This document discusses skin sparing mastectomy (SSM) and nipple sparing mastectomy (NSM). It provides details on the anatomy of the breast and history of breast cancer treatment. SSM aims to remove all breast tissue while preserving the skin and NAC. NSM further preserves the nipple. Selection criteria for NSM include small tumor size and distance from NAC. Outcomes of SSM and NSM are similar to MRM with acceptable morbidity. Complication rates of NSM include nipple necrosis around 7% and occult nipple involvement around 10%. Frozen section of subareolar tissue during NSM helps guide decision for NAC removal. Overall, SSM and NSM provide improved cosmetic
Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Surface MalignanciesMary Ondinee Manalo Igot
The prognosis of most peritoneal surface malignancies were previously dismal. However, with the incorporation of HIPEC to standard of care, we have been seeing doubling of survival for select malignancies. Appropriate patient selection is crucial.
Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Surface MalignanciesMary Ondinee Manalo Igot
The prognosis of most peritoneal surface malignancies were previously dismal. However, with the incorporation of HIPEC to standard of care, we have been seeing doubling of survival for select malignancies. Appropriate patient selection is crucial.
Oncoplastic Breast surgery is simultaneous application of lumpectomy and reconstructive techniques. The word ‘oncoplastic’ is derived from the Greek words ‘onco’ (tumour) and ‘plastic’ (to mould).
Approximately 10% to 30% of patients submitted to BCS alone are not satisfied with the aesthetic outcomes like “swan beak/ parrot beak deformities. The main reasons are related this is the tumour resection which can produce asymmetry, retraction, and volume changes in the breast.
Recently, increasing attention has been focused on oncoplastic procedures since the immediate application of plastic breast surgery techniques provide a wider local excision while still achieving the goals of a better breast shape and symmetry to obtain oncologically sound and aesthetically pleasing results. Thus, by means of customized techniques the surgeon ensures that oncologic principles are not jeopardized while meeting the needs of the patient from an aesthetic point of view.
Oncoplastic Breast surgery is simultaneous application of lumpectomy and reconstructive techniques. The word ‘oncoplastic’ is derived from the Greek words ‘onco’ (tumour) and ‘plastic’ (to mould).
Approximately 10% to 30% of patients submitted to BCS alone are not satisfied with the aesthetic outcomes like “swan beak/ parrot beak deformities. The main reasons are related this is the tumour resection which can produce asymmetry, retraction, and volume changes in the breast.
Recently, increasing attention has been focused on oncoplastic procedures since the immediate application of plastic breast surgery techniques provide a wider local excision while still achieving the goals of a better breast shape and symmetry to obtain oncologically sound and aesthetically pleasing results. Thus, by means of customized techniques the surgeon ensures that oncologic principles are not jeopardized while meeting the needs of the patient from an aesthetic point of view.
presentation covering the general anatomy of breast, radiological investigations implicated in diagnosing breast conditions, method of obtaining histopathological diagnosis, and benign breast conditions
A concise presentation on etiopathogenesis of head and neck cancer, oral potentially malignant disorders and role of epigenetics in head and neck cancer.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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.
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.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
SKIN SPARING AND NIPPLE SPARING MASTECTOMY
1. PROF.S.SUBBIAH et al.
Skin sparing and
Nipple sparing
mastectomy
Department of Surgical Oncology
Centre for Oncology
GRH,Royapettah
2. PROF.S.SUBBIAH et al.
Breasts & Women
• Breasts - not considered as parts of body alone
• Symbol of femininity and motherhood
• Self confidence
• Loss of breast change in social behavior,
eating behavior, depression
3. PROF.S.SUBBIAH et al.
Anatomy of breast
• Modified sweat gland
• Within the superficial fascia of the anterior
chest wall
• Second rib to sixth or seventh rib
• Sternal border medially to the midaxillary line
laterally
5. PROF.S.SUBBIAH et al.
Anatomy of nipple
• Fat free area under NAC
• 15–20 lactiferous ducts converge in a radial direction on the tip of nipple
• The dermis of the skin merges with superficial fascia which envelops the
parenchyma of the breast
• Colour of NAC - by blood vessels lying close to surface in long dermal
papillae
• At puberty and with each pregnancy - increase in the melanin content of
the basal cells
• Subareolar plexus of lymphatics
6. PROF.S.SUBBIAH et al.
History of breast cancer
• 3600 yrs ago
• No treatment for 1700 yrs
• Hippocrates - not to excise - in 400 BC
• Galen - Black bile theory or humoral theory
Coagulam of black bile
• Escharotomy - 1st century AD
• Guillotine approach - Renaissance period
• Mastectomy - 17th and 18th century
7. PROF.S.SUBBIAH et al.
Evolution of concepts in breast cancer
treatment
No
treatment
Escharotomy
Guillotine
Radical
mastectomy
Modified
radical
mastectomy BCS
SSM
NSM
8. PROF.S.SUBBIAH et al.
Radical mastectomy
• William Steward Halsted - in 1882
• 0% perioperative mortality
• 3 yr local recurrence rate - 6 %
• 3 yr locoregional recurrence rate - 22%
• 5 yr survival 45% (twice when
compared to untreated patients)
• Willie Mayer
10. PROF.S.SUBBIAH et al.
Extended radical mastectomy
• Removal of more regional lymph nodes
• Supraclavicular, internal mammary &
mediastinal nodes
• Increased morbidity and mortality
• Abandoned
11. PROF.S.SUBBIAH et al.
Modified radical mastectomy
• Patey and Dyson - 1940
• Preservation of pectoralis major
• 50% patients needed skin grafting
• No difference in outcome
• Conclusion : Without systemic treatment,
mortality is hardly affected by type and extent of
local treatment
• Because in a high percentage of patients, the
disease is systemic on presentation
12. PROF.S.SUBBIAH et al.
Modified radical mastectomy
• Auchincloss in 1970 - horizontal incision
• Madden - vertical incision
• Preservation of both pectoral muscles
• Equally effective
• Less morbidity
• Gold standard technique
13. PROF.S.SUBBIAH et al.
Breast conserving surgery
• Fisher - disease was systemic from beginning
- microscopic metastases were present
in most patients
- impact of extensive surgery on survival
was minimal
• BCS - in 1990
• Breast conserving surgery + radiotherapy was
equally as effective as mastectomy
14. PROF.S.SUBBIAH et al.
MRM --> Breast conservation
• One size fits all concept - proven wrong
• Now Tailor made approach for each individual
patients
15. PROF.S.SUBBIAH et al.
Skin sparing mastectomy
• Toth and Lambert - 1991
• Initially major concern regarding the amount of
residual breast tissue remaining on the longer skin
flaps, inframammary fold, and axillary tail
• Barton et al disproved it
• Well-planned incisions
• To allow immediate reconstruction
• Better breast contour and cosmetic results
17. PROF.S.SUBBIAH et al.
Skin sparing mastectomy - 4 types
• Type 1 - only nipple areola complex removed
• Type 2 - NAC is removed along with skin overlying the
tumour & biopsy site as one specimen
• Type 3 - Similar to type 2 but resected separately leaving
intact tissue in between
• Type 4 - NAC is removed along with certain amount of
skin using wise pattern breast reduction skin incision
19. PROF.S.SUBBIAH et al.
Skin sparing mastectomy
• Indications :
Just like any other mastectomy
• Small and medium size breasts - Types 1 to 3 SSM
• Large ptotic breasts - Type 4 SSM
• Absolute contraindications :
1. Skin involvement by the tumour
2. Inflammatory carcinoma
20. PROF.S.SUBBIAH et al.
Results of SSM
• Recurrence after SSM - 3.8% to 10.4%
For NSSM - 1.7% to 11.5%
• No statistically significant difference between
the two groups
• Skin flap ischemia and necrosis - 11% (same as
NSSM)
21. PROF.S.SUBBIAH et al.
SSM - Benefits
• Reduced postmastectomy deformity and
improved breast shape
• Scars are better and reduced
• Need for extensive tissue expansion and for
myocutaneous flaps is minimal
• Immediate reconstruction has a beneficial
impact on patient’s psychology
22. PROF.S.SUBBIAH et al.
Nipple sparing mastectomy
• Freeman in 1962 - for benign diseases
• Total skin sparing mastectomy
• Patient's dissatisfaction regarding shape of the
reconstructed NAC, lack of projection and color
match --> concept of NSM
23. PROF.S.SUBBIAH et al.
NSM - Criteria for patient selection
1. Prophylactic mastectomy
2. Management of Cancer
Size of tumour <3 cm
Distance from nipple areola complex >2-4 cm
No bloody nipple discharge
Clinically no involvement of nipple areola
Frozen section from subareolar area negative
Not centrally located tumours
24. PROF.S.SUBBIAH et al.
NSM - Criteria for patient selection
• Debatable
Lymph node status
Preoperative chemotherapy /radiotherapy
• Not advisable based on tumour biology
ER(-), PR (-), LVI (+)
• Absolute contraindications
1. Skin involvement by the tumour
2. Inflammatory carcinoma
28. PROF.S.SUBBIAH et al.
NSM - Technique
• Dermis and epidermis of the nipple are
left behind
• But all the ducts are removed from the
lumen of the nipple
• Distal part of the ducts is sent for frozen
section
• If it is positive convert to SSM by
removing the NAC
29. PROF.S.SUBBIAH et al.
Subareolar frozen section
• Sensitivity - 91%
• Specificity - 98%
• False negative rate - 8.7%
• Occult carcinoma in retained NAC - 1.2 to 5.9%
- Most often DCIS
• Debate regarding role of Frozen section - as it
distorts the specimen
• Some centers - NAC managed in second stage if HPE
is positive
31. PROF.S.SUBBIAH et al.
NSM - outcomes
• Locoregional recurrence rate - 1.8%
• Distant metastasis rate - 2.2 %
• Most reconstructions - Implant and/or tissue expander
• Only 13.8% used autologous tissue
• Overall pooled complication rate - 22%
Two-stage reconstruction (expander to implant) - 52.8%
One stage reconstruction (direct to implant) - 16.7%
Autologous reconstruction - 23.7 %
32. PROF.S.SUBBIAH et al.
Nipple necrosis
• Nipple necrosis rate - 7%
Before 2010 - 10.22%
After 2010 - 6.46%
• Based on incision types
Highest in transareolar - 81.82%
Least in previous mastopexy incision - 4.76%
33. PROF.S.SUBBIAH et al.
Erectile function & sensation of NAC
• Nerves traveling along the chest wall from lateral
edge of sternum to medial aspect of NAC
• Wagner et al
• Measured nipple erection preoperatively and at 6
& 12 mon after NSM
• Nipple erection was preserved in the majority of
patients
35. PROF.S.SUBBIAH et al.
Two stage NSM
1. NAC is detached from underlying lactiferous
glands through a periareolar incision
2. NSM after 2-3 weeks
• Subareolar biopsy is performed during the
first operation
• Drawbacks of frozen section are eliminated
36. PROF.S.SUBBIAH et al.
ELIOT
• Electron beam intraoperative radiotherapy
• Petit and Veronasi
• Radiosurgical treatment combining
subcutaneous mastectomy with IORT
• Total necrosis of NAC - 3.5%
• Partial necrosis - 5.5%
• Prosthesis removal - 4.3%
• Same result as post-op RT
37. PROF.S.SUBBIAH et al.
Take home message
• Tailor made approach for breast cancer
• Reconstruction considered as an integral part of breast
cancer surgeries
• SSM and NSM needs careful selection of patients
• Similar oncological outcome with acceptable morbidity
for SSM and NSM compared to MRM
• NSM should include frozen section of subareolar area