Breast Surgery 1-5

Questions on Breast Surgery - MCH Exam Preparation

Q1. Contraindication for Breast Conserving Surgery in Carcinoma Breast?

a) Small lump to breast ratio

b) Central tumor mass

c) Tumor size less than 5 cm

d) Young age of the patient

1) b
Breast conservation involves resection of the primary breast cancer with at least 10 mm   margin of normal-appearing breast tissue, adjuvant radiation therapy, and assessment of axillary lymph node status.
Breast conservation surgery is contraindicated when
-- the tumor is multicentric and multifocal
-- the tumor is central, the advantages of preserving the breast are lost as nipple areola complex is sacrificed
-- tumor is to breast ratio is large ie the form of breast is not preserved
-- Patient is not a candidate for radiation exposure, eg pregnancy, previous history of radiation SLE etc
Age is no criteria.
Bailey 28th page 935

 Q2. Which is not true regarding BRCA mutations in breast cancer?
a) BRCA 1 tumors are high grade as compared to BRCA 2
b) BRCA 1 breast cancer are hormone receptor  positive
c) BRCA 1 breast tumor are aneuploid
d) BRCA 1 breast cancer have an increased S phase fraction

2) b

BRCA1- associated breast tumors have a worse prognosis than BRCA2- associated breast cancers.

They are high grade, associated with negative ER- PR receptors, increased S phase fraction and aneuploid.

 Q3 ) Which of the following muscles do not form the  posterior relation of breast?
   a) Pectoralis major
   b) Serratus Anterior
   c) Rectus Abdominis
   d) Lattismus Dorsi

3. d
The deep or posterior surface of the breast rests on the fascia of the pectoralis major, serratus anterior, and external oblique abdominal muscles, and the upper extent of the rectus sheath.

Schwartz Surgery


Q4 Minimum number of lymph nodes to be dissected in Axillary sampling in breast conservation surgery is

   a) 2
   b) 3
   c) 4

   d) 5

4. c
Minimum number of lymph nodes to be removed in Axillary sampling is 4 and in Sentinel Lymph node biopsy is 2
In Breast conservation surgery the axilla can be dealt in three separate ways;
1. Sentinel Lymph Node Biopsy
2. Axillary sampling
3. Axillary Dissection
 Sentinel Lymph node biopsy  axillary sampling is done for clinically node negative axilla.

 Q5) In Breast Reconstructive surgery after mastectomy which of the following is not true regarding TRAM flap
a) TRAM flap may be based on a pedicled Superior Epigastric artery
b) TRAM flap can be transferred as a free flap
c)  It is a type of  myocutaneous flap
d) It uses supraumbilical fat

5) d
TRAM flap places the scar in a more acceptable location similar to an abdominoplasty scar.
The lower abdominal area provides soft tissue of similar consistency to the breast with favorable results.
TRAM flap is receiving blood supply from the superior epigastric vessels. These connect with the deep inferior epigastric
(DIE) vessels via a rich circuit known as choke vessels, usually above the level of the umbilicus.
It can be used as a free flap
 For unilateral breast reconstruction, usually the contralateral TRAM is used to facilitate inset by decreasing the arc of rotation and subsequently the risk of vascular compromise from pressure on the pedicle
It uses infraumbilical suprapubic fat and not supraumbilical fat.
 Disadvantages of
the pedicled TRAM flap include epigastric bulge, the potential for
partial flap loss, or fat necrosis when the metabolic demands of the
tissue are not met, especially in large flaps, as well as longer recovery
period with risk of abdominal wall weakness, bulge, or hernia
Sabiston 21 st  edition page 862

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