Plastic Surgery of the Breast - Breast Cancer v15-Clinical Case Scenario 1 Breast Cancer

Clinical Case Scenario 1 Breast Cancer

Pdf Summary

The provided text discusses a clinical case scenario involving a 64-year-old female patient who has been diagnosed with ductal carcinoma in situ (DCIS) of the breast after initially declining a biopsy upon noticing mammographic abnormalities. The case highlights several considerations in determining the appropriate course of treatment and reconstructive options.<br /><br />The major decision in this case revolves around choosing between lumpectomy and mastectomy. Lumpectomy is an option if the patient agrees to adjuvant radiation therapy, whereas a mastectomy may avoid the need for radiation. The patient also has symptomatic macromastia, making her a good candidate for oncoplastic reduction, which could be performed at the time of lumpectomy.<br /><br />The text further delves into the controversial nature of sentinel lymph node biopsy in cases of DCIS. The decision to conduct this biopsy often depends on the presence of micro-invasive components, especially if a mastectomy is chosen, since a subsequent sentinel node biopsy wouldn't be possible.<br /><br />Adjuvant treatment decisions, including the use of chemotherapy or endocrine therapy, depend significantly on the surgical approach and other patient and tumor characteristics. The patient needs to be counseled on all reconstructive options post-surgery to fully understand the implications of her treatment choices.<br /><br />Additionally, the text mentions the emerging consideration of nipple-sparing mastectomy, a procedure whose indications are expanding across various breast sizes and degrees of ptosis. Alongside this expansion, specialized reconstruction techniques are increasingly being applied.<br /><br />This clinical scenario underscores the need for comprehensive patient education on treatment implications, especially concerning the interplay between oncologic surgery choices and reconstructive options in managing breast cancer.

Keywords

ductal carcinoma in situ

DCIS

breast cancer

lumpectomy

mastectomy

oncoplastic reduction

sentinel lymph node biopsy

nipple-sparing mastectomy

reconstructive options

patient education