Report 45 y.o patient with
two children ages 10 and 13
Mother had breast cancer at age 65
Gail 5 yr risk score 1.7
Undergoes yearly mammograms
CC View of Mammogram May 2001
CC View of Mammogram April 2002
3.5cm Mass Upper Outer Quadrant
![Page 4: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/4.jpg)
Case Report
US confirmed the existence of 3.5 cm mass
Core biopsy showed a poorly differentiated carcinoma
![Page 5: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/5.jpg)
Diagnosing Breast Cancer: Abnormal Mammograms
Benign AppearingCalcifications
Suspicious Calcification
![Page 6: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/6.jpg)
Breast Cancer Rules
Rule #1: There is no difference in survival
between Mastectomy and Lumpectomy
![Page 7: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/7.jpg)
Breast Cancer Rules
Rule #2: If you have a lumpectomy, you also
need Radiation Therapy
![Page 8: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/8.jpg)
Breast Cancer Rules
Rule #3: The operation you chose has
nothing to do with whether or not you will need chemotherapy.
![Page 9: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/9.jpg)
Breast Cancer Rules
Rule #4: Most Mastectomy patients do not
need Radiation Therapy.
![Page 10: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/10.jpg)
Breast Cancer Rules
Rule #5: If you have a lumpectomy and you
have positive lymph nodes, you do NOT need to go back and have a Mastectomy.
![Page 11: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/11.jpg)
Breast Cancer Rules
Rule #6: Whether or not you need
chemotherapy is determined by The size of the primary tumor How aggressive is the primary tumor Lymph node status Age of the patient
![Page 12: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/12.jpg)
Partial Mastectomy (Lumpectomy)
Versus MastectomyHow do you chose?
![Page 13: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/13.jpg)
Partial Mastectomy (Lumpectomy) Contraindications
A. Previous history of Radiation Therapy B. More than one cancer in same breast C. Large tumor, small breast, cosmetic
deformity D. Nipple involvement
![Page 14: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/14.jpg)
Surgery Terms
Excisional Biopsy vs. Lumpectomy Partial Mastectomy vs. Lumpectomy Incisional Biopsy
![Page 15: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/15.jpg)
Mastectomy
Difference betweenTotal (simple) MastectomyModified Radical Mastectomy
![Page 16: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/16.jpg)
Skin Sparing Mastectomy
Skin sparing mastectomy preserves the majority of the breast skin and the inframammary fold
The entire nipple and areola are removed
![Page 17: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/17.jpg)
Radical Mastectomy
Is Radical Mastectomy still in use?
What is it?
![Page 18: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/18.jpg)
Subcutaneous Mastectomy
Is Subcutaneous Mastectomy a cancer operation?
How does it differ from Total Mastectomy?
![Page 19: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/19.jpg)
Sentinel Node Biopsy
Major advance Almost no risk of lymphedema Blue dye Nuclear medicine
![Page 20: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/20.jpg)
Sentinel Lymph Node Biopsy Quickly becoming the
gold standard May be as accurate or
more accurate than ALN dissection while limiting the complications and costs
Involves injection off Technitium-99 sulfur colloid and or 1% isosulfan blue dye
Multiple ongoing trials including B-32 NSABP
![Page 21: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/21.jpg)
Reconstruction
Tissue expander Latissimus dorsi TRAM
![Page 22: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/22.jpg)
Reconstruction: Tissue expander
Encapsulated silicone implant reconstruction corrected with tissue expansion. The capsule is first excised, and the tissue expander is used to create an oversized pocket for the implant.
![Page 23: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/23.jpg)
Reconstruction: Latissimus Dorsi
A, Preop view: 67-YO following MRM. B, Postop view: following left autogenous latissimus reconstruction w/o implant. Opposite breast reduction mammoplasty required for symmetry.
![Page 24: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/24.jpg)
Reconstruction: TRAM
A & B, Preop & Postop views following left free TRAM reconstruction. Skin replacement included all skin between scar & inframammary fold. Nipple reconstruction, opposite mastopexy done at separate procedure.
![Page 25: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/25.jpg)
Breast Reconstruction in the Skin Sparing Mastectomy TRAM flap Latissimus flap Implant/Expander Silicone is
preferred and is available on study protocol
Tram flap with nipple reconstruction and tatooing
![Page 26: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/26.jpg)
When to Consult?
Medical Oncology Radiation Oncology
![Page 27: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/27.jpg)
Chemotherapy
What is NeoAdjuvant Chemotherapy?
When is it used?
![Page 28: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/28.jpg)
Mammotome Biopsy
![Page 29: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/29.jpg)
Minimally Invasive Excisional Biopsy: Whats New? Ultrasound guided
directional vacuum assisted breast biopsy with 11g and 8g mammotome
Introduced in 1996 these devices use vacuum to draw the tissue into a chamber and a rotating cutter dissects the specimen (Mammotome)
![Page 30: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/30.jpg)
Mammosite
![Page 31: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/31.jpg)
Variable 4 to 5 cm balloon
Multilumen, silicone catheter
Radiation source port pathway
Inserted obturator toprevent bending orcoiling of the catheter shaft
Needleless injection site
![Page 32: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/32.jpg)
Mammosite
![Page 33: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/33.jpg)
Mammosite PlacementTime of Lumpectomy Post-lumpectomy
Open Cavity
Scar Entry (SET)
Ultrasound Guided
![Page 34: Breast Cancer Surgery 2004 William A. Barber, M.D. Piedmont Hospital](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649ddf5503460f94ad7fcc/html5/thumbnails/34.jpg)
3-Dimensional rendering of applicator surface
CT Image of Mammosite