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Breast Cancer Surgery 2004. William A. Barber, M.D. Piedmont Hospital. Breast Cancer Screening. Case Report. 45 y.o patient with two children ages 10 and 13 Mother had breast cancer at age 65 Gail 5 yr risk score 1.7 Undergoes yearly mammograms. CC View of Mammogram May 2001.

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breast cancer surgery 2004

Breast Cancer Surgery 2004

William A. Barber, M.D.

Piedmont Hospital

case report
Case Report
  • 45 y.o patient with two children ages 10 and 13
  • Mother had breast cancer at age 65
  • Gail 5 yr risk score 1.7
  • Undergoes yearly mammograms

CC View of Mammogram May 2001

3.5cm Mass Upper

Outer Quadrant

CC View of Mammogram April 2002

case report4
Case Report
  • US confirmed the existence of 3.5 cm mass
  • Core biopsy showed a poorly differentiated carcinoma
diagnosing breast cancer abnormal mammograms
Diagnosing Breast Cancer: Abnormal Mammograms

Benign Appearing




breast cancer rules
Breast Cancer Rules

Rule #1:

  • There is no difference in survival between Mastectomy and Lumpectomy
breast cancer rules7
Breast Cancer Rules

Rule #2:

  • If you have a lumpectomy, you also need Radiation Therapy
breast cancer rules8
Breast Cancer Rules

Rule #3:

  • The operation you chose has nothing to do with whether or not you will need chemotherapy.
breast cancer rules9
Breast Cancer Rules

Rule #4:

  • Most Mastectomy patients do not need Radiation Therapy.
breast cancer rules10
Breast Cancer Rules

Rule #5:

  • If you have a lumpectomy and you have positive lymph nodes, you do NOT need to go back and have a Mastectomy.
breast cancer rules11
Breast Cancer Rules

Rule #6:

  • Whether or not you need chemotherapy is determined by
    • The size of the primary tumor
    • How aggressive is the primary tumor
    • Lymph node status
    • Age of the patient
partial mastectomy lumpectomy

Partial Mastectomy (Lumpectomy)

Versus Mastectomy

How do you chose?

partial mastectomy lumpectomy13
Partial Mastectomy (Lumpectomy)
  • Contraindications
    • A. Previous history of Radiation Therapy
    • B. More than one cancer in same breast
    • C. Large tumor, small breast, cosmetic deformity
    • D. Nipple involvement
surgery terms
Surgery Terms
  • Excisional Biopsy vs. Lumpectomy
  • Partial Mastectomy vs. Lumpectomy
  • Incisional Biopsy


Difference between

Total (simple) Mastectomy

Modified Radical Mastectomy

skin sparing mastectomy
Skin Sparing Mastectomy
  • Skin sparing mastectomy preserves the majority of the breast skin and the inframammary fold
  • The entire nipple and areola are removed
radical mastectomy

Radical Mastectomy

Is Radical Mastectomy still in use?

What is it?

subcutaneous mastectomy

Subcutaneous Mastectomy

Is Subcutaneous Mastectomy a cancer operation?

How does it differ from Total Mastectomy?

sentinel node biopsy
Sentinel Node Biopsy
  • Major advance
  • Almost no risk of lymphedema
  • Blue dye
  • Nuclear medicine
sentinel lymph node biopsy
Sentinel Lymph Node Biopsy
  • Quickly becoming the gold standard
  • May be as accurate or more accurate than ALN dissection while limiting the complications and costs
  • Involves injection off Technitium-99 sulfur colloid and or 1% isosulfan blue dye
  • Multiple ongoing trials including B-32 NSABP


Tissue expander

Latissimus dorsi


reconstruction tissue expander
Reconstruction: Tissue expander

Encapsulated silicone implant reconstruction corrected with tissue expansion. The capsule is first excised, and the tissue expander is used to create an oversized pocket for the implant.

reconstruction latissimus dorsi
Reconstruction: Latissimus Dorsi

A, Preop view: 67-YO following MRM. B, Postop view: following left autogenous latissimus reconstruction w/o implant. Opposite breast reduction mammoplasty required for symmetry.

reconstruction tram
Reconstruction: TRAM

A & B, Preop & Postop views following left free TRAM reconstruction. Skin replacement included all skin between scar & inframammary fold. Nipple reconstruction, opposite mastopexy done at separate procedure.

breast reconstruction in the skin sparing mastectomy
Breast Reconstruction in the Skin Sparing Mastectomy
  • TRAM flap
  • Latissimus flap
  • Implant/Expander
  • Silicone is preferred and is available on study protocol

Tram flap with nipple reconstruction and tatooing

when to consult

When to Consult?

Medical Oncology

Radiation Oncology



What is NeoAdjuvant Chemotherapy?

When is it used?

minimally invasive excisional biopsy whats new
Minimally Invasive Excisional Biopsy: Whats New?
  • Ultrasound guided directional vacuum assisted breast biopsy with 11g and 8g mammotome
  • Introduced in 1996 these devices use vacuum to draw the tissue into a chamber and a rotating cutter dissects the specimen (Mammotome)

Inserted obturator to

prevent bending or

coiling of the catheter shaft

Radiation source

port pathway

Multilumen, silicone catheter

Variable 4 to 5 cm balloon

Needleless injection site

mammosite placement
Mammosite Placement


Time of Lumpectomy

Open Cavity

Ultrasound Guided

Scar Entry (SET)


CT Image of Mammosite

3-Dimensional rendering of applicator surface