This document provides information about breast surgery and breast cancer. It discusses the anatomy of the breast including its structure, blood supply, and lymphatic drainage. It also covers common benign breast diseases such as fibroadenoma, duct papilloma, and breast abscess. The document discusses clinical assessment of breast cancer including history, examination, and investigations. It provides details on TNM staging and pathological classification of breast cancer. Finally, it describes different surgical procedures for breast cancer including simple mastectomy, modified radical mastectomy, and breast conserving surgery.
OPEN INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy
• In this video today, I have discussed Open Inguinal Hernia Repair.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Minimally invasive/accessed surgery comprises of robotic and non robotic surgery. Non robotic surgery includes laparoscopy, endoscopy, arthroscopy and etc.
OPEN INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy
• In this video today, I have discussed Open Inguinal Hernia Repair.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Minimally invasive/accessed surgery comprises of robotic and non robotic surgery. Non robotic surgery includes laparoscopy, endoscopy, arthroscopy and etc.
THYROIDECTOMY- Operative Surgery
Dear viewers,
Greetings from “Surgical Educator”
Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries. I have already uploaded two videos on open and Laparoscopic Appendicectomy. In this video today, I have discussed Thyroidectomy Surgery. However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery. Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful. This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
Surgicaleducator.blogspot.com
Youtube.com/c/surgicaleducator
Thank you for watching the videos.
This presentation gives a fine description about stoma and ostomy. This contains the details regarding types, complications and the advices that you should give to a patient with a stoma.
LAPAROSCOPIC CHOLECYSTECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #laparoscopiccholecystectomy #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and Open Cholecystectomy.
• In this video today, I have discussed Laparoscopic Cholecystectomy- the flagship procedure for laparoscopic surgeries.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and the links are:
• https://www.youtube.com/watch?v=VStEzI1jL8Y
• https://www.youtube.com/watch?v=O8j4kwpzd24
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
Lt hemicolectomy - Surgical Approach, Complications.Vikas V
This is a detailed Presentation of the surgical procedure - Left Hemicolectomy. It deals with the Surgical anatomy, Indications, Surgical Steps, Complications of the Procedure
THYROIDECTOMY- Operative Surgery
Dear viewers,
Greetings from “Surgical Educator”
Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries. I have already uploaded two videos on open and Laparoscopic Appendicectomy. In this video today, I have discussed Thyroidectomy Surgery. However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery. Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful. This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
Surgicaleducator.blogspot.com
Youtube.com/c/surgicaleducator
Thank you for watching the videos.
This presentation gives a fine description about stoma and ostomy. This contains the details regarding types, complications and the advices that you should give to a patient with a stoma.
LAPAROSCOPIC CHOLECYSTECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #laparoscopiccholecystectomy #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and Open Cholecystectomy.
• In this video today, I have discussed Laparoscopic Cholecystectomy- the flagship procedure for laparoscopic surgeries.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and the links are:
• https://www.youtube.com/watch?v=VStEzI1jL8Y
• https://www.youtube.com/watch?v=O8j4kwpzd24
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
Lt hemicolectomy - Surgical Approach, Complications.Vikas V
This is a detailed Presentation of the surgical procedure - Left Hemicolectomy. It deals with the Surgical anatomy, Indications, Surgical Steps, Complications of the Procedure
presentation covering the general anatomy of breast, radiological investigations implicated in diagnosing breast conditions, method of obtaining histopathological diagnosis, and benign breast conditions
breast is the mammary gland with lobes and ductules with lactiferous ducts.
it extends from 2nd intercostal to 6 intercostal ribs and lies over pectoralis major muscle
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
3. Situation and deep relations
Lies in superficial fascia of the pectoral region (except for
tail)
Axillary tail of Spence pierces the deep fascia & lies in the
deep fascia
Extent
Vertically; 2nd to 6th ribs
Horizontally; lateral border of sternum to the mid-
axillary line
Deep relations
Pectoral fascia: the deep fascia which the breast lies on
Muscles which lies deeper to the breast
Pectoralis major
Serratus anterior
External oblique
Retro mammary space: loose areolar tissue which
separates the breast from the pectoral fascia
4. The skin
Nipple
Conical projection
Just below the centre of the breast
At the level of 4th intercostals space
Pierced by 15 to 20 lactiferous ducts
Contains circular smooth muscles : make the
nipple stiff
Contains longitudinal smooth muscles : make
the nipple flatten
Has few modified sweat & sebaceous glands
Rich in nerve supply
Has many sensory end organs at the termination
of nerve fibres
Devoid of hair
5. The parenchyma
• glandular tissue
• 15 to 20 lobes
• each lobe is a cluster of alveoli
• drained by a lactiferous duct
• lactiferous ducts converge towards the nipple & open on it
• each duct has a dilation called a lactiferous sinus near its termination
6. The stroma
Fibrous stroma
Supporting framework of the gland
Forms septa known as the suspensory ligaments of Cooper
Anchor the skin to the pectoral fascia
Fatty stroma
Main bulk of the gland
Distributed all over the breast;
except beneath the areola & nipple
7. Blood supply
Arterial supply : arteries converge on the breast &
are distributed from the anterior surface; the
posterior surface is relatively avascular
Internal thoracic artery : through its perforating
branches
Some branches of axillary artery;
• Lateral thoracic artery
• Superior thoracic artery
• Acromiothoracic artery
(thoracoacromial artery)
Lateral branches of the posterior intercostal
arteries
8. Venous drainage : veins follow arteries;
first converge towards the base of the
nipple & form an anastomotic venous
circle, from where veins run in
superficial & deep sets
The superficial veins drain into;
Internal thoracic vein
Superficial veins of the lower
part of the neck
The deep veins drain into;
Internal thoracic vein
Axillary vein
posterior intercostal veins
9. Nerve supply
Anterior & lateral cutaneous branches of the 4th to 6th intercostal nerves
Convey sensory fibres to the skin
Convey autonomic fibres to smooth muscle & to blood vessels
Nerves do not control the secretion of milk (controlled by prolactin hormone)
11. • FibroAdenoma
• Duct Ectasia
• Duct Papilloma
• Phylloides Tumour
• Breast Abscess
Benign Breast Diseases
12. Fibroadenoma Simplex
• Young women
• Rubbery firm, smooth, very mobile mass
• Mostly a clinical diagnosis
• Early years after Menarche 16-25 years
• Overall incidence is highest in 30s and 40s
• Lobular in origin / Mostly remain static
• 1-3cm in size increase over 1-5 years
• Most common in left breast and upper outer quadrants.
13. Giant Fibroadenoma
• 30 % of all Fibroadenoma
• Greater than 6 cm
• Differential diagnosis with Phyllodes Tumor
• Confirmed via histology
• 4% are reported in pregnancy and lactating adenomas.
• Women on HRT has increased incidence.
15. Managment
• Overall Conservative.
• Reassurance
• Offer exicision
• if >3cm / rapid increase
• Symptomatic
• Patients choice, patients satisfaction.
• Surgical- If within 3cm of nipple, periareolar incision.
• Alternative- Laser Ablation, Cryosurgery
• Hormonal- Tamoxifen. Not favored due to unwanted
side effects.
16. Benign Duct Papilloma
1. Discrete Duct papilloma- common
2. Multiple duct papillomas-rare
Discrete Papilloma 2-3mm diameter, grows along the length of duct,
no pre malignant potential. Either observe or excise.
Multiple Papilloma Involve peripheral ductules, premalignant
potential, complete excision with healthy margins.
17. Duct Ectasia
• Dilatation of the ducts
• Leads to stagnation and accumulation of discharge
• May cause ulceration
• If Blood discharge- Duct excision
Mx
Microdochetomy
Had Field operation( in case of multiple)
22. MAJOR POINTS TO BE NOTED:
• Age
• Lump in breast: Mode of onset, duration, rate of growth
• Pain
• Breast or axillary changes
• Nipple: Retraction, Discharge
• Past history: H/O irradiation, cancers
• Personal history: Marital status, menstrual history
• Family history
HISTORY TAKING
23. POSITIONS:
• Arms by her side
• Arms straight up in the air
• Hands on her hips (with and
without pectoral muscle
contraction)
• Arms extended forward in a sitting
position leaning forward
• Semi recumbent position with
head raised by 45°
INSPECTION
24. MAJOR POINTS TO BE NOTED:
• Breast: Symmetry, Size, Shape, Edema (peau d’ orange), Any
visible lump or fungation
• Skin: Retraction, Erythema, Ulceration
• Nipple: Retraction, Erythema, Ulceration, Discharge
INSPECTION
25. • In sitting, semi-recumbent and recumbent position
• Examination of all quadrants of the breast, along with the axillary tail
• Done with the pads of the middle 3 fingers; avoid grasping and pinching
motion
PALPATION OF BREAST
26. POINTS TO BE NOTED IN CASE OF BREAST LUMP:
• Temperature
• Tenderness
• Number
• Situation
• Size
• Shape
• Surface
• Consistency
• Margin
• Mobility or fixity of lump
Fixity to skin, breast tissue, pectoral muscle and fascia, chest
wall
PALPATION OF BREAST
27. • Assessment of axillary lymphadenopathy
• Patient’s arm is supported on the non
examining arm of examiner to maintain
relaxation
• Examination with pads of middle 3 fingers in a
circular motion
PALPATION OF AXILLA
36. Total or simple mastectomy:
• Removal of the entire breast tissue,
• No dissection of lymph nodes or removal of muscle.
• Sometimes adjacent lymph nodes are removed along
with the breast tissue.
37. Pre-operative management
•Triple assessment.
•Metastatic workup.
•Routine blood investigations.
•Pre-anesthetic evaluation.
•Control of medical conditions like diabetes and hypertension.
•Counseling and written informed consent.
•Parts preparation- neck to mid thigh including pelvic region, axilla
and arm.
39. Operative procedures- Simple
Mastectomy
• Indications:
• Stage I and stage IIa carcinoma
• Large cancers that persist after adjuvant therapy
• Multifocal or multicentric CIS.
• Incision:
• Horizontal elliptical incision is marked so as to include the entire
areolar complex.
• Should be 1-2cm away from the tumor margins.
• Skin sparing incision- if breast reconstruction is planned
• Two skin edges should be of equivalent length
Type of Incision….....
40.
41.
42.
43. Simple Mastectomy-procedure
•Skin incision is deepened with electro-
cautery.
•A plane between breast fat and the subcutaneous fat,
seen as white fibrous plane.
•Dissection is carried in this plane and
flaps are raised inferiorly and superiorly.
•Ideally thickness of the flap should be 7-
10mm.
44. Simple Mastectomy-procedure
•Extent of dissection:
•Superiorly till clavicle,
•Laterally till P.major lateral border
•Medially to the sternal border, and
•Inferiorly till infra-mammary fold
•Breast tissue along with the pectoral fascia
(controversial) is dissected from the P.major.
45. Simple Mastectomy-procedure
•Care must be taken to ligate perforating branches of lateral thoracic and anterior
intercostal vessels.
•Wound irrigated with sterile water to crenate (shrivel or shrink)
cancerous cells.
•Subcutaneous tissue is closed using 00 absorbable interrupted sutures.
•Skin closed using 00 non-absorbable mattress sutures or using
staples.
46. Modified Radical Mastectomy (MRM):
• Removal of breast tissue and axillary lymph nodes.
• No removal of pectoral muscle.
• 3 Modification
1. Patey’s Modified Radical Mastectomy: Pectoralis major muscle is
preserved and Pectoralis minor removed + level III
2. Scanlon’s Modified Radical Mastectomy: Pectoralis minor muscle
is divided but not removed + Level III
3. Auchincloss’ Modified Radical Mastectomy: Pectoralis minor is
retraced but not divided + Level 1, Level II Cleared but Level III are
left
Auchincloss’ Modified Radical Mastectomy is widely practiced nowadays.
47. Operative procedures- Modified radical Mastectomy
• Indications:
• Early breast cancer (most commonly done)
• Residual large cancers that persist after adjuvant therapy
• Multifocal or multicentric disease.
• Incision:
• Oblique elliptical incision angled towards axilla.
• Should include the entire areolar complex and previous scars, if present.
• Should be 1-2cm away from the tumor margins.
• Two skin edges should be of equivalent length
48. Modified radical Mastectomy-procedure
•Procedure till approaching axilla is
same as simple mastectomy.
•Extent of dissection:
•Superiorly till clavicle,
•Laterally till anterior margin of latissimus dorsi.
•Medially to the sternal border, and
•Inferiorly till the costal margin near the insertion of the
rectus sheath.
49. Modified radical Mastectomy-procedure
•The specimen is retracted upwards and laterally to expose
P.minor.
•The dissection is continued to axillary lymph node
clearance.
•Care must be taken not to injure medial pectoral nerve and vessels.
•The axillary investing fascia is incised to expose the axillary group of lymph
nodes.
50. Modified radical Mastectomy-procedure
• The inter-pectoral (Rotter) group of lymph nodes are removed.
• Then dissection can be done either from medial to lateral or vise-
versa.
• The loose lateral areolar tissue in axillary space is dissected to expose
the axillary vein.
• The investing layer of axillary vessels is cut, the tributaries are
transfixed and cut.
• Dissection is carried out laterally including lateral grp (level I) of
lymph nodes.
51. Modified radical Mastectomy-procedure
• The level II lymph nodes between superior trunk of intercostobranchial bundle and axillary
vein are removed.
• The central grp of lymph nodes are removed carefully separating
from axillary vein and its tributaries.
• While dissecting medially, long thoracic nerve is encountered, which lies anterior to the
subscapular muscle. The dissection carried out anterior and medial to long thoracic nerve and the
specimen delivered.
52. Modified radical Mastectomy-procedure
•Care must be taken while dissecting in axillary area to
preserve,
•Medial and lateral pectoral nerve.
•Long thoracic vessels and nerve
•Nerve to latissimus dorsi.
•Axillary vein.
•Wound irrigated with sterile water to shrink/crenate cancerous cells.
•2 drains, 1 below and other above P.major are secured.
•Subcutaneous tissue is closed using 00 absorbable interrupted
sutures.
•Skin closed using 00 non-absorbable mattress sutures or using staples.
53. Post-operative care
•Wound examined on post-op day 3.
•Drain can be removed when it is < 30ml.
•Any collection is to be aspirated under aseptic precautions.
•Staples can be removed after 10days.
•Arm movements started in the 1st week..
•Active shoulder and upper limb exercises are started from 2
weeks
54. OtherTypes of mastectomy
3.Halsted’s Radical Mastectoŵy:
• Most extensive type.
• Breast tissue, axillary lymph nodes and pectoral muscles are removed.
• Disadvantages:
• Bad scars and unacceptable deformity.
• Reduced range of mobility of shoulder
55. Types of mastectomy
4.Subcutaneous mastectomy:
• Simple mastectomy sparing nipple.
• Rarely done, as a large amount of
breast tissue is left in situ.
5.Skin sparing mastectomy:
–Total/simple mastectomy or modified
radical mastectomy with preservation
of as much as breast skin as possible
needed for breast reconstruction.
–Local recurrence is
acceptable, 0-3%.
6. Breast conserving surgery:
•Wide local excision/Lumpectomy
•Quadrantectomy.
56. Breast conserving surgery
•Indications:
•Stage 0 (CIS), Stage I, Stage IIa
breast
•Single lesion.
carcinoma.
• Method:
•Wide local
excision/Lumpectomy
or Quadrantectomy +
axillary lymph node
clearance +
radiotherapy.
57. Types of mastectomy
7. Toilet mastectomy:
• Done in fungating or ulcerative
growths.
• Palliative simple
mastectomy.
58. Breast conserving surgery
•Advantages:
•Maintenance of appearance and
function of breast.
•Disease free interval is same as
MRM.
•Better quality of life and
psychological advantage.
• Contraindications:
• Multicentric tumor.
• Positive margins after excision.
• Size > 4cm (relative).
• Advanced stages.
• No assess to radiation/ poor
patient compliance.
• C/I for radiation: SLE/ Rheumatoid arthritis/
Scleroderma/ pregnancy/ prior chest
radiation.
59. Breast conserving surgery-Procedure
• Reshaping of breast tissue is done
•Incision-circular/ radial/ subareolar incision near to the tumor,
about 3-4cm.
•Excision of the carcinoma tissue with a margin of atlaeast 1cm
of normal breast tissue to get a 2-mm cancer-free margin.
•If tumor is situated superficially then excision of that part of skin.
•If tumor is deep then tumor is excised till pectoralis major.
•Depending on post-surgical defect
•Primary closure or
60. Breast conserving surgery-Lumpectomy
•After skin incision, subcutaneous tissue is deepened using electric cautery.
•Skin with subcuticular 3-0 absorbable sutures.
•While dissecting the breast tissue, better to use scalpel.
•Care must be taken while dissecting to palpate the tumor, so that entire lesion is excised. Specimen
radiography can be done to check for clear margins.
•Hemoclips are applied along the margins of the cavity.
•Wound closed in 2 layers:
•Subcutaneous tissue with interrupted inverted 3-0 absorbable suture.
136
61. Breast conserving surgery-Procedure
Quadrantectomy:
•Usually done for lesion in the upper outer and inner lower
quadrants.
•Radial incision is taken.
•Entire breast tissue in that quadrant is excised till pectoral fascia.
•Wound closed in multiple layers:
•Breast tissue with interrupted 3-0 absorbable suture.
•Subcutaneous tissue with interrupted inverted 3-0 absorbable suture.
•Skin with subcuticular 3-0 absorbable suture.
63. Breast conserving surgery
•After BCS, radiotherapy is essential, otherwise the
local recurrence rate is unacceptably high
•Without radiotherapy, the local recurrence can be as high as 40%
64. Breast reconstruction surgery
• The most common reason of breast reconstruction surgery, is for
psychological well being.
• Reconstructive surgery post mastectomy can be either immediate or
delayed.
• Immediate
• Skin sparing
• Better outcomes
• Delayed
• When immediate reconstruction is contraindicated.
• Other reconstructive options
65. Breast reconstruction surgery
• Types:
• Latissimus dorsi myocutaneous flap.
• Transverse rectus abdominus myocutaneous (TRAM) flap.