Principles and Techniques in Oncoplastic Breast Cancer Surgery

✍ Scribed by Mahmoud El-Tamer

• Publisher: World Scientific Publishing Company
• Year: 2012
• Tongue: English
• Leaves: 250
• Edition: 1
• Category: Library

✦ Synopsis

Oncoplastic breast cancer surgery is one of the fastest-growing domains in breast surgery. This approach is continuing to gain practice acceptance due to increased emphasis on both optimum cosmetic outcome and maintenance of a sound oncologic basis. This book summarizes the basic principles and techniques using evidence-based data. Patient images and comprehensive drawings complete this practical guide for surgeons who treat diseases of the breast.

✦ Table of Contents

CONTENTS
List of Contributors
Acknowledgments
Introduction
1. Surgical Anatomy of the Breast Mahmoud El-Tamer and Sunny Mitchell
1.1 Topology of the Breast: An Overview
1.2 Fascia
1.3 Raising Flaps
1.4 Ligaments of Cooper and Horizontal Septum
1.5 Arterial Supply of the Breast
1.5.1 Lateral Mammary Artery
1.5.2 Internal Mammary Artery
1.5.3 Thoracoacromial Artery
1.5.4 Posterior Intercostal Arteries
1.6 Venous Drainage of the Breast
1.7 Lymphatics
1.8 Nerve Supply
1.9 Nipple Areola Complex
1.9.1 Innervation
1.9.2 Blood Supply
1.9.3 Areola
References
2. Surgical Landmarks and Measurements Suri Ponamgi and Mahmoud El-Tamer
2.1 Breast Measurement
2.2 Breast Markings
2.3 Vertical Mastopexy/Reduction Markings
References
3. Neoadjuvant Therapy Laurie Kirstein, Susan K. Boolbol, and Mahmoud El-Tamer
3.1 Introduction
3.2 Background
3.2.1 Early Trials
3.2.2 Patient Selection
3.2.2.1 Exclusionary criteria
3.2.3 Tumor Size
3.3 Staging
3.3.1 Current Staging Guidelines
3.3.2 The Role of Imaging
3.3.3 Mammogram
3.3.4 Ultrasonography
3.3.5 Magnetic Resonance Imaging (MRI)
3.4 Predictors of Response
3.4.1 Response to NCT Based on Molecular Subtype
3.4.1.1 Triple negative
3.4.1.2 HER2 positive
3.5 Gene Profiling
3.6 Hormone Receptor-Positive Tumors
3.7 Invasive Lobular Carcinoma
3.8 Surgery After NCT
3.8.1 Surgical Decision Making
3.8.2 Resection Volume and Margins
3.8.3 Axillary Evaluation
3.8.4 Sentinel Node Biopsy Prior to NCT
3.8.5 Sentinel Node Biopsy After NCT
3.9 Locoregional Failure: Incidence and Predictors
3.10 Predictors of Relapse
3.10.1 Tumor and Patient Characteristics
3.10.2 Residual Disease After NCT
3.11 Future Directions
3.11.1 PARP Inhibitors
3.11.2 Vascular Endothelial Growth Factor (VEGF) Inhibitors
3.12 Conclusion
3.12.1 Patient Vignettes
3.12.1.1 Patient 1
3.12.1.2 Patient 2
References
4. Skin Incisions Mahmoud El-Tamer
4.1 Periareolar Incision
4.2 Inframammary Incision
4.3 Skin Closure
References
5. Margins in Breast Cancer Surgery Adriana D. Corben and Monica Morrow
5.1 Methods of Margin Evaluation
5.1.1 Radial Margin Approach
5.1.2 Shaved Margin Approach
5.1.3 Cavity Shave Approach
5.1.4 Other Issues Related to Margin Assessment
5.2 Margin Width and Local Recurrence: Invasive Cancer
5.2.1 The Influence of Histology on Margin Width
5.2.2 Other Factors Influencing Local Control in Invasive Cancer
5.2.3 Margins After Neoadjuvant Chemotherapy
5.2.4 Summary and Conclusions: Invasive Cancer
5.3 Margin Width and Local Recurrence: DCIS
5.3.1 DCIS: Summary and Conclusions
References
6. Resection of the Tumor Mahmoud El-Tamer
6.1 General Principles and Preoperative Planning
6.2 Resection of the Primary
6.2.1 General Principles
6.2.2 Technical Aspects
References
7. Repair of Breast Defects Mahmoud El-Tamer
7.1 General Principles
7.1.1 Transverse Closure
7.1.2 Radial Closure
7.1.3 Triangular Closure (Also Known as “Mercedes” Closure)
7.1.4 Purse-String Closure
7.1.5 Mobilization of Surrounding Subcutaneous Tissue
References
8. Oncoplastic Breast Reduction Tara L. Huston, Christine H. Rohde, Mahmoud El-Tamer, and Jeffrey Ascherman
8.1 Introduction
8.2 The Oncoplastic Approach
8.3 Patient Selection and Preoperative Breast Evaluation
8.4 History and Physical
8.5 Types of Breast Reduction
8.6 Relevant Anatomy
8.7 Technical Considerations
8.8 Incision
8.9 Pedicle
8.10 Radiation Therapy
8.11 Complications
8.12 Long-Term Oncologic Results
8.13 Breast Cancer Surveillance
8.14 Cosmetic and Functional Outcomes
8.15 Future Directions
References
9. Mastopexy Mahmoud El-Tamer
9.1 Introduction
9.2 Dome Mastopexy
9.3 Benelli Mastopexy
References
10. Skin-Sparing Mastectomy Walter Paul Weber and Mahmoud El-Tamer
10.1 Introduction
10.2 Incision
10.3 Mastectomy
10.4 Axillary Staging
10.5 Reconstruction
10.6 Safety
10.7 Postoperative Complications
10.8 Completeness of Mastectomy
10.9 Completeness of Tumor Removal and Local Recurrence Rates
10.10 Cosmesis
References
11. Nipple-Sparing Mastectomy Sunny Mitchell and Sheldon Feldman
11.1 Introduction
11.2 Rationale
11.3 Why Not Perform NSM?
11.4 Most Frequently Cited Landmark Study
11.5 Basic Science
11.5.1 Breast Ductal Anatomy
11.5.2 The Terminal Ductal Lobular Unit
11.6 Proposed Metrics
11.7 Selection
11.7.1 Size
11.7.2 Presence and Degree of Ptosis (Grade 1–3, Pseudoptosis)
11.8 Exclusionary Criteria
11.9 Preoperative Evaluation
11.9.1 Clinical Breast Exam
11.9.2 Patient History
11.9.3 Imaging
11.9.4 Planning
11.10 Plastic Reconstructive Surgery Considerations
11.11 Comorbidities
11.12 Intraoperative Technique
11.12.1 Incision Planning
11.12.2 Spy Device
11.12.3 Inframammary Fold Incision
11.12.4 Lateral Radial Incision
11.12.5 Radial 6 O’clock Incision
11.12.6 Previous Lumpectomy Scar Incision
11.12.7 Transareolar Incision
11.12.8 Tumor Site Incision
11.13 Endoscopy
11.13.1 Endoscopic Technique
11.13.2 Accessing SLNB
11.13.3 Dissection
11.13.4 Coring
11.14 Additional Technical Notes
11.15 Intraoperative Radiation with Electrons (ELIOT)
11.16 Outcomes
11.16.1 Viability
11.16.2 Sensation
11.16.3 Aesthetics
11.16.4 Recurrence Rates
11.16.5 Prophylactic NSM
11.17 Clinical Pearls
11.17.1 What Is the Learning Curve?
11.17.2 What Special Instruments Are Required?
11.18 Summary and Conclusions
11.18.1 Unresolved Issues Postmastectomy
References
12. Radiation Therapy Robert R. Kuske, Jr.
12.1 Background
12.2 Oncoplastic Surgery and 5-Day Interstitial Brachytherapy
12.3 Oncoplastic Surgery with 3-Dimensional Conformal PBI
12.4 Intraoperative Radiotherapy During Oncoplastic Surgery
12.5 Conclusions
References
Index