Surgery

Question 1

Surgery options for breast cancer

Answer 1

• Breast-conserving surgery
• Mastectomy (removal of whole breast)
• Axillary clearance if cancer found in nodes (risk of lymphoedema - impaired lyphmatic drainage in affected arm)

Question 2

Reconstructive surgery options for mastectomy

Answer 2

• Immediate
• Delayed - months or years after initial mastectomy
• Partial reconstruction - flap or fat tissue to fill gap
• Reduction and reshaping so both breasts match
• Breat implant
• Flap reconstruction - tissue from another part of body to reconstruct breast

Question 3

Types of flap reconstructive surgeries for mastectomy

Answer 3

• Latissimus Dorsi Flap: breast reconstructed using portion of latissimus diorsi, skin and fat tissue
• Transverse Rectus Abdominis Flap (TRAM Flap)

Both either:
- “Pedicled”- keeping original blood supply and moving tissue under skin to new location
- “Free flap” - cutting tissue away and transplanting it to new location
- Deep Inferior Epigastric Perforator Flap (DIEP Flap): reconstruction using skin and subcutaneous fat from abdo

Question 4

Breast cysts

Answer 4

• Bengin, fluid-filled lumps
• Most common cause of breast lumps, most occur between 30 to 50
• Might be pain, may fluctuate in size over menstrual cycle
• Exam: smooth, well-circumscribed, mobile, possibly fluctuant

Refer for further assessment to exclude cancer, imagining +/- aspiration/excision

Question 5

Bowel cancer: surgical resection

Answer 5

• Ideally resection of affected section of bowel
• Right hemicolectomy involves removal of the caecum, ascending and proximal transverse colon.
• Left hemicolectomy - removal of the distal transverse and descending colon.
• High anterior resection (sigmoid colectomy) - removal of sigmoid colon
• Low anterior resection - removal of sigmoid colon and upper rectum , sparing lower rectum and anus
• Abdomino-perineal resection (APR) - remove rectum + anus +/- sigmoid colon and suturing over the anus = permanent colostomy
• Hartmann’s procedure - emergency procedure for e.g. acute obstruction by a tumour, removal of rectosigmoid colon, and removal of rectal stump > colostomy creation

Question 6

Hernia