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Breast Reconstruction

This document summarizes various options for breast reconstruction after mastectomy. It discusses the benefits of immediate versus delayed reconstruction. It also describes techniques such as expander/implant reconstruction, latissimus dorsi flaps, TRAM/DIEP flaps, and fat grafting. Each option has pros and cons related to factors like operating time, recovery, donor site morbidity, and natural appearance. Patient selection depends on desired outcomes, medical factors, and type of prior breast surgery or treatment.

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Syed Irfan Arif
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71 views35 pages

Breast Reconstruction

This document summarizes various options for breast reconstruction after mastectomy. It discusses the benefits of immediate versus delayed reconstruction. It also describes techniques such as expander/implant reconstruction, latissimus dorsi flaps, TRAM/DIEP flaps, and fat grafting. Each option has pros and cons related to factors like operating time, recovery, donor site morbidity, and natural appearance. Patient selection depends on desired outcomes, medical factors, and type of prior breast surgery or treatment.

Uploaded by

Syed Irfan Arif
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Breast reconstruction

Penny L McManus FRCS

Consultant oncoplastic breast surgeon


Hull UK
Breast Reconstruction
 Immediate (with mastectomy)
 Better cosmetic outcomes
 Cheaper
 Early Psychological benefit

 Delayed
 Patient has more time to consider options
 Adjuvant therapy completed
 Higher long term patient satisfaction rates
Skin sparing mastectomy for immediate reconstruction
Techniques in Breast
Reconstruction
 Expander/Implant

 Latissimus Dorsi (LD)

 TRAM / DIEP

 Other free flaps – SGAP, IGAP, TUG

 lipomodeling
Implant Reconstruction
 2 stage:
 Tissue expander then permanent silicon
implant

 1 stage:
 Permanent expander-implant
 Permanent implant with dermal sling or
Acellular dermal matrix
2 stage implant reconstruction
 Delayed and immediate

 Submuscular tissue
expander

 Serial expansion

 Change to permanent
silicone implant
Tissue expander placed in submuscular pocket
Delayed 2 stage implant reconstruction
Advantages

 Short operating time


and recovery
 Low complication rate
 No donor site
morbidity
 Normal appearance in
clothing
Disadvantages
 2 operations
 No ptosis
 No change with body
weight/age
 Feels cold
 Late complications

Radiotherapy
Immediate implant with dermal sling
 Wise pattern mastectomy
 Lower pole skin de-
epithelialised & sutured to
lower edge pectoralis

 Ptotic breasts
 Patients requesting
reduction

 Risk reduction
mastectomy
Immediate implant with dermal sling
Immediate implant with acellular dermal
matrix
 Strattice, Alloderm,
Permacol, Surgimend
 Sutured to lower edge
pectoralis and
inframammary fold
 Smaller, non-ptotic
breast
 High complications rate
 High cost
Immediate implant with ADM
Complications
 Early
 Wound breakdown

 Infection  explantation

 Rotation

 Late

Capsular contracture (20% at 10 years)

Deterioration of overlying tissues

Implant rupture
Patient selection
 Patient desires & expectations

 Small, non-ptotic breast


 Contralateral reduction or mastopexy

 Avoid in diabetics, smokers, steroids, RT


Latissimus Dorsi Flap
Extended Latissimus Dorsi flap
Extended LD flap
Pros and Cons
 Operating time 4-5  Donor site scar and
hours morbidity
 Stay 4 days  Twitching
 Recovery 4-5 week
 Seroma
 Safe and reliable flap
 Flap failure
 Can be irradiated if
autologous  Flap atrophy
LD with implant
Preop immediate LD + Implant 2 years postop

Preop delayed LD + Implant 2 years postop


Autologous LD
Preop immediate LD 3 months postop

Preop delayed LD 12 months postop


Autologous LD & fat transfer

Pre-op 5 years post-op

Pre-op
2 years post-op
TRAM/DIEP Flaps
 Anterior abdominal wall tissue

 Pedicled
 Transverse Rectus Abdominis Myocutaneous
(TRAM) Flap
 Free:

Free TRAM

Deep Inferior Epigastric Perforator (DIEP) Flap
 SIEA flap

 Operating time 6-8 hours


 Stay 4-5 days
 Recovery 7-8 weeks
Pros and Cons
 Larger reconstruction  longer operating time
 Muscle sparing  higher risk of flap loss
 Natural feel &
consistency  donor site morbidity
 “tummy tuck”  donor site scar
Fat grafting
 Autologous fat transfer / Lipomodeling

 Fat removed by liposuction from areas of excess


 Centrifuged in theatre to remove blood and dead
cells
 Injected into breast

 Can be used with other types of reconstruction


 Can be used to correct defects after breast
conserving surgery or failed reconstruction
 Low morbidity
Fat transfer
Fat transfer to revise reconstruction
Fat transfer for asymmetry
Fat transfer for breast conserving surgery defect
Fat transfer alone for reconstruction
Summary
 Reconstruction benefits patients
 Wide range of options
 Patient selection is key

 “Reconstructive ladder”
Thank you

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