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Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
Breast Cancer by dr Isa Basuki
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Breast Cancer by dr Isa Basuki

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Presented at AWS General Hospital under supervision of dr. P.M.T. Mangalindung O. SpB

Presented at AWS General Hospital under supervision of dr. P.M.T. Mangalindung O. SpB

Published in: Health & Medicine
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  • 1. • Shift work (night shifts)
  • 2. Results: Breast cancer risk was increased among subjects who frequently did not sleep during the period of the night when melatonin levels are typically at their highest (OR = 1.14 for each night per week; 95% CI = 1.01 to 1.28). Conclusion:The results of this study provide evidence that indicators of exposure to light at night may be associated with the risk of developing breast cancer
  • 3. Statistically significant associations were observed between breast cancer and work durations of ≥5 years with ≥6 consecutive night shifts, with the highest risk observed for progesterone receptor–positive tumors (odds ratio = 2.4, 95% confidence interval: 1.3, 4.3; P-trend = 0.01)
  • 4. inflammatory carcinoma
  • 5. Inspection of the breast in the upright position with the patient’s arms to the side (A), in the air (B), and hands on hips (C). (From Bland KI, Copeland EM III.The breast, 3rd ed. Philadelphia:WB Saunders,2004.)
  • 6. Examination of the cervical (A), supraclavicular (B), and axillary nodes (C). (From Bland KI, Copeland EM III.The breast, 3rd ed. Philadelphia:WB Saunders, 2004.)
  • 7. older than 40 years
  • 8. axillary lymph node metastases
  • 9. A, Stellate mass in the breast. The combination of a density with spiculated borders and distortion of surrounding breast architecture suggests a malignancy B, Clustered microcalcifications. Fine, pleomorphic, and linear calcifications that cluster together suggest the diagnosis of ductal carcinoma in situ C, Ultrasound image of breast cancer. The mass is solid, contains internal echoes, and displays an irregular border. Most malignant lesions are taller than they are wide
  • 10. D, Ultrasound image of a simple cyst. By ultrasound, the cyst is round with smooth borders, there is a paucity of internal sound echoes, and there is increased through-transmission of sound, with enhanced posterior echoes E, Breast MRI showing gadolinium enhancement of a breast cancer. Rapid and intense gadolinium enhancement reflects increased tumor vascularity. Lesion contour and size may also be assessed by MRI .
  • 11. PrimaryTumor (T) TX Primary tumor cannot be assessed T0 No evidence of primary tumor Tis Carcinoma in situ Tis (DCIS ) Ductal carcinoma in situ Tis (LCIS ) Lobular carcinoma in situ Tis (Paget’s) Paget’s disease of the nipple not associated with invasive carcinoma or carcinoma in situ (DCIS and/or LCIS ) in the underlying breast parenchyma. T1 Tumor ≤20 mm in greatest dimension T1mi Tumor ≤1 mm in greatest dimension T1a Tumor >1 mm but ≤5 mm in greatest dimension T1b Tumor >5 mm but ≤10 mm in greatest dimension T1c Tumor >10 mm but ≤20 mm in greatest dimension T2 Tumor >20 mm but ≤50 mm in greatest dimension T3 Tumor >50 mm in greatest dimension T4 Tumor of any size with direct extension to the chest wall and/or to the skin T4a Extension to the chest wall, not including only pectoralis muscle adherence or invasion T4b Ulceration and/or ipsilateral satellite nodules and/or edema of the skin T4c BothT4a andT4b T4d Inflammatory carcinoma
  • 12. Regional Lymph Nodes (N) pNX Regional lymph nodes cannot be assessed pN0 No regional lymph node metastasis pN0(i−) No regional lymph node metastasis histologically, negative IH C pN0(i+) Malignant cells in regional lymph node(s) no greater than 0.2 mm pN0(mol−) No regional lymph node metastasis histologically, negative molecular findings (IHC) pN0(mol+) Positive molecular findings (RT -PCR), but no metastasis detected by histology or IHC pN1 Micrometastases; or metastases in one to three axillary nodes; and/or in internal mammary nodes with metastases detected by sentinel lymph node biopsy but not clinically detected pN1mi Micrometastases (>0.2 mm and/or >200 cells but none >2.0 mm) pN1a Metastases in one to three axillary nodes; at least one metastasis >2.0 mm pN1b Metastases in internal mammary nodes with micrometastasis or macrometastases detected by sentinel lymph node biopsy (not clinically detected) pN1c Metastases in one to three axillary nodes and in internal mammary nodes with micrometastases or macrometastases detected by sentinel lymph node biopsy but not clinically detected pN2 Metastases in four to nine axillary nodes; or in clinically detected internal mammary lymph nodes in the absence of axillary lymph node metastases pN2a Metastases in four to nine axillary nodes (at least one tumor deposit >2.0 mm) pN2b Metastases in clinically detected internal mammary lymph nodes in the absence of axillary lymph node metastases pN3 Metastases in ten or more axillary nodes; or in infraclavicular (level III axillary nodes); or in clinically detected ipsilateral internal mammary lymph nodes in the presence of one or more positive level I, II axillary nodes; or in more than three axillary lymph nodes and internal mammary lymph nodes, with micrometastases or macrometastases detected by sentinel lymph node biopsy but not clinically detected; or in ipsilateral supraclavicular lymph nodes
  • 13. Distant Metastases (M) M0 No clinical or radiographic evidence of distant metastases cM0(i+) No clinical or radiographic evidence of distant metastases, but deposits of molecularly or microscopically detected tumor cells in circulating blood, bone marrow, or other nonregional nodal tissue that are no larger than 0.2 mm in a patient without symptoms or signs of metastases M1 Distant detectable metastases as determined by classic clinical and radiographic means and/or histologically proven larger than 0.2 mm
  • 14. ANATOMIC STA GE PROGNOSTICGROUP 0 Tis N0 M0 IA T1 N0 M0 IB T0 T1 N1mi N1mi M0 M0 IIA T0 T1 T2 N1 N1 N0 M0 M0 M0 IIB T2 T3 N1 N0 M0 M0 IIIA T0 T1 T2 T3 T3 N2 N2 N2 N1 N2 M0 M0 M0 M0 M0 IIIB T4 T4 T4 N0 N1 N2 M0 M0 M0 IIIC AnyT N3 M0 IV AnyT Any N M1
  • 15. The Halsted radical mastectomy involved removing the breast with the overlying skin, the pectoralis major and minor muscles, and the level I, II, and III axillary lymph nodes. (From Bland KI, Copeland EM III.The Breast, 3rd ed. Philadelphia: WB Saunders, 2004.)
  • 16. The classic Stewart elliptical mastectomy incision. The medial aspect is at the lateral edge of the sternum and the lateral aspect overlies the latissimus dorsi muscle. (From Bland KI, Copeland EM III.The breast, 3rd ed. Philadelphia:WB Saunders, 2004.)
  • 17. The classic Orr oblique elliptical mastectomy incision. (From Bland KI, Copeland EM III.The breast, 3rd ed. Philadelphia: WB Saunders, 2004.)
  • 18. Total mastectomy with and without axillary dissection. A, Skin incisions are generally transverse and surround the central breast and nipple-areolar complex. B, Skin flaps are raised sharply to separate the gland from the overlying skin and then the gland from the underlying muscle. Simple mastectomy divides the breast from the axillary contents and stops at the clavipectoral fascia. C, In modified radical mastectomy, dissection continues into the axilla and generally extends up to the axillary vein, with removal of level I and II nodes. Division of a branch of the axillary vein is shown, with separation of the node-bearing axillary fat from the axillary vein at the superior aspect of the dissection.
  • 19. Breast-conserving surgery. A, Incisions to remove malignant tumors are placed directly over the tumor, without tunneling. A transverse incision in the low axillary region is used for sentinel node biopsy or axillary dissection.The axillary dissection is identical to the procedure for a modified radical mastectomy.The boundaries of the operation are the axillary vein superiorly, the latissimus dorsi muscle laterally, and the chest wall medially.The inferior dissection enters the tail of Spence (the axillary tail of the breast). Inset, Excision cavity of the lumpectomy. B, In sentinel node biopsy, a similar transverse incision is made, which may be located by percutaneous mapping with the gamma probe if radiolabeled colloid is used. It is extended through the clavipectoral fascia and the true axilla is entered.The sentinel node is located by its staining with dye, radioactivity, or both, and dissected free as a single specimen
  • 20. • Surgical Reconstruction
  • 21. Type Advantages Disadvantages Implant One stage procedure, minimal prolongation, hospitalization, or recovery. Low cost. Poor symmetry if skin removed or in large ptotic breasts. Capsular contracture, leakage, rupture possible. Tissue expander Short operative time. Hospitalization, recovery not prolonged. Low cost. Multiple physician visits postop. Poor symmetry large or ptotic breasts. Capsular contracture, leakage rupture possible. Latissimus dorsi flap Very low risk of flap loss. Natural contour with autogenous tissue. Donor site scar. Usually requires an implant. Moderate prolongation hospitalization and recovery.
  • 22. Type Advantages Disadvantages Transverse rectus abdominous myocutaneous (TRAM) flap Natural contour. Good match for large or ptotic breasts. Abdominoplasty. Donor site scar. Fat necrosis, flap loss possible. Abdominal wall weakness plus hernia. Significant prolongation hospitalization plus recovery. Deep inferior epigastric perforator (DIEP) flap Natural contour. Muscle sparing. Abdominoplasty. Donor site scar. Need for microsurgeon. Flap loss possible. Moderate prolongation hospitalization plus recovery. Superior gluteal artery perforator flap Natural contour. Alternative donor site. Donor site scar. Need for microsurgeon. Flap loss possible. Moderate prolongation hospitalization plus recovery.
  • 23. Patients are marked preoperatively in the standing position for anatomic landmarks as well as the proposed DIEP flap procedure. Slight adjustments to the suprapubic marking can be made during surgery to assure a tension-free closure of the abdomen
  • 24. Isolation of the DIEP flap on the selected perforators proceeds under loupe magnification, and begins by opening the anterior rectus sheath around each perforator. A very small cuff of the fascia can be harvested along with each perforator, as shown here, but routinely, no fascia is harvested. The rectus abdominis muscle is split along the direction of its fibers during DIEP flap harvest. All small side branches originating from the selected perforators or the deep inferior epigastric vessels are carefully ligated and divided as the dissection proceeds.
  • 25. End-to-end microanastomoses are fashioned between the deep inferior epigastric vessels and either the thoracodorsal or internal mammary recipient vessels. Once perfusion is re-established, the DIEP flap is debulked, contoured, and inset. Areas of the skin island underlying the native mastectomy flaps are deepithelialized in situ.
  • 26. Atlas of Breast Surgery DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology Greenfield’s Surgery: Scientific Principles & Practice Mastery of Surgery Netter’s Surgical Anatomy and Approaches SabistonTextbook of Surgery

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