Ductoscopy-Guided and Conventional Surgical Excision
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Surgical Options for Breast Cancer
The Breast Center Smilow Cancer Hospital 20 York Street, North Pavilion New Haven, CT 06510 Phone: (203) 200-2328 Fax: (203) 200-2075 SURGICAL OPTIONS There are a number of surgical procedures available today for the treatment of breast cancer. You will likely have a choice and will need to make your own decision, in consultation with your specific surgeon, about the best option for you. We offer you a choice because the research on the treatment of breast cancer has clearly shown that the cure and survival rates are the same regardless of what you choose. The choices can be divided into breast conserving options (i.e. lumpectomy or partial mastectomy) or breast removing options (mastectomy). A procedure to evaluate your armpit (axillary) lymph nodes will likely occur at the same time as your breast surgery. This is done to help determine the likelihood that cells from your breast cancer have left the breast and spread (metastasized) to another more dangerous location. This information will be used to help decide about your need for chemotherapy or hormone blocking drugs after surgery. PARTIAL MASTECTOMY (LUMPECTOMY) A partial mastectomy involves removing the cancer from your breast with a rim, or margin, of normal breast tissue. This allows the healthy noncancerous part of your breast to be preserved, and usually will not alter the sensation of the nipple. The benefit of this surgical choice is that it often preserves the cosmetics of the breast. Your surgeon will make a decision about the volume of tissue that needs removal in order to maximize the chance of clear margins as confirmed by our pathologist. -
Therapeutic Mammaplasty Information for Patients the Aim of This Booklet Is to Give You Some General Information About Your Surgery
Oxford University Hospitals NHS Trust Therapeutic mammaplasty Information for patients The aim of this booklet is to give you some general information about your surgery. If you have any questions or concerns after reading it please discuss them with your breast care nurse practitioner or a member of staff at the Jane Ashley Centre. Telephone numbers are given at the end of this booklet. Author: Miss P.G.Roy, Consultant Oncoplastic Breast Surgeon Oxford University Hospitals NHS Trust Oxford OX3 9DU page 2 Therapeutic mammaplasty This operation involves combining a wide local excision (also known as a lumpectomy) with a breast reduction technique resulting in a smaller, uplifted and better shaped breast. This means that the lump can be removed with a wide rim of healthy tissue. The nipple and areola are preserved with their intact blood supply and the remaining breast tissue is repositioned to allow reshaping of the breast. The scars are either in the shape of a lollipop or an anchor (as shown below). You may have a drain placed in the wound to remove excess fluid; this is usually left in for 24 hours. This procedure can be carried out on one or both of your breasts, as discussed with your surgeon. Vertical mammaplasty Lollipop scar Wise pattern Anchor shaped scar mammaplasty page 3 Your nipple is moved to a new position to suit your new breast shape and size but it may end up in a position different to your wishes. The surgeon will try to achieve a mutually agreed breast size whilst performing the operation; however a cup size cannot be guaranteed and there are likely to be further significant changes to your breast after radiotherapy. -
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SGA200171.qxp 3/24/11 1:50 PM Page 158 Abstracts SGNA’S 38TH ANNUAL COURSE May 6-11, 2011 | Indianapolis, Indiana WE ARE PLEASED TO PRESENT THE ABSTRACTS FROM SGNA’S 38TH ANNUAL COURSE, SGNA: THE LINK BETWEEN PRACTICE AND CARE. THE DIVERSITY OF THESE TOPICS CERTAINLY REFLECTS THE RICHNESS AND BREADTH OF OUR SPECIALTY.IN KEEPING WITH THE TRADITION OF THE ANNUAL COURSE, WE HOPE THE FOLLOWING ABSTRACTS WILL ENCOURAGE DISCUSSIONS FOR IMPROVING NURSING PRACTICE AND PATIENT CARE OUTCOMES. Kathy A. Baker, PhD, RN, ACNS-BC, CGRN, FAAN Editor TRAIN THE TRAINER: THE NURSE quality of care and patient safety; and a growing need MANAGER’S GUIDE TO THE REPROCESSING COMPETENCY to solve the fiscal dilemma of meeting the significant care demands of the patients we serve are just some of Jane Allaire, RN, CGRN the drivers for improved performance. In an effort to James Collins, BS, RN, CNOR improve efficiency, numerous facilities have begun to Michelle E. Day, MSN, RN, CGRN use Lean methods. These methods have been successful Cynthia M. Friis, MEd, BSN, RN, BC in eliminating waste and redundancy in endoscopy work processes resulting in improved financial, patient Patricia Maher, RN, CGRN satisfaction, and safety performance. Identifying the Joan Metze, BSN, RN waste, creating standard work processes, and using data which also serve as benchmarks will provide a The process for reprocessing flexible gastrointestinal baseline for the implementation of Lean methods. An endoscopes, as outlined by the Society of important part of implementing new processes in the Gastroenterology Nurses and Assocciates, will be thor- gastrointestinal unit is facilitating the change process. -
Evaluation of Nipple Discharge
New 2016 American College of Radiology ACR Appropriateness Criteria® Evaluation of Nipple Discharge Variant 1: Physiologic nipple discharge. Female of any age. Initial imaging examination. Radiologic Procedure Rating Comments RRL* Mammography diagnostic 1 See references [2,4-7]. ☢☢ Digital breast tomosynthesis diagnostic 1 See references [2,4-7]. ☢☢ US breast 1 See references [2,4-7]. O MRI breast without and with IV contrast 1 See references [2,4-7]. O MRI breast without IV contrast 1 See references [2,4-7]. O FDG-PEM 1 See references [2,4-7]. ☢☢☢☢ Sestamibi MBI 1 See references [2,4-7]. ☢☢☢ Ductography 1 See references [2,4-7]. ☢☢ Image-guided core biopsy breast 1 See references [2,4-7]. Varies Image-guided fine needle aspiration breast 1 Varies *Relative Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate Radiation Level Variant 2: Pathologic nipple discharge. Male or female 40 years of age or older. Initial imaging examination. Radiologic Procedure Rating Comments RRL* See references [3,6,8,10,13,14,16,25- Mammography diagnostic 9 29,32,34,42-44,71-73]. ☢☢ See references [3,6,8,10,13,14,16,25- Digital breast tomosynthesis diagnostic 9 29,32,34,42-44,71-73]. ☢☢ US is usually complementary to mammography. It can be an alternative to mammography if the patient had a recent US breast 9 mammogram or is pregnant. See O references [3,5,10,12,13,16,25,30,31,45- 49]. MRI breast without and with IV contrast 1 See references [3,8,23,24,35,46,51-55]. -
Therapeutic Mammoplasty
Therapeutic mammoplasty This information is for women undergoing a therapeutic mammoplasty and explains what happens during the operation, outlining the benefits, alternatives and risks of surgery. If there is anything that you do not understand or you have further questions or concerns please speak to one of the breast care nurses. Their contact details are listed at the end of this document. What is a therapeutic mammoplasty? Therapeutic mammoplasty is an operation to remove the breast cancer (therapeutic) and then reshape the breast by removing skin and breast tissue (mammoplasty), to try to preserve a normal breast shape that will usually be smaller and more uplifted. There is a limit to how much breast tissue can be removed with a standard lumpectomy without adversely affecting the appearance of the breast, but this technique allows us to remove more breast tissue and attempt to leave an acceptable cosmetic outcome. The operation is suitable for women with moderate to larger breasts, and who have a degree of droop (ptosis). If there is significant asymmetry (difference between your breasts) afterwards, the breast on the other side may also need to be reduced, to provide a better match in size and shape if so desired. This is known as symmetrisation surgery and will be performed at a later date. What are the advantages? • The technique aims to produce a normal breast shape with no indentation, distortion or loss of cleavage that might otherwise be likely. It is particularly useful for lower breast tumours that are more likely to develop a deformity if a simple lumpectomy is performed. -
Lumpectomy/Mastectomy Patient/Family Education
LUMPECTOMY/MASTECTOMY PATIENT/FAMILY EDUCATION Being diagnosed with breast cancer can be emotionally challenging. It is important to learn as much as possible about your cancer and the available treatments. More than one type of treatment is commonly recommended for breast cancer. Each woman’s situation is unique and which treatment or treatments that will be recommended is based on tumor characteristics, stage of disease and patient preference. Surgery to remove the cancer is an effective way to control breast cancer. The purpose of this educational material is to: increase the patient’s and loved ones’ knowledge about lumpectomy and mastectomy to treat breast cancer; reduce anxiety about the surgery; prevent post-operative complications; and to facilitate physical and emotional adjustment after breast surgery. THE BASICS There are three primary goals of breast cancer surgery: 1. To remove a cancerous tumor or other abnormal area from the breast and enough surrounding breast tissue to leave a “margin of safety” around the tumor or affected area. 2. To remove lymph nodes from the armpit area (axilla) to check for possible spread of cancer (metastasis) or remove lymph nodes that are already known to contain cancer. 3. Sometimes one or both breasts are removed to prevent breast cancer if a woman is at especially high risk for the disease. Breast cancer surgery can be done before or after chemotherapy (if chemotherapy is recommended). Radiation therapy and hormonal therapy (if recommended) are typically done after surgery. There are several types of breast surgery. The type of surgery best suited for a specific woman depends on the type of breast disease, the size and location of the breast disease/tumor(s) in the breast, and the personal preference of the patient. -
Lumpectomy and Mastectomy Surgery Comparison
Lumpectomy and Mastectomy Surgery Comparison Surgery to remove cancer from the breast can be done with either lumpectomy or mastectomy. Your surgeon will tell you if one option is better for you than the other. Or, you may be eligible for both and must decide which procedure to have. Survival rate (chance of being alive at a certain time point) is the same with both surgeries. For this reason, both surgical options are considered equal in the treatment of breast cancer. Lumpectomy Lumpectomy is the removal of the part of the breast that has cancer. Other names for this surgery are segmental and partial mastectomy. This surgery is for patients who have a small area of disease in relation to breast size. Lumpectomy must be followed by radiation to be considered appropriate treatment. Radiation usually begins four to six weeks after surgery. For patients receiving partial breast radiation, treatment will begin about one week after surgery. There are several possible courses of radiation. Your radiation doctor will discuss the best course for you. Sometimes the cancer cannot be felt during a physical exam. When this happens, a wire or locator device will be placed in your breast the morning of surgery. Medicine to numb the involved area of the breast is given before this device is inserted. This wire or locator device will guide your surgeon to the area of the breast to be removed. Lumpectomy Pros and Cons Pros Cons Outpatient surgery. Greater possibility of re-excision (additional surgery). Shorter recovery. Usually requires radiation. No drain. Possible cosmetic change. -
Mammary Ductoscopy, Aspiration and Lavage
Cigna Medical Coverage Policy Effective Date ............................ 2/15/2014 Subject Mammary Ductoscopy, Next Review Date ...................... 2/15/2015 Coverage Policy Number ................. 0057 Aspiration and Lavage Table of Contents Related Coverage Policies Coverage Policy .................................................. 1 Emerging Breast Biopsy/Localization General Background ........................................... 1 Procedures Coding/Billing Information ................................. 10 Electrical Impedance Scanning (EIS) and References ........................................................ 10 Optical Imaging of the Breast Genetic Testing for Susceptibility to Breast and Ovarian Cancer (e.g., BRCA1 & BRCA2) Magnetic Resonance Imaging (MRI) of the Breast Mammography Prophylactic Mastectomy INSTRUCTIONS FOR USE The following Coverage Policy applies to health benefit plans administered by Cigna companies. Coverage Policies are intended to provide guidance in interpreting certain standard Cigna benefit plans. Please note, the terms of a customer’s particular benefit plan document [Group Service Agreement, Evidence of Coverage, Certificate of Coverage, Summary Plan Description (SPD) or similar plan document] may differ significantly from the standard benefit plans upon which these Coverage Policies are based. For example, a customer’s benefit plan document may contain a specific exclusion related to a topic addressed in a Coverage Policy. In the event of a conflict, a customer’s benefit plan document always supersedes the information in the Coverage Policies. In the absence of a controlling federal or state coverage mandate, benefits are ultimately determined by the terms of the applicable benefit plan document. Coverage determinations in each specific instance require consideration of 1) the terms of the applicable benefit plan document in effect on the date of service; 2) any applicable laws/regulations; 3) any relevant collateral source materials including Coverage Policies and; 4) the specific facts of the particular situation. -
Mammary Ductoscopy in the Current Management of Breast Disease
Surg Endosc (2011) 25:1712–1722 DOI 10.1007/s00464-010-1465-4 REVIEWS Mammary ductoscopy in the current management of breast disease Sarah S. K. Tang • Dominique J. Twelves • Clare M. Isacke • Gerald P. H. Gui Received: 4 May 2010 / Accepted: 5 November 2010 / Published online: 18 December 2010 Ó Springer Science+Business Media, LLC 2010 Abstract terms ‘‘ductoscopy’’, ‘‘duct endoscopy’’, ‘‘mammary’’, Background The majority of benign and malignant ‘‘breast,’’ and ‘‘intraductal’’ were used. lesions of the breast are thought to arise from the epithe- Results/conclusions Duct endoscopes have become lium of the terminal duct-lobular unit (TDLU). Although smaller in diameter with working channels and improved modern mammography, ultrasound, and MRI have optical definition. Currently, the role of MD is best defined improved diagnosis, a final pathological diagnosis cur- in the management of SND facilitating targeted surgical rently relies on percutaneous methods of sampling breast excision, potentially avoiding unnecessary surgery, and lesions. The advantage of mammary ductoscopy (MD) is limiting the extent of surgical resection for benign disease. that it is possible to gain direct access to the ductal system The role of MD in breast-cancer screening and breast via the nipple. Direct visualization of the duct epithelium conservation surgery has yet to be fully defined. Few allows the operator to precisely locate intraductal lesions, prospective randomized trials exist in the literature, and enabling accurate tissue sampling and providing guidance these would be crucial to validate current opinion, not only to the surgeon during excision. The intraductal approach in the benign setting but also in breast oncologic surgery. -
Breast Cancer Treatment
Breast Cancer Treatment Breast cancer overview The American Cancer Society estimates that more than 266,000 new cases of invasive breast cancer may be diagnosed in 2018. It is now possible to detect most breast cancers at a very early stage. With early detection and improved treatments more women are surviving breast cancer. In fact, breast cancer survival has increased steadily over the last five decades. Today, women have more treatment options than ever before. See the Mammography (https://www.radiologyinfo.org/en/info/mammo) , Breast Cancer Screening (https://www.radiologyinfo.org/en/info/screening-breast) and Breast Cancer disease (https://www.radiologyinfo.org/en/info/breast-cancer) pages for more information and to learn about early detection. What are my treatment options? Treatment options overview Surgical treatment options include mastectomy or breast conservation therapy (BCT). Mastectomy is an operation to remove the entire breast, and usually the entire nipple. Often an axillary (armpit) sampling is also done which removes the glands under the arm called axillary nodes. The surgeon may evaluate just one or two nodes (sentinel node/s) or may perform a more extensive axillary dissection to check for disease spread. Mastectomy sometimes requires a hospital stay. A drainage tube is sometimes temporarily left in the surgical cavity after a mastectomy to help prevent fluid accumulation. Women who undergo a mastectomy have the option of breast reconstruction. Breast conservation surgery removes the breast tumor and a margin of surrounding normal tissues. It is also known by other names: lumpectomy, partial mastectomy, segmental mastectomy or quadrantectomy. Radiation therapy usually follows lumpectomy to eliminate any microscopic cancer cells in the remaining breast tissue. -
What's New in Breast Surgery?
What’s New in Breast Surgery? Hilary Shapiro-Wright, DO FACOS Surgical Breast Oncologist Lynn Women’s Health and Wellness Institute What’s New in Breast Surgery?? Hidden Scar Surgery • Concept has been around for decades • 1st goal: to remove all the cancer • 2nd goal: minimizes the visibility of the scar with the best cosmetic outcome • Peri-areolar region, axillary region, along inframammary fold • Can be done with breast conservation or mastectomy (selective patient’s) • Small to average size breasts • Tumor not close to the nipple • No visible reminder • Increased confidence, decreased emotional scars Oncoplastic Surgery • Used when a large amount of tissue needs to be removed which would leave deformity of the breast • Allows for breast conservation in patients who otherwise may not be a candidate • Breast cancer surgery combined with plastic surgery techniques • Preserves the cosmetic outcome and quality of life • The remaining breast tissue is sculpted to realign the nipple and areola and restore a natural appearance to the breast shape. • Does not compromise local control of the disease • 3 principals of oncoplastic breast surgery 1. No cancer left behind: obtain tumor free margins 2. Immediate breast reconstruction 3. Immediate symmetry with the other breast • Level 1 (oncoplastic lumpectomy) • Goal: Moving tissue to fill the space created by lumpectomy to avoid deformity • Level 2 • Advanced techniques: Mastopexy (breast lift, nipple lift) Reduction Mammoplasty (breast reduction) • Often considered for women with large breasts or with large tumors • www.link.galegroup.com Benefits of Hidden Scar Surgery and Oncoplastic Breast Surgery • More tissue is removed at the site of the cancer • Larger specimens = Larger Margins = Less Return to OR • Improved cosmetic outcome • Improved emotional outcome • Less visible reminder • Overall better outcomes for patients • For women with larger breasts: less symptoms, back pain, neck pain • Most insurance covers these procedures . -
Radical Mastectomy and Reconstruction by Brittany Stapp-Caudell
B I L A T E R A L T O T A L M O D I F I E D Radical Mastectomy and Reconstruction by Brittany Stapp-Caudell As thousands of women every year are being diagnosed with breast cancer, bilateral mastectomies are becoming both the prophylactic as well as the therapeutic procedure of choice for women young and old to prevent as well as to combat the aggressive, potentially deadly breast cancers. This arti cle will investigate the indications for mastectomy surgery, as well as a case study of a bilateral modified radical mastectomy in the clinical setting. I N T R O D U C T I O N n today’s society, the term “mastectomy” is commonplace L E A R N I N G O B J E C T I V E S in medical terminology, as well as in the postings of an I operating room’s surgery schedule and insurance billing ▲ Examine the evolution of the requests. As thousands of women every year are being diag- mastectomy procedure nosed with breast cancer, bilateral mastectomies are becoming both the prophylactic, as well as therapeutic procedure of choice ▲ Explore the affected anatomy for women, young and old, to prevent and combat aggressive, potentially deadly, breast cancers. ▲ Compare and contrast different surgical options for breast cancer B R E A S T A N A T O M Y The female breasts are paired anatomical structures on the ante- ▲ Evaluate the breast cancer rior portion of the thoracic region of a human being. Both males staging process and females have breasts, although the normal anatomy and physiology of the structures varies vastly between the two sexes.