Meme Kanserinde Mastektomi ile Eş Zamanlı Rekonstruksiyon
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1) Locally advanced breast cancer involves large tumors that have often spread to nearby lymph nodes but not distant sites. This makes the cancer inoperable with surgery alone.
2) Left untreated, locally advanced breast cancer can cause skin and tissue damage from ulceration, bleeding, and infection at the breast as well as pain, swelling, and blockages from spread to lymph nodes in the armpit.
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This document discusses reconstructive breast surgery options after mastectomy or breast conservation therapy. It describes the multidisciplinary approach required and covers timing considerations for reconstruction. The two main types of reconstruction - prosthetic devices and autologous tissue reconstruction - are outlined. Autologous techniques discussed include pedicled and free TRAM flaps, latissimus dorsi flap, and various perforator flaps. Future directions like supramicrosurgery and tissue regeneration are also mentioned.
Fat grafting in Plastic Surgery
Fat grafting involves harvesting fat from areas like the abdomen through liposuction and refining it to separate viable fat cells from other components. The purified fat is then reinjected into areas like the face and breasts through microdroplet injections between skin layers to augment volume. Potential complications include irregular contours, necrosis of grafted fat, and infection. However, stem cells found in fat tissue are also being researched for uses like wound healing, skin engineering, and repairing various organs. Fat grafting is a popular aesthetic procedure that has been improved through techniques preserving high viability of transplanted fat cells.
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Breast conserving therapy (BCT) involves breast conserving surgery followed by radiation therapy to eliminate residual cancer cells. BCT aims to provide equivalent survival to mastectomy with an acceptable cosmetic outcome and low recurrence rates. Patient selection involves evaluating tumor characteristics, breast imaging to determine extent of disease, and ruling out contraindications like multicentric tumors or prior radiation to the breast. The goal of surgery is a complete excision with negative margins followed by radiation therapy. Complications can include seroma, infection, and arm issues, though are less common than following mastectomy. BCT provides an alternative to mastectomy for many breast cancer patients when appropriate criteria are met.
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1. Breast reconstruction surgery has evolved significantly since its beginnings in the late 19th century, with various flap techniques and the use of implants.
2. Reconstruction can be done immediately after mastectomy or delayed, and involves autologous tissue flaps like TRAM flaps, prosthetic implants, or a combination.
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This document provides information on breast oncoplastic surgery techniques:
- Oncoplastic surgery (OPS) integrates plastic surgery with breast-conserving cancer surgery to allow for wider excisions without compromising breast shape. It ranges from simple reshaping to advanced mammoplasty techniques.
- Key factors in determining the appropriate OPS approach are excision volume, tumor location, breast density, and glandular composition. Excisions over 20% of breast volume or from certain locations risk deformity. OPS allows excision of up to 1000g compared to 80g for standard surgery.
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This document discusses oncoplastic breast surgery techniques. It begins by explaining breast conserving treatment and its goals of providing survival equivalent to mastectomy while achieving low recurrence rates. It then discusses various breast conserving surgery procedures like lumpectomy and quadrantectomy. The document focuses on the compromise between wide excision margins and satisfactory aesthetic results in breast conserving surgery. It also discusses various reconstruction techniques used after breast conserving surgery, including breast implants, fat grafting, flap procedures, and oncoplastic breast reconstruction. The principles and mechanisms of oncoplastic surgery are explained. Techniques for peripheral and central tumors are classified.
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- Ideal suture materials that resist infection and provide strength for closure.
- Indications for leaving the abdomen open such as damage control surgery or intra-abdominal hypertension.
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- Factors to consider before definitive reconstruction such as optimizing patient status and using tension-free techniques like component separation with mesh reinforcement for a durable repair.
Breast Reconstruction - Jane Rothwell
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LOCALLY ADVANCED BREAST CANCER
1) Locally advanced breast cancer involves large tumors that have often spread to nearby lymph nodes but not distant sites. This makes the cancer inoperable with surgery alone.
2) Left untreated, locally advanced breast cancer can cause skin and tissue damage from ulceration, bleeding, and infection at the breast as well as pain, swelling, and blockages from spread to lymph nodes in the armpit.
3) Treatment options include chemotherapy to shrink the tumor and make it operable, radiation therapy to the breast and nearby lymph nodes, and hormone therapy for hormone receptor-positive cancers.
Brachioplasty
Brachioplasty is a procedure to remove excess skin and fat from the arm. It was first described in 1954 and has since undergone modifications. Major advances came in 1995 when Lockwood proposed anchoring the arm flap to underlying fascia to address loose skin. Brachioplasty procedures have increased with the rise in bariatric surgeries. There are several classification systems for arm deformities following weight loss, including Appelt's classification which considers both skin laxity and fat amounts. Brachioplasty techniques aim to remove excess skin and fat while minimizing scarring. Potential complications include seromas, nerve damage, wound issues, and unfavorable scarring.
Breast augmentation complications
Glandular hypomastia, or inadequate breast development, can be caused by developmental factors, genetic conditions like Poland syndrome, or weight loss/breastfeeding after childbirth. It affects women's self-esteem and quality of life. Breast augmentation surgery aims to increase volume and improve shape/symmetry by creating a pocket and inserting an implant. Common complications include infection, malposition, capsular contracture (scar tissue formation), rippling, implant rupture, and rare cases of breast implant-associated lymphoma. Close monitoring and additional surgery may be needed to address complications. Informed consent is important given women's health concerns regarding implants.
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Meme Kanserinde Mastektomi ile Eş Zamanlı Rekonstruksiyon
- 1. MASTEKTOMİ İLE EŞ ZAMANLI MEME REKONSTRUKSİYONU Doç. Dr. Cihangir Özaslan Ankara Onkoloji Hastanesi
- 18. İnvaziv meme kanserinde lokal nüks 45 (+DCIS) 26 60 70 72 49 49 (lokal ileri) 73 118 65 (+DCIS) 59 58.6(+DCIS) 49(+DCIS) 2.0 6.2 3.9 5.2 7.0 5.1 4.0 4.5 5.6 5.5 5.4 5.3 1.7 51 372 77 518 114 71 25 176 177 539 112 210 225 Slavin Newman Simmons Petit Kroll Rivadeneria Foster Medina-Franco Spiegel-Butler Carlson Gerber Vaughan Greenway Takip (ay) Lokal nüks (%) Hasta sayısı Araştırıcı
- 19. DCIS’de lokal nüks 45 ay 3.7 yıl 9.8 yıl 49 ay 82.3 ay 0 3 0 0 3.3 26 95 44 28 223 Slavin Rubio Spiegel-Butler Grenway Carlson Takip Lokal nüks (%) Hasta sayısı Araştırıcı
- 24. Petit JY. Breast Cancer Res Treat, 2008
- 41. 17-22cm 7-12cm
- 63. Tek taraflı mastektomi Küçük orta meme Risk faktörü yok Büyük meme Sigara Obez hasta Radyoterapi Küçük orta meme Radyoterapi Tek pediküllü TRAM Çift pediküllü TRAM Free flep Vasküler geciktirilmiş TRAM Karşı tek pediküllü TRAM Free flep Vasküler geciktirilmiş TRAM
- 64. Alt vertikal orta hat kesisi Orta-büyük meme Küçük meme İki pediküllü TRAM Aynı taraf tek taraflı yarı-TRAM flep Subkostal kesi Karşı tek pediküllü TRAM Vasküler geciktirilmiş TRAM Serbest TRAM Genişletilmiş latismus dorsi Diğer serbest flepler