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Difference between a free TRAM vs. a pedicled TRAM flap

A free TRAM flap is separated from the body freeing it from the original blood vessels and re-attached to new blood vessels in the chest or axilla.

The pedicled TRAM flap derives its blood flow from the upper part of the rectus muscle and is rotated and tunneled into the chest.

Both have the transverse abdominal muscle, fat and skin transferred but the free TRAM has a stronger blood flow and could be a reasonable choice in patients with a potentially impaired blood supply such as smokers, diabetics, and obese patients.

More information regarding plastic surgery in Modesto for breast reconstruction.

Gail Model of Breast Cancer Risk Assessment

What are the 7 key risk factors for breast cancer used in the Gail Model?

  1. Age
  2. Age at first period (late is better)
  3. Age at the time of birth of first child (earlier is better)
  4. Family history of breast cancer (mother, sister or daughter)
  5. Number of past breast biopsies
  6. Number of breast biopsies showing atypical hyperplasia
  7. Ethnicity

The model calculates the risk of developing breast cancer over the next 5 years and also the risk over a lifetime.


What is Perjeta, a breast cancer drug?

Perjeta is Pertuzumab

Perjeta is Pertuzumab

  • It is a targeted therapy to be used before surgery and in combination with other HER2 postive breast cancer drugs such as Herceptin (trastuzumab).
  • Perjeta has a different way of working than the other HER2 positive breast cancer medications.
  • Pertuzumab is a monoclonal antibody (like trastuzumab). The first of its class in a line of agents called “HER dimerization inhibitors.”
  • Both Perjeta and Herceptin target HER2 but work in complementary ways.  The combination may increase the death of cancer cells.
  • Perjeta is contraindicated in pregnancy.
  • FDA approved for Genentech (makers of Herceptin, too) on September 12, 2013.
  • Before surgery usage is called neoadjuvant or now called primary systemic therapy.

Invasive vs Noninvasive breast cancer

Some thoughts about the differences between Invasive and non-invasive breast cancer.

Invasive Breast Cancer

Invasive breast cancer is sometimes called infiltrating.  The cancers spread outside the membrances that lines the duct or lobule; thus can travel to other parts of the body.  Stage I, II, III, or IV breast cancer is invasive breast cancer.

Non-invasive is also called in-situ.

The cancer cells have remained within their place of origin.  DCIS (Ductal Carcinoma In-Situ) is considered a precancerous lesion.  LCIS (Lobular Carcinoma In-Situ) isn’t considered precancerous because it won’t eventually evolve itself into a invasive cancer; however, it doesn increase the risk of cancer in both breasts.  Thus LCIS can be considered a marker for increased breast cancer risk.