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Surgery Pimp Facts Surgical Recall
Terms in this set (70)
superior boundary of axilla
posterior boundary of axilla
long thoracic nerve
lateral boundary of axilla
medial boundary of axilla
lateral to, deep to, or medial to pectoral minor muscle, depending on level of nodes taken
what four nerves must the surgeon be aware of in axilla?
long thoracic nerve, thoracodorsal nerve, medial pectoral nerve, lateral pectoral nerve
Long thoracic nerve
midaxillary line on serratus anterior. serratus anterior keeps scapula in place. get winged scapula
Thoracodorsal nerve or subscapular nerve
innervates latissimus dorsi
medial pectoral nerve
runs laterally or through the pectoral mnior. lateral to the lateral pectoral nerve. pec minor and major muscles
lateral pectoral nerve
runs medial to the medial pectoral nerve. innervates pectoralis major.
cutaneous nerve that crosses axilla transverseley
intercostobrachial nerve. nick it and lose sensation.
what is so weird about pectoral nerves
names describe orientation from brachoal plexus
large vein that marks axilla
lateral lymph drainage of breast
axillary lymph nodes
medial drainage of breast
parasternal nodes which run with internal mammary artery
Level I axillary lymph nodes
Low. lateral to pectoral minor
Level II axillary lymph nodes
Middle. deep to pectoal minor
Level III axillary lymph nodes
high. medial to pectoral minor
Which has worst prognosis?
runs inferior to superior so level III axillary lymph nodes has worst prognosis
between pectoralis major and minor muscles, usually not removed unless they are enlarged or suspicious intraoperatively
tail of spence
tail of breast tissue that tapers into axilla
lifetime incidence of breast cancer
12% lifetime risk
% of women with breast cancer with no known risk factors
percentage of breast cancer in women older than 70 years
prophylactic bilateral mastectomy
relative risk of hormone replacement therapy causing breast cancer?
why does skin reaction in breast cancer occur?
tumor involvement of cooper's ligaments and subsequent traction on ligaments pull skin inward
different types of invasive breast cancer
infiltrating ductal carcinoma 75%. 15% medullary carcinoma. 5% infiltrating lobular carcinoma. 2% tubular carcinoma. 1% colloid mucinous carcinoma. 1% inflammatory breast cancer
fibrocystic disease of breast
Most common breast tumor in patients younger than 30yo
Most common cause of bloody nipple discharge in a young woman. if peripheral, has higher risk of malignancy so can excisional biopsy lumpectomy
What is the most common cause of breast mass after breast trauma?
What is the most common cause of green, straw-colored or brown nipple discharge
found on mammogram, a spiculated mass with CENTRAL LUCENCY with or without microcalcifications. ASSOCIATED WITH TUBULAR CARCINOMA, SO MUST BIOPSY
screening recommendations for breast cancer: breast exams
self exam monthly. 20-40 breast exam every 2-3 years by phusician. >40 years annual breast exam by phusician
Baseline mammogram age
yearly or every other year mammogram after
yearly mammogram after
best time for breast self exam
1 week after menstrual period
mammography more diagnositc in which age?
older women becuase undergoes fatty replacement with age, making masses more visible. younger women have more fibrous tissue.
best image technique for women <30
path specimen methods
FNA, core needle biopsy, mammotome stereotactic biopsy, open biopsy ither incisional cutting a piece or excisional entire mass
indications for biopsy
persistent mass after aspiration, solid mass, blood in cyst aspirate,suspicious leison by mammo, ultrasound or MRI, bloody nipple discharge, ulcer or dermatitis of nipple, patient's concern
how do you biopsy if nonpalpable
stereotactic mammotome biopsy or ultrasond needle localization biopsy
Needle localization biopsy
needle localization by radiologist, followed by biopsy, removed breast tissue must be checked by mammogram after to ensure all suspicous lesion taken out
mammogram guided computerized stereotactic core biopsy
what is obtianed first, the mammogram or biopsy?
mammogram first, otherwise tissue removal could alter mammo findings.
suspicious mammo findings
mass, microcalcifications, stellate/spiculated mass.
breast exam, ultrasound if younger than 30 mammogram if older, then biopsy.
if ultrasound cyst
aspirate, send to cytology
*when do you open biopsy for a cyst?
in the case of a second cyst occurrence. Bloody fluid in cyst. palpable mass after aspiraton
history risk factors for breast cancer: NAACP
Nulliparity, Age at menarch <13y, Age at menopause >55yo, Cancer of the breast (self or family), Pregnancy with first child >30yo
Physical/anatomic risk factors for breast cancer? CHAFED LIPS
Cancer in the breast, Hyperplasia, Atypical hyperplasa, Female, Elderly, DCIS, LCIS, Inherited genes, Papilloma, Scloering adenosis
Breast cancer - Stage I
Tumor <2cm, No metastases, No nodes
Breast cancer stage IIA
tumor <2cm with mobile axillary lymoh noes or tumor 2-5cm with no nodes
Breast cancer - Stage IIB
Tumor 2-5cm, Mobile axillary node, OR Tumor >5cm, No nodes
common sites of mets in breast cancer
Lymph nodes> lung pleura> liver> bone> brain
modified radical mastectomy
Breast, axillary nodes (level Ii, I) and nipple-areolar complex are removed
Pectoralis msucles are NOT removed. Drains in axilla and chest wall
when do you remove drains after axillary dissection
<30cc drainage per day OR POD #14
major contraindication to lumpectomy and raiation
pregnancy. Previous radiation to chest. positive margins, collagen vascular disease like lupus or scleroderma, extensive DCIS diffuse microcalcificaitons.
relative contraindications to lumpectomy and radiation
lesion that cannot be seen on the mammograms, very small breast
where do you place drains in MRM?
axilla and chest wall
potential complications fo modified radiacl mastectomy
ipsilateral lymphedema, infection, injury to nerves, skin flap necrosis, hematoma/seroma, phantom breast syndrome
why do you not paralyze patient during axillary dissection?
becuase long thoracic and thoracodorsal need to be stimulated with muscle contraction to identify them. thoracodorsal stimulates lat dorsi, long thoracic stimulates serratus anterior
sentinal lymph node biopsy
inject blue dye and technetium labeled sulfur colloid. primary node via image and geiger counter.
indication for sentinel lymph node biopsy
T1 or T2 women with negative lymph nodes (stage Ia Ib)
can prevent breast cancer
Transverse Rectus Abdominus Myocutaneous flap
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