Seminars in surgical oncology
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Ambulatory surgical procedures are a large and increasing fraction of all surgery in the United States. A specialized health care team must be assembled to care for these patients and meet their special needs. Ambulatory surgery patients should be selected according to medical and psychosocial criteria. ⋯ Premedication should be supportive, and verbal as well as medicinal; drugs include ataractics and analgesics. All forms of general or regional anesthesia may be used. Recovery goals must be well defined, aiming for "home readiness." Ambulatory anesthesia care is concluded with postdischarge follow-up, for quality assurance and risk management.
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The goal of breast reconstruction is to reconstruct breasts which meet the patient's expectations both psychologically and aesthetically, while adhering to the principles of sound oncological management. Breast reconstruction is usually started around 3 to 9 mos after mastectomy. The simplest method of reconstruction uses tissue available after mastectomy and a silicone implant. ⋯ Fat and skin from the buttocks may be used in a microsurgical transfer technique. Prophylactic mastectomy and immediate breast reconstruction are still controversial, but are options for the woman who is worried about the development of breast cancer. The reconstruction of the nipple and areola is only done after reconstructed breast symmetry is ascertained.