Transcript PPT format - Carolinas HealthCare System

BREAST RECONSTRUCTION
FORUM
Patient Evaluation
• Cancer Operation:
-How has the patient been treated?
-What is the treatment plan?
-Radiation history
-Lumpectomy with radiation vs mastectomy -vs
bilateral mastectomy
Patient evaluation
•
Patient variables:
-Body habitus (enough tissue vs too much)
-Past surgical history (? Previous
abdominoplasty)
-Social history (smoking ?)
-Patients wishes and education
• Internet
• Opinion on implants
• “Save my muscle”
Breast Reconstruction
• Tissue Expander/ Implant Recon. • Autologous Recon. (patient’s own
tissue)
-Latissimus Dorsi Flap
-TRAM
-DIEP
-GAP
Pros
• Implants
-Shorter operations
-Body Habitus not a factor
-Greater variability in adjusting
size
• Autologous
-Less long term complications
-Breast will adjust with weight changes
-Natural appearance
-Long term studies show patients feel
reconstruction is “own breast”
Cons
• Implants
-Does not work with radiation
-Short term implant
complications
-Long term implant complications
-Capsular contracture
• Autologous
-Longer surgery
-Body Habitus
-BMI<35
-Non smokers
-Longer recovery
Radiation Therapy
• Radiation affects the skin and subcutaneous
tissue. The skin color or turgor may be affected.
Most important is radiation affects the blood
vessels in the skin and subcutaneous tissues.
• These changes affect the type of reconstruction
and the results.
• Due to these changes it is important to include
this variable when discussing your reconstruction
options.
Tissue Expander/ Implant
•
Tissue Expander is inserted into the Breast
“Pocket” under the muscle.
•
The estimated recovery time for this
procedure is 2-3 weeks. Weekly office
visits will be required in order to fill the
expander, with Saline, until ideal size is
attained.
•
Once expansion is completed the patient
will wait 3 months.
Tissue Expander/ Implant
• The permanent implant will be placed during the
second surgical procedure.
• Follow up at the office will be scheduled for 1-2
weeks after the second surgery.
• The patient will wait for 3 months before
scheduling further surgery i.e.) symmetry/ nipple
reconstruction. Following that procedure the
patient will be seen in 2 weeks.
• Again there will be a 3 month waiting period
before the final step, Areola tattoo, is completed.
Latissimus Dorsi Flap with Tissue
Expander
Incision is made in the upper back. The latissimus muscle is
tunneled through the axilla and placed into the mastectomy
defect.
The flap itself is only about one inch thick usually requiring an
expander/ implant to be placed in order to match the opposite
breast. The muscle/ tissue with an expander are shaped into
a breast mound.
The estimated recovery time for this procedure is 4-6 weeks.
This surgical procedure last approximately 4-6 hours. The
patient does have a hospital stay anywhere from 2-3 days.
Follow up will be scheduled for 1 week following discharge
from the hospital. Post op visits will occur weekly in order to
fill the expander, with Saline, until ideal size is attained.
•
Latissimus Dorsi Flap with Tissue
Expander
Incision is made in the upper back. The latissimus
muscle is tunneled through the axilla and placed into
the Breast “Pocket.”
•
The flap itself is only about one inch thick usually
requiring an expander/ implant to be placed in order to
match the opposite breast. The muscle/ tissue with an
expander are shaped into a breast mound.
•
The estimated recovery time for this procedure is 4-6
weeks. This surgical procedure last approximately 4-6
hours. The patient does have a hospital stay
anywhere from 2-3 days.
•
Follow up will be scheduled for 1 week following
discharge from the hospital. Post op visits will occur
weekly in order to fill the expander, with Saline, until
ideal size is attained.
Latissimus Dorsi Flap with Tissue
Expander
• Once expansion is completed the patient will
wait 3 months.
• The permanent implant will be placed during the
second procedure. Follow up will be scheduled
for 1-2 weeks.
• The patient will wait for 3 months before
scheduling further surgery i.e.) symmetry/ nipple
reconstruction. Following that procedure patient
will be seen in 2 weeks.
• Again there will be a 3 month waiting period
before the final step, Areola tattoo, is completed.
•
•
DIEP
Deep Inferior Epigastric Perforator Flap
This surgical procedure has evolved from the traditional
TRAM Flap, a non-muscle sparing flap. The DIEP
procedure allows the abdominal muscles to stay (six
pack abs) in place which aids in preventing hernias from
occurring
DIEP
•
This surgical procedure has evolved from the traditional TRAM Flap, a non-muscle
sparing This procedure is more complex than the latissimus dorsi muscle flap or a
TRAM flap. It requires two well trained mircovascular surgeons. It is a longer
surgical procedure and is not an option for everyone.
•
A CT Angiogram of the patient’s abdomen/ pelvis will be required in order to
determine the patient’s eligibility for this specific surgical procedure.
•
An elliptical incision is made in the abdominal tissue/ fat. That tissue with the blood
supply is removed from the abdomen as a “Free Flap” and reattached to the
vessels in the Breast “Pocket.” The flap is shaped into a breast mound.
•
The estimated recovery time for this procedure is 4-8 weeks. The surgical
procedure last approximately 6-12 hours. The patient does have a hospital stay
anywhere from 3-5 days.
flap. The DIEP procedure allows the abdominal muscles to stay (six pack abs) in
place which aids in preventing hernias from occurring
•
DIEP Cont.
• Follow up at the office will be scheduled for 1
week following the patient’s discharge from the
hospital. The patient will follow up weekly for
approximately 3 weeks. Subsequent surgical
procedures may be necessary to give the breast
its ideal shape.
• Once the breast is shaped, the patient will wait for
3 months before proceeding with the nipple
reconstruction. Following that procedure the
patient will be seen in 2 weeks.
• Again there will be a 3 month waiting period
before the final step, Areola tattoo, is completed.
NO SMOKING
• Causes constriction of blood vessels which slows down
the wound healing process. Nicotine decreases the
speed in which oxygen and nutrients reach the skin
edges, affecting wound healing and causing a higher
incidence of complications.
• Because of the seriousness of these potential problems,
we require all patients to discontinue the use of tobacco
products at least 2 months prior to the surgery date.
• A urine nicotine test will be administered prior to
scheduling surgery as well as on the day of surgery!
Complications
-Bleeding
-Fluid accumulation (seroma)
-Infection
-Tissue necrosis
-Capsular contracture
• However, risk for complications during Breast
Reconstruction are no greater than any other surgical
procedure!
• Any incision in the skin will leave a scar, how well the
scar heals is patient dependent (the surgeon does not
determine the scars appearance)!
Drains
Each one of these procedures does require the
placement of drain(s).
This allows for the excess fluid to be removed.
It is important NOT to shower while the drains
are in place!
Drains will be removed when the fluid
accumulation is below 30cc for more than 24
consecutive hours.
In Conclusion
Breast Reconstruction is a commitment from both you and
your physician.
The entire process from beginning (mastectomy) to end
(areola tattoo) takes approximately a year!
We, at CMC Cosmetic and Plastic Surgery, want you to
make an educated choice about breast reconstruction. We
are here not only to answer questions but be a supportive part
of your breast reconstruction journey.
YOU ARE NOT ALONE!