The commonest scars for non-cancer procedures are those following lumpectomy of benign lumps or following breast augmentation (cosmetic, or for breast asymmetry).
The common procedures for breast augmentation are IMF11 scars. Sometimes periareolar, transaxillary or even periumbilical access incisions are used. Mastopexy (breast lift) and reduction surgery may be performed through periareolar, vertical or Wise-pattern ‘anchor-shaped’ scars.
What are the specific features of certain breast implants?
Some implants, namely expanders, have an internal (integrated) or external (subcutaneous) port to allow transcutaneous inflation with saline in clinic. They are generally replaced with a definitive implant once the desired size is achieved, but some, such as the Becker Adjustable Implant, allow the injection port to be pulled out via a small incision, leaving a self-sealing valve within the main implant that can be left as a definitive device.
Capsular contracture is the body’s over-scarring around breast implants, and should be documented in patients with breast implants. Baker classified capsular contractures as class I (normal), II (palpable), III (visible), IV (painful).
What is peau d’orange?
The characteristic ‘orange-peel’ skin appearance overlying a breast is caused by lymphatic obstruction by invasive carcinoma (i.e. it represents malignant lymphoedema). It signifies a T4 tumour.
What is Paget’s disease of the breast?
Paget’s disease is an eczematous change in the appearance of the nipple thought to be caused by ductal carcinoma in situ cells that migrate into the nipple. It is sometimes associated with an underlying breast cancer.
What is SLNB?
Sentinel lymph-node biopsy (SLNB) is a technique whereby axillary lymph nodes are identified using dyes injected into the breast (radiocolloid and blue dye) and removed for surgical tumour staging. A positive biopsy will usually lead to total axillary lymph-node clearance at the time of surgery or as a separate procedure. A negative biopsy avoids unnecessary axillary node clearance, reducing the risk of procedural morbidity, such as arm lymphoedema.
What is the commonest type of post-mastectomy breast reconstruction?
The commonest type of reconstruction used is implant reconstruction. In some countries in Southeast Asia, without access to breast implants, TRAM flaps are the most common type of breast reconstruction.
What is an implant reconstruction?
Implant reconstruction is the commonest form of breast reconstruction. An implant is inserted into a submuscular (subpectoral) pocket. The inferior pole is usually covered with muscle (in small-breasted women), with the patient’s own skin (dermal flap – in large-breasted women) or increasingly with acellular dermal matrix (ADM).
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