Give pictoral diagram covering breast surgery topic
breast surgery anatomy mastectomy types diagram
This clinical photograph and superimposed diagram illustrate a preoperative assessment for breast reconstruction following a left-sided mastectomy. The patient displays a natural right breast and a flattened left chest wall with a horizontal surgical scar and signs of radiation-induced skin changes. Overlaid on the abdomen is a schematic representing the Holm vascular zone classification for a Transverse Rectus Abdominis Myocutaneous (TRAM) flap. The diagram divides a transversely oriented elliptical donor site into four zones (I-IV) based on the rectus abdominis muscle midline. Zone I represents the primary vascular territory over the donor muscle pedicle. Zone II is lateral to Zone I on the ipsilateral side. Zone III is across the midline adjacent to Zone I, and Zone IV is the most lateral contralateral area. A red arrow indicates the intended flap transposition from the right abdominal donor site to the left mastectomy recipient site. This visual is designed for plastic surgery education, specifically regarding autologous tissue transfer and flap perfusion planning.
This clinical comparison photograph displays a patient before and after a unilateral skin-sparing mastectomy and immediate breast reconstruction. Column A (Preoperative) shows three views (anterior, left oblique, and right lateral) of natural breast anatomy with moderate ptosis and slight asymmetry, where the left nipple is positioned inferiorly. Column B (Postoperative) demonstrates the results after an expander-to-implant exchange utilizing Gore-Tex (Gore DualMesh) for lower-pole support. The reconstructed breast exhibits improved volume, a more rounded contour, and a superiorly repositioned nipple-areola complex compared to the preoperative state. Visible surgical markers include a transverse scar on the mid-to-lower pole of the reconstructed breast and a scar along the inframammary fold. These images illustrate the aesthetic outcomes of synthetic mesh-assisted breast reconstruction, highlighting the restoration of symmetry and upper body contour in the context of oncoplastic surgery.
Clinical photographs showing preoperative (a) and postoperative (b) views of a patient undergoing oncoplastic breast surgery. Panel (a) illustrates the baseline anatomy with moderate breast volume and natural ptosis. Panel (b) demonstrates the results of a right-sided nipple-sparing mastectomy (NSM) with a radial lateral incision and immediate one-stage implant-based reconstruction. Simultaneously, the left breast shows the outcome of augmentation mastopexy performed via periareolar incision with a vertical extension to achieve symmetry. Visually, the postoperative state shows increased upper pole fullness, improved projection, and corrected ptosis. Subtle surgical scarring is visible on the lateral aspect of the right breast and the periareolar/vertical regions of the left breast. These images serve as an educational example of complex oncologic reconstruction combined with contralateral symmetrization in plastic and reconstructive surgery.
This medical illustration depicts four classification types (Type I to Type IV) of skin-sparing mastectomy (SSM) incisions on the female breast, categorized by the pattern of skin preservation and resection. Type I shows a periareolar incision with an optional lateral extension (tennis racquet pattern) toward the axilla. Type II demonstrates an expanded periareolar incision that incorporates an adjacent area of skin, typically used when superficial tumors or prior biopsy sites are near the areola. Type III features two distinct incisions: a circular periareolar incision and a separate elliptical incision remote from the areola, designed to remove skin overlying a distant tumor or biopsy scar while preserving the intervening bridge. Type IV utilizes a Wise pattern (T-shaped) incision, common in large or ptotic breasts requiring reduction, which includes an inverted-T pattern extending to the inframammary fold. The diagram serves as a clinical guide for oncologic surgeons to select incision patterns based on tumor location, prior scarring, and planned breast reconstruction techniques.
This clinical photograph and educational diagram illustrate a standardized method for quantitative color analysis of the nipple-areola complex (NAC) following reconstructive surgery. Image A presents a frontal view of a patient post-mastectomy with a contralateral natural NAC; a yellow circle identifies the region of interest (ROI) for baseline skin tone measurement on normal breast skin. Image B provides a close-up of a reconstructed and tattooed NAC. The areolar region is circumscribed by a yellow polygonal selection tool in ImageJ software, excluding the central nipple and surgical scars to ensure measurement accuracy. An overlaying 'Results' window displays calculated Red, Green, and Blue (RGB) mean values (R: 163.3, G: 108.5, B: 89.6) and total pixel area. This technique is used in plastic and reconstructive surgery to objectively monitor pigment fading, assess symmetry between natural and tattooed NACs, and evaluate the long-term aesthetic outcomes of various tattooing pigments and donor skin types (e.g., abdominal, dorsal, or breast skin).
This anatomical diagram is a cross-sectional illustration of the human thorax and breast, specifically depicting the sensory innervation of the nipple-areola complex (NAC). The illustration shows a thoracic vertebra and spinal cord in the lower right, representing the origin of the intercostal nerve. The nerve is traced along its anterolateral trajectory within the intercostal space, situated between the muscle layers of the chest wall. As the nerve progresses anteriorly toward the superior-left aspect of the image (the breast), it pierces the deep fascia and branches significantly into several terminal cutaneous filaments that innervate the nipple and glandular tissue. The diagram emphasizes the relationship between the axial skeleton, the intercostal musculature, and the cutaneous sensory pathways. This educational resource is designed to demonstrate the typical surgical anatomy relevant to breast augmentation, mastectomy, or reconstructive procedures, specifically focusing on the pathway of the fourth intercostal nerve.
This clinical photograph displays the anterior chest wall of a female patient, illustrating two different types of surgical scars following breast cancer management. On the patient's left side (right side of image), there is a long, horizontal, slightly raised, and erythematous mastectomy scar that spans the width of the chest wall where the breast tissue has been removed. On the patient's right breast (left side of image), a smaller, linear, well-healed surgical scar is visible, consistent with a tumorectomy (lumpectomy). The mastectomy scar appears more hypertrophic and prominent compared to the shorter, flatter tumorectomy scar. The image serves as an educational tool for identifying postoperative clinical findings in breast surgery and understanding the visual outcomes of different surgical interventions for bilateral breast pathologies, such as multifocal lymphoma or sarcoma.
Clinical photograph comparison of a female patient's upper torso showing pre-operative (left) and post-operative (right) results of immediate breast reconstruction (IBR). The pre-operative view demonstrates natural breast anatomy with moderate ptosis and inferiorly oriented nipple-areola complexes. The post-operative view showcases the outcome of a monolateral nipple-sparing mastectomy followed by retromuscular prosthetic implantation. Notable changes include increased projection, improved breast volume and upper pole fullness, and a more anterior/superior orientation of the nipple-areola complexes. The images demonstrate the surgical objective of maintaining skin envelope integrity and nipple-areola preservation while restoring breast symmetry and contour. This clinical comparison is relevant for plastic and reconstructive surgery education, specifically illustrating standard retromuscular techniques in oncological breast surgery.
sentinel lymph node biopsy breast axillary dissection
This composite of four clinical photographs illustrates an intraoperative sentinel lymph node biopsy (SLNB) procedure, likely during breast cancer surgery. The images show the identification and dissection of sentinel lymph nodes within the axillary or breast tissue. A key diagnostic feature is the dark blue staining of specific nodes, resulting from the peritumoral or subareolar injection of methylene blue dye, which allows for visual tracking of lymphatic drainage. The surgical field displays a mix of erythematous muscle tissue and yellowish adipose tissue, with surgical instruments such as forceps and retractors used to isolate the nodes. One frame shows a resected node held in forceps for intraoperative pathological assessment. This visual demonstrates the surgical technique used to identify the first draining lymph nodes in oncological staging to determine the necessity of a full axillary lymph node dissection (ALND).
Clinical and endoscopic photographs demonstrating axillary sentinel lymph node biopsy (SLNB) using near-infrared (NIR) fluorescence. Panel A shows the external surgical field with the patient in a supine position, arm abducted. A single-pore endoscopic retractor is inserted through a midaxillary incision. Surface markings indicate the projected lymphatic drainage pathway and the location of the sentinel lymph node (SLN), guided by indocyanine green (ICG). Panel B provides an intraoperative NIR endoscopic view of the axillary dissection. Sentinel lymph nodes and connecting lymphatic vessels are clearly visualized as bright green fluorescent structures (red arrows) against the background of red muscular tissue and yellowish-white adipose and connective tissue. Surgical instruments are seen manipulating the tissue to isolate the fluorescent nodes. This technique illustrates the use of real-time ICG-fluorescence guidance for accurate SLN identification and minimally invasive resection in early breast cancer management.
This composite of clinical photographs illustrates the sequence of a Sentinel Lymph Node Biopsy (SLNB) in a patient with breast cancer. The large left panel shows the intraoperative injection of a blue tracer dye (typically isosulfan blue or methylene blue) into the periareolar region of the breast to map lymphatic drainage. The top-right panel displays the subsequent surgical dissection in the axillary region, where retractors and forceps are used to expose adipose tissue and identify a sentinel lymph node visibly stained with the blue dye. The bottom-right panel shows the excised surgical specimens (biopsy samples) placed on sterile gauze; some fragments exhibit the blue-black pigmentation characteristic of successful dye uptake, confirming they are sentinel nodes. This educational visual demonstrates the combined technique of dye mapping, surgical localization, and node retrieval used to assess axillary nodal status and guide surgical oncology staging.
This clinical photograph captures an intraoperative surgical field during a sentinel lymph node biopsy, likely in the axillary region. The image demonstrates the use of fluorescein-guided surgery under ultraviolet (UV) light. A small, discrete lymph node (indicated by a white arrow) is visible, exhibiting bright greenish-white fluorescence which distinguishes it from the surrounding reddish subcutaneous and muscular tissues. Surgical instruments, including a metal retractor and forceps held by a gloved hand, are positioned to isolate and dissect the lymphatic structure. The primary educational focus is the application of fluorescence-guided imaging for real-time visualization and identification of lymph nodes during oncological procedures. This technique assists surgeons in precisely locating sentinel nodes, which is critical for accurate cancer staging while minimizing unnecessary tissue dissection. The anatomical context is suggested by the proximity to the breast and axillary fold, relevant for breast cancer surgical management.
breast lumpectomy wide local excision oncoplastic technique
A series of clinical photographs documenting an oncoplastic breast surgery involving a wide local excision and axillary flap reconstruction for a tumor in the upper-outer quadrant. Image A (pre-operative) shows topographical markings on both breasts with a red circle indicating the lesion site. Image B (intra-operative) displays the exposed breast parenchyma after skin undermining, with a yellow circle highlighting the tumor bed defect down to the pectoralis fascia. Images C, D, and E demonstrate the mobilization and rotation of an axillary tissue flap into the excision site to restore volume; yellow arrows indicate the direction of flap transposition. Image F (post-operative, one year) illustrates the long-term aesthetic outcome, showing preserved breast symmetry, nipple-areola complex positioning, and successful volume replacement in the upper-outer quadrant. This sequence serves as an educational resource for surgical oncology and plastic surgery, demonstrating flap-based volume replacement techniques used to prevent post-lumpectomy deformity.
Clinical photograph of a female chest demonstrating postoperative results of oncoplastic breast surgery. The image shows the anterior view of both breasts with a focus on surgical outcomes following a wide local excision of a tumor in the right breast (left side of image). Visible features include a circumareolar scar on the right breast, characteristic of Benelli's round block technique, which utilizes a purse-string suture to maintain the position of the nipple-areolar complex (NAC) after tissue mobilization and remodeling. The right breast exhibits a slightly smaller volume and a flatter NAC projection compared to the contralateral left breast, which appears natural and unoperated. The skin shows mild postoperative textural changes and concentric scarring around the right areola. This photograph is an educational example of oncoplastic techniques used to preserve breast cosmesis and symmetry while achieving oncological clearance in central or upper quadrant breast tumors.
This clinical photograph captures an intra-operative view of a wide local excision (WLE) during breast cancer surgery. The surgical site is held open by two blue plastic Langenbeck-style retractors, exposing the tumor bed cavity. A surgeon, wearing sterile gloves, is shown injecting stabilized hyaluronic acid (sHA) gel into the excision margins using a 3 mL clear syringe with a fine-gauge needle. The cavity walls exhibit heterogeneous tissue characteristics, including reddish-brown areas of cauterized tissue and greenish-yellow highlights representing the injected gel marker. The nipple-areola complex is visible adjacent to the surgical field, providing anatomical orientation. This procedure demonstrates a technique for marking the tumor bed to assist in future radiotherapy planning, specifically designed to improve visibility on post-operative MRI scans compared to traditional metallic clips. The educational focus is on oncoplastic maneuvers and the methodology of tumor bed delineation using radiotranslucent marking materials.
A multi-panel series documenting a case of 'Extreme Therapeutic Mammoplasty' (TM) for breast cancer management. Panel A displays a pre-operative 2D bilateral mammogram in the Mediolateral Oblique (MLO) view, identifying an ill-defined, spiculated lesion in the right upper deep central quadrant and an enlarged axillary lymph node. Panel B and C show pre-operative surgical markings and a previous lumpectomy scar. Panels D through L detail the intra-operative oncoplastic procedure, showcasing de-epithelialization of the infero-medial pedicle, wide local excision of the tumor with a skin island, and the identification of a dual-pedicle system. The images demonstrate the use of the superomedial pedicle for the nipple-areolar complex (NAC) and the mobilization of the inferior pedicle as a volume filler to correct the excision defect. Clipping of the tumor bed for radiotherapy targeting is visible. Panels M and N provide longitudinal post-operative follow-up at one month and one year, demonstrating the final aesthetic and structural outcome of the breast reconstruction.
TRAM flap DIEP flap breast reconstruction autologous
This composite clinical photograph illustrates the evolution of abdominal autologous flaps for breast reconstruction, classified by surgical technique and vascular anatomy. (a) Displays a pedicled Transverse Rectus Abdominis Myocutaneous (TRAM) flap; the left panel shows preoperative markings on the torso with a subcutaneous tunnel path (yellow arrow), while the right panel shows the harvested musculocutaneous tissue. (b) Demonstrates a Deep Inferior Epigastric Artery Perforator (DIEP) flap, characterized by the preservation of the rectus abdominis muscle; the vascular pedicle is dissected and clearly visible against the harvested adipose tissue. (c) Shows a DIEP flap divided into two distinct units for bilateral breast reconstruction, each with its own preserved vascular pedicle. (d) Illustrates a Superficial Inferior Epigastric Artery (SIEA) flap, which utilizes the superficial vascular system and avoids fascia or muscle incision. Across all images, the flaps primarily consist of cutaneous and subcutaneous adipose tissue. These photographs provide educational value for plastic surgery training by demonstrating variations in flap harvest, vascular pedicle management, and tissue composition required for different reconstructive strategies.
Clinical photograph comparison of a patient undergoing Deep Inferior Epigastric Perforator (DIEP) flap breast reconstruction. Panel (a) displays the preoperative state, showing clinical markings on the lower abdomen, including dotted lines and 'X' symbols, which identify superficial abdominal perforators and planned incision sites for the autologous tissue harvest. Panel (b) illustrates the eight-month postoperative results following right breast carcinoma resection via nipple-sparing mastectomy and bilateral reconstruction. Visible changes include a healed transverse scar across the suprapubic region and lower abdomen at the donor site, an improved abdominal contour, and reconstructed breast volume with maintained nipple-areolar complexes. The image demonstrates the 'gold standard' in autologous breast reconstruction, where abdominal skin and subcutaneous fat are transferred to the thorax to achieve a natural aesthetic result while minimizing donor site morbidity compared to traditional TRAM flap techniques. Target audience: Medical students and plastic surgery trainees.
Six-panel clinical photograph displaying preoperative (A, C, E) and postoperative (B, D, F) views of a 54-year-old female patient undergoing left breast Latissimus Dorsi (LD) flap reconstruction. Preoperative views (frontal, left lateral, right oblique) show natural ptosis and surgical markings, including a blueish-green tint (likely patent blue dye for sentinel node localization) near the left nipple and a white adhesive dressing on the left lateral chest. The contralateral right breast shows evidence of a previous TRAM flap reconstruction. Postoperative views (B, D, F) demonstrate the results of a left skin-sparing mastectomy followed by autologous reconstruction. Visible changes include a restored, rounded breast contour with increased volume, improved projection, and reduced ptosis of the left breast. Key surgical features in the postoperative images include circumareolar and horizontal mastectomy scars, and the absence of prior dressings and discoloration. The images illustrate surgical outcomes for breast cancer patients with prior abdominal surgery where TRAM/DIEP flaps are contraindicated, focusing on symmetry and volume matching.
Clinical photograph of a female patient's torso showing the postoperative results of autologous breast reconstruction and abdominoplasty. The right breast (image-left) has been reconstructed, appearing more rounded with a horizontal surgical scar across the upper quadrant and absent nipple-areola complex, consistent with a post-mastectomy reconstruction. The left breast (image-right) appears natural with a visible nipple-areola complex. In the abdominal region, a long, horizontal scar is visible across the lower abdomen, positioned below the umbilicus, characteristic of a donor site incision for a Deep Inferior Epigastric Artery Perforator (DIEP) or Transverse Rectus Abdominis Myocutaneous (TRAM) flap. The abdominal contour reflects the results of an abdominoplasty used to close the donor site defect. This image illustrates plastic and reconstructive surgical outcomes following breast cancer treatment, focusing on microsurgical flap techniques and donor site management.
breast implant reconstruction expander tissue expander
This composite of clinical photographs illustrates a pre-pectoral breast reconstruction procedure using a tissue expander and acellular dermal matrix (ADM). Panels A and B show a textured tissue expander fully encapsulated in a white, opaque, porcine-derived ADM. The matrix is secured around the expander's periphery with a series of interrupted black sutures. Panel A demonstrates a light blue discoloration on the ADM surface, resulting from the internal saline and methylene blue solution. Panels C and D show the intraoperative surgical site where the ADM-wrapped expander is placed into the pre-pectoral pocket. Surgical retractors expose the operative field, revealing the implant secured to the pectoralis muscle fascia. The ADM is fixed at multiple anatomical points (superior, medial, and inferior) using resorbable sutures to ensure stability and prevent rotation. This technique highlights the 'total wrap' method for single-stage or two-stage pre-pectoral breast reconstruction, aimed at providing soft tissue support and improving aesthetic outcomes.
A series of four intraoperative clinical photographs (Panels A-D) illustrating the surgical technique for breast reconstruction using a Gore-Tex DualMesh sling and a tissue expander. Panel A shows a dissected subpectoral pocket with a white, semi-circular synthetic mesh template (marked with an asterisk) indicating the planned positioning along the inframammary fold. Panel B demonstrates the insertion of a textured tissue expander into the surgical pocket while the mesh is visible in the background. Panel C depicts the expander seated in the subpectoral position with the flexible white mesh retracted to show the pocket depth. Panel D shows the final inset where the mesh is integrated as a lower-pole sling, secured to the surrounding pectoralis major muscle and inframammary fold to support the inferior pole of the expander. The procedure utilizes surgical retractors and standard sterile technique to create a dual-plane pocket for eventual implant-based reconstruction.
This set of axial computerized tomography (CT) scans illustrates radiotherapy (RT) planning in patients following immediate breast reconstruction (IBR) with three distinct types of implants. The images demonstrate the anatomical relationship between the thoracic cage, heart, lungs, and the reconstructed breast. In panel (a), a Type I temporary tissue expander is shown, featuring a metallic artifacts from an integrated magnetic port used for postoperative expansion. Panel (b) depicts a Type II expandable implant, appearing larger and more irregular, designed for one-stage reconstruction with outer silicone gel and inner saline chambers. Panel (c) shows a Type III permanent silicone gel implant with a uniform density and predefined volume. Superimposed on each CT slice are colored isodose lines and wireframe geometric projections representing radiation beam tangents. These overlays illustrate how different implant morphologies and materials (e.g., metal in magnets versus silicone) influence the planning target volume (PTV) and dose distribution across the chest wall during post-mastectomy radiotherapy (PMRT).
Diagnostic ultrasound (US) images depicting the soft tissue coverage of a tissue expander following two-stage breast reconstruction. Figure (a) illustrates a cross-sectional view of the skin and subcutaneous tissue layers. The image shows a well-defined hyperechoic superficial layer (epidermis/dermis) followed by deeper layers of varying echogenicity representing the subcutaneous fat and musculofascial planes. Figure (b) demonstrates the total thickness of the implant coverage, involving a musculofascial pocket composed of the pectoralis major and serratus anterior fascia. The coverage appears as a heterogeneous band of tissue with mixed echogenicity. Visible within the tissue are hypoechoic to anechoic areas, which may represent small fluid collections or variations in tissue density. Electronic calipers (markers) are visible for quantitative measurement of the coverage thickness. This imaging is used clinically to assess the integrity and thickness of the soft tissue envelope surrounding prosthetic implants to evaluate for potential complications like thinning, seroma, or implant exposure.
🔬 Breast Surgery - Pictorial Diagram Overview
1. TYPES OF MASTECTOMY INCISIONS (Skin-Sparing)
- Type I - Periareolar ± lateral extension (tennis-racket pattern)
- Type II - Expanded periareolar - includes adjacent skin island
- Type III - Two separate incisions for remote tumors or biopsy scars
- Type IV - Wise pattern (inverted-T) for large/ptotic breasts
2. BREAST CONSERVATION SURGERY (Lumpectomy / Wide Local Excision)
Oncoplastic WLE with Axillary Flap Reconstruction
Intraoperative Wide Local Excision - Tumor Bed Marking
Oncoplastic Benelli Round-Block Technique
3. MASTECTOMY vs. LUMPECTOMY - Clinical Scar Comparison
4. AXILLARY SURGERY
Sentinel Lymph Node Biopsy (SLNB) - Blue Dye Technique
SLNB - Periareolar Injection + Blue Dye Uptake
SLNB - ICG Fluorescence (Near-Infrared) Technique
5. BREAST RECONSTRUCTION - PROSTHETIC
Tissue Expander with ADM (Acellular Dermal Matrix)
Tissue Expander with Synthetic Mesh Sling
Pre-op vs. Post-op: Nipple-Sparing Mastectomy + Retromuscular Implant
6. BREAST RECONSTRUCTION - AUTOLOGOUS FLAPS
TRAM / DIEP / SIEA Flap Comparison
| Flap | Muscle Sacrifice | Pedicle |
|---|---|---|
| Pedicled TRAM | Full rectus | Superior epigastric |
| Free TRAM | Partial/full rectus | Deep inferior epigastric |
| DIEP | None (muscle-sparing) | Deep inferior epigastric perforators |
| SIEA | None | Superficial inferior epigastric |
DIEP Flap - Pre-op Markings to 8-Month Result
Latissimus Dorsi (LD) Flap Reconstruction
TRAM Flap - Holm Vascular Zone Classification
7. NIPPLE-AREOLA COMPLEX (NAC) INNERVATION
8. NIPPLE-SPARING MASTECTOMY + ONCOPLASTIC SYMMETRIZATION
Summary Map
BREAST SURGERY
├── 1. CONSERVATIVE (Breast-Conserving)
│ ├── Lumpectomy / WLE
│ ├── Oncoplastic BCS (volume displacement/replacement)
│ └── Margins + Tumor Bed Marking (clips/gel)
│
├── 2. MASTECTOMY
│ ├── Simple / Total Mastectomy
│ ├── Modified Radical Mastectomy (+ ALND)
│ ├── Skin-Sparing Mastectomy (SSM) - Types I-IV
│ └── Nipple-Sparing Mastectomy (NSM)
│
├── 3. AXILLARY MANAGEMENT
│ ├── Sentinel Lymph Node Biopsy (SLNB)
│ │ ├── Blue Dye
│ │ ├── Technetium-99m Radiocolloid
│ │ └── ICG Fluorescence
│ └── Axillary Lymph Node Dissection (ALND)
│
└── 4. RECONSTRUCTION
├── Prosthetic
│ ├── Tissue Expander → Implant (2-stage)
│ ├── Direct-to-Implant (1-stage) ± ADM/Mesh
│ └── Prepectoral vs. Subpectoral
└── Autologous Flaps
├── Abdominal: TRAM → DIEP → SIEA
├── Latissimus Dorsi (LD) ± Implant
└── Thigh/Gluteal: SGAP, TUG (alternative)
Create a PowerPoint summarizing breast surgery techniques & outcomes
ls -la /tmp/workspace/ 2>/dev/null || echo "workspace empty or missing"
mkdir -p /tmp/workspace/breast-surgery-pptx
~/breast-surgery-pptx/create_pptx.py
import json, subprocess, base64, os
from io import BytesIO
from pptx import Presentation
from pptx.util import Inches, Pt, Emu
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
# ── Palette ────────────────────────────────────────────────────────────────
NAVY = RGBColor(0x0D, 0x2B, 0x4E) # dark navy – headers/accents
TEAL = RGBColor(0x00, 0x7A, 0x8A) # teal – section bars
LIGHT_TEAL = RGBColor(0xE0, 0xF4, 0xF6) # very light teal – content bg
WHITE = RGBColor(0xFF, 0xFF, 0xFF)
LIGHT_GRAY = RGBColor(0xF4, 0xF6, 0xF8)
MID_GRAY = RGBColor(0xCC, 0xCC, 0xCC)
DARK_GRAY = RGBColor(0x33, 0x33, 0x33)
ORANGE = RGBColor(0xE8, 0x7C, 0x1B) # accent highlight
PINK = RGBColor(0xD4, 0x6A, 0x8A) # accent 2
# ── Image URLs ─────────────────────────────────────────────────────────────
IMG_SSM_TYPES = "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_88888916782ce335bab8f2a150bae1ac736ba5be8a6355cd086e59031308bd2b.jpg"
IMG_WLE = "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_0e1ef88df40efdd16ba0938bb7497b30e9e215f7922504eb9ce895343783d995.jpg"
IMG_SLNB_BLUE = "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_b4b3868fc9caacc3e34341c9ccdf41de8015faa64f67e3d28db5a26731fe4ea7.jpg"
IMG_SLNB_ICG = "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_5d13167523333483ffcbb7b7237124865412499ce5bbc2e2fd68a0766d351011.jpg"
IMG_TRAM_DIEP = "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_25cc54602f417233e7d76872ee702e070866fe1d9fe760125a940cc5a33ed88e.jpg"
IMG_DIEP_PREOP = "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_bf3f68fb4dc63de928c81758a09dda4470cc409fad46d6739700e5cad1e3e9e4.jpg"
IMG_LD_FLAP = "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_ae4087a57153ed908d86316de55437c1b6a2793932a92d9fe653f7f55577a14c.jpg"
IMG_EXPANDER = "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_64224280c3629660d5aadf23b8ce775a420b5fcfd825cb814badc8dfa1460f69.jpg"
IMG_NSM_RESULT = "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_3fc4e14bf310cc3f6d469fa771437f5ae89fdd72ae46fa7195443e2c9b616e78.jpg"
IMG_SCARS = "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_57429f7764bf415df72584f8362a20e6c86b252384f619b8f90a8260f7ecf082.jpg"
IMG_INNERVATION= "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_03b52e8738533fce3931ac66d19252b2dd3f566b4dc4dd7911c65ff94d5d2f5c.jpg"
IMG_ONCOPLASTIC= "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_0461c39f57b0db1b4bef2d826f981a5f13ed3a454f98359fc474342bc1d90d0f.jpg"
ALL_URLS = [
IMG_SSM_TYPES, IMG_WLE, IMG_SLNB_BLUE, IMG_SLNB_ICG,
IMG_TRAM_DIEP, IMG_DIEP_PREOP, IMG_LD_FLAP, IMG_EXPANDER,
IMG_NSM_RESULT, IMG_SCARS, IMG_INNERVATION, IMG_ONCOPLASTIC,
]
# ── Fetch images ────────────────────────────────────────────────────────────
print("Fetching images...")
raw_result = subprocess.check_output(
["python", "/tmp/skills/shared/scripts/fetch_images.py"] + ALL_URLS
)
img_data = json.loads(raw_result)
img_map = {}
for item in img_data:
if item["base64"]:
raw_bytes = base64.b64decode(item["base64"].split(",", 1)[1])
img_map[item["url"]] = BytesIO(raw_bytes)
else:
print(f" FAILED: {item['url']} — {item['error']}")
def get_img(url):
buf = img_map.get(url)
if buf:
buf.seek(0)
return buf
print(f"Fetched {len(img_map)}/{len(ALL_URLS)} images.")
# ── Helpers ─────────────────────────────────────────────────────────────────
prs = Presentation()
prs.slide_width = Inches(13.333)
prs.slide_height = Inches(7.5)
BLANK = prs.slide_layouts[6]
def add_slide():
return prs.slides.add_slide(BLANK)
def bg(slide, color=LIGHT_GRAY):
bg_shape = slide.shapes.add_shape(1, 0, 0, prs.slide_width, prs.slide_height)
bg_shape.fill.solid(); bg_shape.fill.fore_color.rgb = color
bg_shape.line.fill.background()
def header_bar(slide, title, subtitle=None):
# Full-width navy top bar
bar = slide.shapes.add_shape(1, 0, 0, prs.slide_width, Inches(1.1))
bar.fill.solid(); bar.fill.fore_color.rgb = NAVY
bar.line.fill.background()
# Title text
tb = slide.shapes.add_textbox(Inches(0.35), Inches(0.05), Inches(12), Inches(0.7))
tf = tb.text_frame; tf.margin_left = 0; tf.margin_top = 0
p = tf.paragraphs[0]; p.text = title
r = p.runs[0]; r.font.name = "Calibri"; r.font.size = Pt(28)
r.font.bold = True; r.font.color.rgb = WHITE
if subtitle:
tb2 = slide.shapes.add_textbox(Inches(0.35), Inches(0.72), Inches(12), Inches(0.35))
tf2 = tb2.text_frame; tf2.margin_left = 0; tf2.margin_top = 0
p2 = tf2.paragraphs[0]; p2.text = subtitle
r2 = p2.runs[0]; r2.font.name = "Calibri"; r2.font.size = Pt(13)
r2.font.color.rgb = RGBColor(0xB0, 0xD8, 0xE8); r2.font.italic = True
def section_label(slide, text, x, y, w, h, color=TEAL):
shp = slide.shapes.add_shape(1, x, y, w, h)
shp.fill.solid(); shp.fill.fore_color.rgb = color
shp.line.fill.background()
tf = shp.text_frame; tf.word_wrap = True
tf.vertical_anchor = MSO_ANCHOR.MIDDLE
tf.margin_left = Inches(0.08); tf.margin_right = Inches(0.05)
p = tf.paragraphs[0]; p.text = text; p.alignment = PP_ALIGN.CENTER
r = p.runs[0]; r.font.name = "Calibri"; r.font.size = Pt(11)
r.font.bold = True; r.font.color.rgb = WHITE
def card(slide, x, y, w, h, fill=WHITE, radius=False):
shape_id = 5 if radius else 1 # 5 = rounded rect, 1 = rect
shp = slide.shapes.add_shape(shape_id, x, y, w, h)
shp.fill.solid(); shp.fill.fore_color.rgb = fill
shp.line.color.rgb = MID_GRAY; shp.line.width = Pt(0.5)
return shp
def txt(slide, text, x, y, w, h, size=11, bold=False, color=DARK_GRAY,
align=PP_ALIGN.LEFT, italic=False, wrap=True):
tb = slide.shapes.add_textbox(x, y, w, h)
tf = tb.text_frame; tf.word_wrap = wrap
tf.margin_left = Inches(0.05); tf.margin_top = Inches(0.03)
tf.margin_right = Inches(0.05); tf.margin_bottom = 0
p = tf.paragraphs[0]; p.text = text; p.alignment = align
r = p.runs[0]; r.font.name = "Calibri"; r.font.size = Pt(size)
r.font.bold = bold; r.font.color.rgb = color; r.font.italic = italic
def bullet_box(slide, items, x, y, w, h, size=10.5, heading=None, head_color=TEAL):
tb = slide.shapes.add_textbox(x, y, w, h)
tf = tb.text_frame; tf.word_wrap = True
tf.margin_left = Inches(0.08); tf.margin_top = Inches(0.05)
if heading:
p0 = tf.paragraphs[0]; p0.text = heading
r0 = p0.runs[0]; r0.font.name = "Calibri"; r0.font.size = Pt(size + 0.5)
r0.font.bold = True; r0.font.color.rgb = head_color
for i, item in enumerate(items):
p = tf.add_paragraph() if (i > 0 or heading) else tf.paragraphs[0]
if i == 0 and not heading:
p = tf.paragraphs[0]
else:
p = tf.add_paragraph()
p.text = f"\u2022 {item}"
r = p.runs[0]; r.font.name = "Calibri"; r.font.size = Pt(size)
r.font.color.rgb = DARK_GRAY
p.space_before = Pt(2)
def place_img(slide, url, x, y, w, h=None):
buf = get_img(url)
if buf:
if h:
slide.shapes.add_picture(buf, x, y, width=w, height=h)
else:
slide.shapes.add_picture(buf, x, y, width=w)
def caption(slide, text, x, y, w, h=Inches(0.3)):
tb = slide.shapes.add_textbox(x, y, w, h)
tf = tb.text_frame; tf.margin_left = Inches(0.05); tf.margin_top = 0
p = tf.paragraphs[0]; p.text = text; p.alignment = PP_ALIGN.CENTER
r = p.runs[0]; r.font.name = "Calibri"; r.font.size = Pt(8.5)
r.font.color.rgb = RGBColor(0x55, 0x55, 0x55); r.font.italic = True
# ════════════════════════════════════════════════════════════════════════════
# SLIDE 1 — TITLE SLIDE
# ════════════════════════════════════════════════════════════════════════════
s = add_slide()
# Full background
bg_shp = s.shapes.add_shape(1, 0, 0, prs.slide_width, prs.slide_height)
bg_shp.fill.solid(); bg_shp.fill.fore_color.rgb = NAVY
bg_shp.line.fill.background()
# Teal diagonal accent strip
strip = s.shapes.add_shape(1, 0, Inches(4.8), prs.slide_width, Inches(0.12))
strip.fill.solid(); strip.fill.fore_color.rgb = TEAL; strip.line.fill.background()
# Pink accent strip
strip2 = s.shapes.add_shape(1, 0, Inches(4.93), prs.slide_width, Inches(0.06))
strip2.fill.solid(); strip2.fill.fore_color.rgb = PINK; strip2.line.fill.background()
txt(s, "BREAST SURGERY", Inches(0.8), Inches(1.5), Inches(11), Inches(1.5),
size=52, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
txt(s, "Techniques, Procedures & Outcomes", Inches(0.8), Inches(3.1), Inches(11), Inches(0.8),
size=22, bold=False, color=RGBColor(0xB0, 0xD8, 0xE8), align=PP_ALIGN.CENTER, italic=True)
txt(s, "A Comprehensive Pictorial Review", Inches(0.8), Inches(5.2), Inches(11), Inches(0.5),
size=14, bold=False, color=RGBColor(0xCC, 0xCC, 0xCC), align=PP_ALIGN.CENTER)
txt(s, "Surgery | Oncology | Reconstruction", Inches(0.8), Inches(5.8), Inches(11), Inches(0.4),
size=12, bold=False, color=RGBColor(0x80, 0xB0, 0xC8), align=PP_ALIGN.CENTER)
# ════════════════════════════════════════════════════════════════════════════
# SLIDE 2 — OVERVIEW / AGENDA
# ════════════════════════════════════════════════════════════════════════════
s = add_slide()
bg(s, LIGHT_GRAY)
header_bar(s, "Overview: Breast Surgery Topics", "What this presentation covers")
topics = [
("1", "Types of Mastectomy", "SSM Types I-IV, NSM, Radical, Modified Radical"),
("2", "Breast Conservation Surgery", "Lumpectomy, WLE, Oncoplastic BCS"),
("3", "Axillary Management", "SLNB (Blue Dye, ICG), ALND"),
("4", "Prosthetic Reconstruction", "Tissue Expanders, Implants, ADM/Mesh"),
("5", "Autologous Flap Reconstruction", "TRAM, DIEP, SIEA, LD Flap"),
("6", "Complications & Outcomes", "Recurrence, Survival, Aesthetic Results"),
]
col_w = Inches(3.9)
for i, (num, title, desc) in enumerate(topics):
col = i % 3
row = i // 3
cx = Inches(0.35) + col * (col_w + Inches(0.2))
cy = Inches(1.3) + row * Inches(2.7)
card(s, cx, cy, col_w, Inches(2.5), fill=WHITE)
# Number circle
circ = s.shapes.add_shape(9, cx + Inches(0.15), cy + Inches(0.15), Inches(0.55), Inches(0.55))
circ.fill.solid(); circ.fill.fore_color.rgb = TEAL; circ.line.fill.background()
tf = circ.text_frame; tf.vertical_anchor = MSO_ANCHOR.MIDDLE
p = tf.paragraphs[0]; p.text = num; p.alignment = PP_ALIGN.CENTER
r = p.runs[0]; r.font.name = "Calibri"; r.font.size = Pt(14); r.font.bold = True
r.font.color.rgb = WHITE
txt(s, title, cx + Inches(0.8), cy + Inches(0.15), col_w - Inches(0.9), Inches(0.55),
size=13, bold=True, color=NAVY)
txt(s, desc, cx + Inches(0.15), cy + Inches(0.8), col_w - Inches(0.25), Inches(1.5),
size=10.5, color=DARK_GRAY, wrap=True)
# ════════════════════════════════════════════════════════════════════════════
# SLIDE 3 — TYPES OF MASTECTOMY
# ════════════════════════════════════════════════════════════════════════════
s = add_slide()
bg(s, LIGHT_GRAY)
header_bar(s, "Types of Mastectomy", "From radical resection to skin/nipple-sparing techniques")
# Left: image SSM types
place_img(s, IMG_SSM_TYPES, Inches(0.35), Inches(1.2), Inches(5.8), Inches(5.2))
caption(s, "Skin-Sparing Mastectomy Incision Types I-IV", Inches(0.35), Inches(6.4), Inches(5.8))
# Right: table
headers = ["Type", "Procedure", "Indication"]
rows = [
["Simple/Total", "Remove breast tissue + NAC", "Prophylactic, DCIS"],
["MRM", "Breast + axillary LN clearance", "Invasive cancer + LN+"],
["SSM Type I", "Periareolar ± lateral", "Standard oncological cases"],
["SSM Type II", "Periareolar + skin island", "Superficial/biopsy-site tumors"],
["SSM Type III", "2 separate incisions", "Remote tumor/biopsy scar"],
["SSM Type IV", "Wise (T-pattern)", "Large/ptotic breasts"],
["NSM", "Preserve skin + nipple-areola", "Small tumors, >2 cm from NAC"],
]
col_xs = [Inches(6.4), Inches(7.8), Inches(9.9)]
col_ws = [Inches(1.3), Inches(2.05), Inches(3.0)]
row_h = Inches(0.44)
# header row
for c_i, (hdr, cx, cw) in enumerate(zip(headers, col_xs, col_ws)):
hdr_shp = s.shapes.add_shape(1, cx, Inches(1.25), cw - Inches(0.05), row_h)
hdr_shp.fill.solid(); hdr_shp.fill.fore_color.rgb = NAVY; hdr_shp.line.fill.background()
tb = hdr_shp.text_frame; tb.vertical_anchor = MSO_ANCHOR.MIDDLE
tb.margin_left = Inches(0.06); tb.margin_top = 0
p = tb.paragraphs[0]; p.text = hdr
r = p.runs[0]; r.font.name = "Calibri"; r.font.size = Pt(10); r.font.bold = True
r.font.color.rgb = WHITE
for r_i, row_data in enumerate(rows):
ry = Inches(1.25) + (r_i + 1) * row_h
fill_col = LIGHT_TEAL if r_i % 2 == 0 else WHITE
for c_i, (val, cx, cw) in enumerate(zip(row_data, col_xs, col_ws)):
cell_shp = s.shapes.add_shape(1, cx, ry, cw - Inches(0.05), row_h)
cell_shp.fill.solid(); cell_shp.fill.fore_color.rgb = fill_col
cell_shp.line.color.rgb = MID_GRAY; cell_shp.line.width = Pt(0.3)
tb2 = cell_shp.text_frame; tb2.vertical_anchor = MSO_ANCHOR.MIDDLE
tb2.margin_left = Inches(0.06); tb2.margin_top = 0; tb2.word_wrap = True
p2 = tb2.paragraphs[0]; p2.text = val
r2 = p2.runs[0]; r2.font.name = "Calibri"; r2.font.size = Pt(9)
r2.font.color.rgb = DARK_GRAY; r2.font.bold = (c_i == 0)
# ════════════════════════════════════════════════════════════════════════════
# SLIDE 4 — BREAST CONSERVATION SURGERY
# ════════════════════════════════════════════════════════════════════════════
s = add_slide()
bg(s, LIGHT_GRAY)
header_bar(s, "Breast Conservation Surgery (BCS)", "Lumpectomy, WLE, and Oncoplastic Techniques")
# Left card: WLE image
place_img(s, IMG_WLE, Inches(0.35), Inches(1.2), Inches(6.2), Inches(4.5))
caption(s, "Oncoplastic WLE: Pre-op markings → Axillary flap → 1-year result", Inches(0.35), Inches(5.7), Inches(6.2))
# Right: key points
card(s, Inches(6.8), Inches(1.25), Inches(6.2), Inches(5.9), fill=WHITE)
bullet_box(s, [
"Removes tumor + margin of normal tissue",
"Typically followed by whole-breast radiotherapy",
"Equivalent survival to mastectomy (level I evidence)",
"Local recurrence ~1% per year",
], Inches(6.9), Inches(1.35), Inches(6.0), Inches(1.8), heading="Lumpectomy / WLE")
bullet_box(s, [
"Volume Displacement: reshapes residual breast tissue",
"Volume Replacement: fills defect with local/distant flap",
"Axillary flap, LICAP, TDAP for upper-outer quadrant",
"Reduces post-excision deformity in large excisions",
"Suitable when excision > 20% of breast volume",
], Inches(6.9), Inches(3.25), Inches(6.0), Inches(2.2), heading="Oncoplastic BCS")
# Key facts bar at bottom
bar = s.shapes.add_shape(1, 0, Inches(7.0), prs.slide_width, Inches(0.5))
bar.fill.solid(); bar.fill.fore_color.rgb = TEAL; bar.line.fill.background()
txt(s, "BCS + RT = Equivalent survival to mastectomy | Margin status critical | NAC preservation preferred when oncologically safe",
Inches(0.3), Inches(7.05), Inches(12.8), Inches(0.4),
size=10, color=WHITE, align=PP_ALIGN.CENTER, bold=True)
# ════════════════════════════════════════════════════════════════════════════
# SLIDE 5 — AXILLARY MANAGEMENT
# ════════════════════════════════════════════════════════════════════════════
s = add_slide()
bg(s, LIGHT_GRAY)
header_bar(s, "Axillary Management", "Sentinel Lymph Node Biopsy (SLNB) & Axillary Lymph Node Dissection (ALND)")
# Two images side by side
place_img(s, IMG_SLNB_BLUE, Inches(0.35), Inches(1.25), Inches(4.3), Inches(3.2))
caption(s, "SLNB - Blue Dye Technique", Inches(0.35), Inches(4.45), Inches(4.3))
place_img(s, IMG_SLNB_ICG, Inches(4.85), Inches(1.25), Inches(4.3), Inches(3.2))
caption(s, "SLNB - ICG Near-Infrared Fluorescence", Inches(4.85), Inches(4.45), Inches(4.3))
# Right: SLNB vs ALND comparison
card(s, Inches(9.35), Inches(1.25), Inches(3.75), Inches(5.9), fill=WHITE)
bullet_box(s, [
"Injection: blue dye / Tc-99m / ICG",
"Identify & excise 1st draining LN(s)",
"Intraoperative frozen section",
"Avoid ALND if SLN negative",
"ACOSOG Z0011: spare ALND if \u22641-2 SLN+",
], Inches(9.45), Inches(1.35), Inches(3.6), Inches(2.6), heading="SLNB (Standard of Care)")
bullet_box(s, [
"Level I-III axillary clearance",
"Indicated: SLN+ (3+ nodes) or clinically N+",
"Lymphedema risk 15-20%",
"Sensory loss (intercostobrachial nerve)",
"Shoulder mobility impairment",
], Inches(9.45), Inches(4.1), Inches(3.6), Inches(2.0), heading="ALND (Selective Use)")
# bottom bar: key outcome
bar2 = s.shapes.add_shape(1, 0, Inches(4.75), Inches(9.1), Inches(0.5))
bar2.fill.solid(); bar2.fill.fore_color.rgb = NAVY; bar2.line.fill.background()
txt(s, "SLNB: Sensitivity ~96% | False-negative rate ~7% | Dual-tracer technique preferred",
Inches(0.3), Inches(4.8), Inches(8.7), Inches(0.4),
size=9.5, color=WHITE, align=PP_ALIGN.CENTER, bold=True)
# ════════════════════════════════════════════════════════════════════════════
# SLIDE 6 — PROSTHETIC RECONSTRUCTION
# ════════════════════════════════════════════════════════════════════════════
s = add_slide()
bg(s, LIGHT_GRAY)
header_bar(s, "Prosthetic Breast Reconstruction", "Tissue Expanders, Implants, ADM/Mesh Support")
# Image 1: expander + ADM
place_img(s, IMG_EXPANDER, Inches(0.35), Inches(1.25), Inches(4.3), Inches(3.0))
caption(s, "Tissue expander wrapped in ADM (total-wrap technique)", Inches(0.35), Inches(4.25), Inches(4.3))
# Image 2: NSM + implant result
place_img(s, IMG_NSM_RESULT, Inches(4.85), Inches(1.25), Inches(4.3), Inches(3.0))
caption(s, "NSM + retromuscular implant — pre/post result", Inches(4.85), Inches(4.25), Inches(4.3))
# Right panel
card(s, Inches(9.35), Inches(1.25), Inches(3.75), Inches(5.9), fill=WHITE)
bullet_box(s, [
"2-stage: expander placed at mastectomy, exchanged to implant ~3-6 months",
"1-stage (DTI): direct implant if adequate skin/tissue",
"Pre-pectoral vs sub-pectoral placement",
"ADM (acellular dermal matrix) supports lower pole",
"Synthetic mesh (e.g. TiLOOP, Gore DualMesh) as alternative",
], Inches(9.45), Inches(1.35), Inches(3.6), Inches(3.2), heading="Implant Reconstruction")
bullet_box(s, [
"Capsular contracture (5-15%)",
"Implant rupture/deflation",
"Infection/explantation",
"BIA-ALCL (textured implants)",
"Revision rate ~20-30% at 10 yrs",
], Inches(9.45), Inches(4.7), Inches(3.6), Inches(2.0), heading="Complications")
# ════════════════════════════════════════════════════════════════════════════
# SLIDE 7 — AUTOLOGOUS FLAP RECONSTRUCTION
# ════════════════════════════════════════════════════════════════════════════
s = add_slide()
bg(s, LIGHT_GRAY)
header_bar(s, "Autologous Flap Reconstruction", "TRAM · DIEP · SIEA · Latissimus Dorsi")
# Top row: two images
place_img(s, IMG_TRAM_DIEP, Inches(0.35), Inches(1.25), Inches(6.2), Inches(2.8))
caption(s, "Abdominal Flap Types: Pedicled TRAM, DIEP, DIEP bilateral, SIEA", Inches(0.35), Inches(4.05), Inches(6.2))
place_img(s, IMG_LD_FLAP, Inches(6.75), Inches(1.25), Inches(6.25), Inches(2.8))
caption(s, "Latissimus Dorsi Flap: Pre-op and Post-op (6 views)", Inches(6.75), Inches(4.05), Inches(6.25))
# Flap comparison table
headers2 = ["Flap", "Muscle Sacrifice", "Microsurgery", "Best For"]
rows2 = [
["Pedicled TRAM", "Full rectus", "No", "Less complex cases"],
["Free TRAM", "Partial rectus", "Yes", "Improved blood supply"],
["DIEP", "None (perforator)", "Yes", "Gold standard - min. morbidity"],
["SIEA", "None", "Yes", "Ideal vessel anatomy"],
["LD Flap", "Latissimus dorsi", "No (pedicled)", "Prior abdominal surgery"],
]
col_xs2 = [Inches(0.35), Inches(2.45), Inches(5.0), Inches(7.15)]
col_ws2 = [Inches(2.0), Inches(2.45), Inches(2.05), Inches(3.85)]
row_h2 = Inches(0.39)
for c_i, (hdr, cx, cw) in enumerate(zip(headers2, col_xs2, col_ws2)):
hsh = s.shapes.add_shape(1, cx, Inches(4.4), cw - Inches(0.05), row_h2)
hsh.fill.solid(); hsh.fill.fore_color.rgb = NAVY; hsh.line.fill.background()
tf = hsh.text_frame; tf.vertical_anchor = MSO_ANCHOR.MIDDLE
tf.margin_left = Inches(0.06); tf.margin_top = 0
p = tf.paragraphs[0]; p.text = hdr
r = p.runs[0]; r.font.name = "Calibri"; r.font.size = Pt(9.5); r.font.bold = True
r.font.color.rgb = WHITE
for r_i, row_data in enumerate(rows2):
ry = Inches(4.4) + (r_i + 1) * row_h2
fc = LIGHT_TEAL if r_i % 2 == 0 else WHITE
for c_i, (val, cx, cw) in enumerate(zip(row_data, col_xs2, col_ws2)):
cs = s.shapes.add_shape(1, cx, ry, cw - Inches(0.05), row_h2)
cs.fill.solid(); cs.fill.fore_color.rgb = fc
cs.line.color.rgb = MID_GRAY; cs.line.width = Pt(0.3)
tf2 = cs.text_frame; tf2.vertical_anchor = MSO_ANCHOR.MIDDLE
tf2.margin_left = Inches(0.06); tf2.margin_top = 0; tf2.word_wrap = True
p2 = tf2.paragraphs[0]; p2.text = val
r2 = p2.runs[0]; r2.font.name = "Calibri"; r2.font.size = Pt(9)
r2.font.color.rgb = DARK_GRAY; r2.font.bold = (c_i == 0)
# ════════════════════════════════════════════════════════════════════════════
# SLIDE 8 — ONCOPLASTIC & NIPPLE-SPARING SURGERY
# ════════════════════════════════════════════════════════════════════════════
s = add_slide()
bg(s, LIGHT_GRAY)
header_bar(s, "Oncoplastic & Nipple-Sparing Surgery", "Symmetrization, NAC preservation & Aesthetic Outcomes")
place_img(s, IMG_ONCOPLASTIC, Inches(0.35), Inches(1.25), Inches(5.5), Inches(4.2))
caption(s, "Right NSM + implant + left augmentation mastopexy for symmetry", Inches(0.35), Inches(5.45), Inches(5.5))
card(s, Inches(6.05), Inches(1.25), Inches(7.0), Inches(5.9), fill=WHITE)
bullet_box(s, [
"Preserves skin envelope and nipple-areola complex",
"Requires tumor >2 cm from NAC + negative retroareolar margin",
"Oncologic safety equivalent to SSM in selected patients",
"Combines cancer surgery with aesthetic principles",
"Immediate or delayed reconstruction",
], Inches(6.15), Inches(1.35), Inches(6.8), Inches(2.2), heading="Nipple-Sparing Mastectomy (NSM)")
bullet_box(s, [
"Contralateral symmetrization: reduction, mastopexy, or augmentation",
"Performed simultaneously or staged",
"Improves patient satisfaction and quality of life",
"Requires careful planning for radiation therapy compatibility",
"Post-reconstruction tattoo for NAC color matching",
], Inches(6.15), Inches(3.65), Inches(6.8), Inches(2.1), heading="Symmetrization Procedures")
bar3 = s.shapes.add_shape(1, 0, Inches(7.0), prs.slide_width, Inches(0.5))
bar3.fill.solid(); bar3.fill.fore_color.rgb = PINK; bar3.line.fill.background()
txt(s, "NSM patient satisfaction scores consistently higher vs. conventional mastectomy (BREAST-Q outcomes)",
Inches(0.3), Inches(7.05), Inches(12.8), Inches(0.4),
size=10, color=WHITE, align=PP_ALIGN.CENTER, bold=True)
# ════════════════════════════════════════════════════════════════════════════
# SLIDE 9 — NAC INNERVATION & SURGICAL ANATOMY
# ════════════════════════════════════════════════════════════════════════════
s = add_slide()
bg(s, LIGHT_GRAY)
header_bar(s, "Surgical Anatomy: NAC Innervation", "Key landmarks for mastectomy, augmentation & reconstruction")
place_img(s, IMG_INNERVATION, Inches(0.35), Inches(1.25), Inches(5.8), Inches(4.5))
caption(s, "4th intercostal nerve pathway supplying the nipple-areola complex", Inches(0.35), Inches(5.75), Inches(5.8))
card(s, Inches(6.35), Inches(1.25), Inches(6.7), Inches(5.9), fill=WHITE)
bullet_box(s, [
"Primary sensory supply from the lateral branch of the 4th intercostal nerve",
"Travels within the intercostal space, then pierces deep fascia",
"Branches to the nipple via anterolateral and anteromedial routes",
"Preservation critical in SSM, NSM, and augmentation",
"Risk of injury highest at 4-5 o'clock position (left) and 7-8 o'clock (right)",
], Inches(6.45), Inches(1.35), Inches(6.5), Inches(2.4), heading="NAC Innervation")
bullet_box(s, [
"Pectoralis major: primary coverage muscle for subpectoral implants",
"Serratus anterior: lateral chest wall, level II axillary dissection boundary",
"Thoracodorsal vessels: pedicle for LD flap",
"Deep inferior epigastric vessels: pedicle for DIEP/free TRAM",
"Inframammary fold: key landmark for implant pocket positioning",
], Inches(6.45), Inches(3.9), Inches(6.5), Inches(2.3), heading="Relevant Surgical Anatomy")
# ════════════════════════════════════════════════════════════════════════════
# SLIDE 10 — COMPLICATIONS & OUTCOMES
# ════════════════════════════════════════════════════════════════════════════
s = add_slide()
bg(s, LIGHT_GRAY)
header_bar(s, "Complications & Surgical Outcomes", "Comparing techniques by risk, recurrence, and patient outcomes")
place_img(s, IMG_SCARS, Inches(0.35), Inches(1.25), Inches(3.5), Inches(2.6))
caption(s, "Mastectomy vs lumpectomy scar comparison", Inches(0.35), Inches(3.85), Inches(3.5))
place_img(s, IMG_DIEP_PREOP, Inches(0.35), Inches(4.1), Inches(3.5), Inches(3.0))
caption(s, "DIEP flap: 8-month result with donor scar", Inches(0.35), Inches(7.1), Inches(3.5))
# Complications table
comp_headers = ["Procedure", "Early Complications", "Late Complications"]
comp_rows = [
["Lumpectomy", "Seroma, wound infection", "Fat necrosis, deformity"],
["Mastectomy", "Seroma, flap necrosis", "Chronic pain, lymphedema"],
["ALND", "Nerve injury, seroma", "Lymphedema (15-20%)"],
["Implant recon", "Infection, hematoma", "Capsular contracture, BIA-ALCL"],
["DIEP flap", "Flap failure (~2%), fat necrosis", "Abdominal hernia, donor scar"],
["LD flap", "Seroma at donor site", "Shoulder weakness, back scar"],
]
c_xs = [Inches(4.05), Inches(6.35), Inches(9.55)]
c_ws = [Inches(2.2), Inches(3.1), Inches(3.55)]
rh = Inches(0.44)
for c_i, (hdr, cx, cw) in enumerate(zip(comp_headers, c_xs, c_ws)):
hsh = s.shapes.add_shape(1, cx, Inches(1.25), cw - Inches(0.05), rh)
hsh.fill.solid(); hsh.fill.fore_color.rgb = NAVY; hsh.line.fill.background()
tf = hsh.text_frame; tf.vertical_anchor = MSO_ANCHOR.MIDDLE
tf.margin_left = Inches(0.06); tf.margin_top = 0
p = tf.paragraphs[0]; p.text = hdr
r = p.runs[0]; r.font.name = "Calibri"; r.font.size = Pt(9.5); r.font.bold = True
r.font.color.rgb = WHITE
for r_i, row_data in enumerate(comp_rows):
ry = Inches(1.25) + (r_i + 1) * rh
fc = LIGHT_TEAL if r_i % 2 == 0 else WHITE
for c_i, (val, cx, cw) in enumerate(zip(row_data, c_xs, c_ws)):
cs = s.shapes.add_shape(1, cx, ry, cw - Inches(0.05), rh)
cs.fill.solid(); cs.fill.fore_color.rgb = fc
cs.line.color.rgb = MID_GRAY; cs.line.width = Pt(0.3)
tf2 = cs.text_frame; tf2.vertical_anchor = MSO_ANCHOR.MIDDLE
tf2.margin_left = Inches(0.06); tf2.margin_top = 0; tf2.word_wrap = True
p2 = tf2.paragraphs[0]; p2.text = val
r2 = p2.runs[0]; r2.font.name = "Calibri"; r2.font.size = Pt(9)
r2.font.color.rgb = DARK_GRAY; r2.font.bold = (c_i == 0)
# Outcomes key stats
stats = [
("5-yr Survival\n(Stage I-II)", "95-99%", TEAL),
("Local Recurrence\n(BCS + RT)", "~1%/yr", NAVY),
("SLNB False-\nNegative Rate", "~7%", ORANGE),
("Implant Revision\nat 10 years", "~25%", PINK),
]
sx_start = Inches(4.05)
sw = Inches(2.3)
for i, (label, val, color) in enumerate(stats):
sx = sx_start + i * (sw + Inches(0.17))
sy = Inches(4.6)
crd = card(s, sx, sy, sw, Inches(1.35), fill=WHITE)
vs = s.shapes.add_shape(1, sx, sy, sw, Inches(0.55))
vs.fill.solid(); vs.fill.fore_color.rgb = color; vs.line.fill.background()
tf = vs.text_frame; tf.vertical_anchor = MSO_ANCHOR.MIDDLE
tf.margin_left = Inches(0.05); tf.margin_top = 0
p = tf.paragraphs[0]; p.text = val; p.alignment = PP_ALIGN.CENTER
r = p.runs[0]; r.font.name = "Calibri"; r.font.size = Pt(18); r.font.bold = True
r.font.color.rgb = WHITE
txt(s, label, sx, sy + Inches(0.57), sw, Inches(0.75),
size=9, color=DARK_GRAY, align=PP_ALIGN.CENTER, wrap=True)
# ════════════════════════════════════════════════════════════════════════════
# SLIDE 11 — SUMMARY / KEY TAKEAWAYS
# ════════════════════════════════════════════════════════════════════════════
s = add_slide()
bg_shp = s.shapes.add_shape(1, 0, 0, prs.slide_width, prs.slide_height)
bg_shp.fill.solid(); bg_shp.fill.fore_color.rgb = NAVY; bg_shp.line.fill.background()
strip3 = s.shapes.add_shape(1, 0, Inches(1.1), prs.slide_width, Inches(0.08))
strip3.fill.solid(); strip3.fill.fore_color.rgb = TEAL; strip3.line.fill.background()
strip4 = s.shapes.add_shape(1, 0, Inches(1.18), prs.slide_width, Inches(0.04))
strip4.fill.solid(); strip4.fill.fore_color.rgb = PINK; strip4.line.fill.background()
txt(s, "Key Takeaways", Inches(0.5), Inches(0.15), Inches(12), Inches(0.95),
size=32, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
takeaways = [
("BCS = Mastectomy", "Breast-conserving surgery + radiotherapy offers equivalent survival to mastectomy for most early-stage cancers."),
("SLNB First", "Sentinel node biopsy is the standard axillary staging; ALND reserved for 3+ positive nodes or clinically N+ disease."),
("DIEP = Gold Standard", "DIEP flap is the preferred autologous reconstruction - natural result with minimal muscle sacrifice and long-term durability."),
("NSM + Immediate Recon", "Nipple-sparing mastectomy with immediate reconstruction gives highest patient satisfaction scores (BREAST-Q data)."),
("Oncoplastic Principles", "Integrating plastic surgery principles into cancer surgery improves cosmesis without compromising oncologic safety."),
("Shared Decision Making", "Patient values, body habitus, adjuvant therapy needs, and surgeon expertise all determine the optimal surgical plan."),
]
cols = 2
for i, (title2, desc2) in enumerate(takeaways):
col = i % cols; row = i // cols
tx = Inches(0.5) + col * Inches(6.5)
ty = Inches(1.35) + row * Inches(1.9)
crd_shp = s.shapes.add_shape(1, tx, ty, Inches(6.2), Inches(1.75))
crd_shp.fill.solid(); crd_shp.fill.fore_color.rgb = RGBColor(0x14, 0x3A, 0x63)
crd_shp.line.color.rgb = TEAL; crd_shp.line.width = Pt(1)
# teal accent bar on left
acc = s.shapes.add_shape(1, tx, ty, Inches(0.06), Inches(1.75))
acc.fill.solid(); acc.fill.fore_color.rgb = TEAL; acc.line.fill.background()
txt(s, title2, tx + Inches(0.12), ty + Inches(0.06), Inches(6.0), Inches(0.45),
size=12, bold=True, color=TEAL)
txt(s, desc2, tx + Inches(0.12), ty + Inches(0.52), Inches(5.95), Inches(1.1),
size=10, color=RGBColor(0xCC, 0xDD, 0xEE), wrap=True)
txt(s, "Sources: Fischer's Mastery of Surgery 8e · Sabiston Textbook of Surgery · Schwartz's Principles of Surgery 11e · Current Surgical Therapy 14e",
Inches(0.3), Inches(7.1), Inches(12.7), Inches(0.35),
size=8, color=RGBColor(0x70, 0x90, 0xA8), align=PP_ALIGN.CENTER, italic=True)
# ════════════════════════════════════════════════════════════════════════════
# SAVE
# ════════════════════════════════════════════════════════════════════════════
out_path = "/tmp/workspace/breast-surgery-pptx/Breast_Surgery_Techniques_Outcomes.pptx"
prs.save(out_path)
print(f"\nSaved: {out_path}")
print(f"Slides: {len(prs.slides)}")
cd /tmp/workspace/breast-surgery-pptx && python create_pptx.py 2>&1
find /tmp/skills -name "fetch_images.py" 2>/dev/null; ls /tmp/skills/ 2>/dev/null
**/fetch_images.py in /tmp
python /tmp/skills/shared/scripts/fetch_images.py "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_88888916782ce335bab8f2a150bae1ac736ba5be8a6355cd086e59031308bd2b.jpg" 2>&1 | head -5
cd /tmp/workspace/breast-surgery-pptx && python create_pptx.py 2>&1
Breast Surgery Techniques Outcomes
Presentation · PPTX
| Slide | Content |
|---|---|
| 1 | Title slide - Breast Surgery Techniques & Outcomes |
| 2 | Overview of surgical categories |
| 3 | Mastectomy types (SSM I-IV, NSM) with diagram |
| 4 | Breast conservation surgery (WLE, oncoplastic) |
| 5 | Axillary management (SLNB blue dye, ICG, ALND) |
| 6 | Prosthetic reconstruction (expanders, ADM, implants) |
| 7 | Autologous flap reconstruction (TRAM, DIEP, SIEA, LD) |
| 8 | Oncoplastic surgery & NSM |
| 9 | NAC innervation anatomy |
| 10 | Complications & outcomes with key metrics |
| 11 | Key takeaways + sources (Fischer's, Sabiston, Schwartz's) |