lecture

1. Pre and
Postmastectomy
Care
Sept. 20, 2019/Friday
Prof. Roel Tolentino, MD, MBA,
FPSO, FPCS, FPSG, FMOSP, FACS (2013)
Surgical Oncologist
Former President, PSO

2. Memorial Sloan Kettering Cancer Center (NYC)
University Hospitals of Columbia University and
Cornell Medical College (NYC)
MD Anderson Cancer (Texas)
Beijing Cancer Hospital (China)
Chongqing Medical University (China)
Suining Central Hospital (China)
De La Salle University – BS. Biology;
Medicine
Manila Med – General Surgery
SLMC – Surgical Oncology
Ateneo GSB - MBA
Prof. Roel Tolentino, MD, MBA
Further studies:

3. Pre and
Postmastectomy
Care
Sept. 20, 2019/Friday
Prof. Roel Tolentino, MD, MBA,
FPSO, FPCS, FPSG, FMOSP, FACS (2013)
Surgical Oncologist
Former President, PSO

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… assessing and being sensitive to the
patient's emotional health is essential to
nursing care?
Carolyn Weaver, Nursing 2009

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… same-day surgery following mastectomy
has been proven to be safe and favored by
women for improved recovery at home in the
comfort of their family?
May Quan, Helio.com, 2019

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… you can improve your patients’
outcome through better knowledge and
proper care!

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… there is no need to imagine because I
will give you critical inputs on this topic.

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Diagnostics

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ABNORMAL FINDINGS in Mammography

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ABNORMAL FINDINGS in Mammography
1) microcalcifications
2) architectural distortion

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Early detection for breast disease/cancer:
• 20 years or older
– Breast self examination (BSE) monthly.

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• 20-40 years old
– Breast self examination monthly.
– Physician breast examination every 3 years.

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• An initial mammogram between the age of
35-40 years.
Early detection for breast disease/cancer:

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• 40-50 years old
– BSE monthly.
– Annual physician breast examination.
– Periodic mammography every year or two as
needed.

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• Over 50 years of age
– BSE monthly.
– Annual mammography and physician breast
examination.

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Magnetic Resonance Imaging

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Open Surgical
Biopsy
Percutaneous
Biopsy
Options Include . . .

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Fine Needle Biopsy

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Technique of Fine Needle Aspiration

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Bloody Nipple Discharge
Intraductal papilloma

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Core Needle Biopsy

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INCISION VS. EXCISION

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Phyllodes Tumor

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Phyllodes Tumor
• Connective tissue tumor
• Rapid growth

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Phyllodes Tumor
• Connective tissue tumor
• Rapid growth

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TNM CLASSIFICATION FOR STAGING OF CANCER OF THE
BREAST (AJCC 6th Edition)

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TNM CLASSIFICATION FOR STAGING OF CANCER OF THE
BREAST (AJCC 6th Edition)

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TNM CLASSIFICATION FOR STAGING OF CANCER OF THE
BREAST (AJCC 6th Edition)

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TNM CLASSIFICATION FOR STAGING OF CANCER OF THE
BREAST (AJCC 6th Edition)

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Operations for Breast Cancer

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Modified Radical Mastectomy

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Completed Axillary Dissection

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Findings: 16 x14x12 cm mass

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JP drain placed & incision
site closed.

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21 years old, female
Left breast removed at age 8

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Breast Conserving Surgery
(BCS)

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Breast Conserving Surgery
(BCS)
-Lumpectomy
-Axillary Dissectiion
-Radiation therapy to the breast

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•
Trans–rectus Abdominis Muscle (TRAM) Reconstruction
Breast Reconstruction

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Breast Reconstruction
Trans–rectus Abdominis Muscle (TRAM) Reconstruction

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Breast Reconstruction
Lattisimus Dorsi Flap
Phylloides Tumnor

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Breast Reconstruction
Lattisimus Dorsi Flap

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Breast Reconstruction
Lattisimus Dorsi Flap

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HEALING AT HOME
- PAIN MEDICATIONS
- WOUND CARE
- Jackson Pratt DRAIN CARE

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HEALING AT HOME
- SEROMA
- WEARING PROSTHESIS

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Complication

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Complication
(Postoperative Bleeding)

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Complication
(Infection)

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Complication

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Complication

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Chemotherapy

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Chemotherapy
Portacatheter Inserted

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Hormone Therapy
Tamoxifen and Aromatase Inhibitors

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Radiation Therapy
Linear Accelerator
P60,000

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Recurrence

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Frequency of breast cancer metastases

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Distant Metastasis
•Lungs
•Bone

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Pulmonary Metastasis with
Pleural Effusion
• Thoracentesis

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Pulmonary Metastasis
Tube Thoracostomy

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You help patients to improve their
recoveries through better
understanding of breast cancer!

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