Transcript BREAST RECONSTRUCTION - University of Mauritius

BREAST
RECONSTRUCTION
Mark S. Granick, MD, FACS
Professor of Surgery, tenured
Chief of Plastic Surgery
Why?
“I have a long life to live and I want to live it whole.”
“I wanted to once again put on a beautiful
nightgown and fill it all out.”
“”I was gardening one day when I bent over and
my prosthesis fell out. Crying I picked it out of
the muddy water. The next day I called a Plastic
Surgeon.”
Patient Questions
Who is a candidate for surgery?
Will breast reconstruction interfere with
cancer treatment or detection?
Are there some women who should not
have a reconstruction?
Does the type of cancer make a
difference?
How does adjuvant therapy impact on
reconstruction?
Patient Questions
How do you get the breasts symmetric?
If a patients gains or loses weight, how
does it affect the reconstruction?
Does a breast reconstruction look and feel
natural?
Are there psychological implications
concerning breast reconstruction?
Goals
Mound reconstruction
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Size
Skin coverage
Nipple reconstruction
Areola reconstruction
Symmetry
Timing
Immediate
Delayed
Options
Implant, with or without expansion
Autogenous
Combination
Implants
1 stage
Skin deficiency uncorrected
Facilitated by alloderm sling
Good for small breasts with minimal ptosis
Late capsular formation
Permanent Expander
1Step
Corrects skin
deficiency
Multiple office visits
Expander - Implant
2 Stages
Corrects skin deficiency
Multiple office visits
Pre-op
Fully Expanded
Implant in Place
Nipple Areola Reconstruction
Autogenous Tissue
Corrects skin deficiency
Normal subcutaneous tissue
No foreign material
Longer operative time
Higher morbidity
Latissimus Dorsi
May require an implant
Cannot be used if the thoracodorsal
pedicle is damaged
Latissimus Dorsi
Latissimus Dorsi
Latissimus Flap Planning
TRAM
Carl Hartrampf,MD
Single or double pedicle
Muscle sparing (perforator)
Cannot use if the rectus muscle is divided
superiorly (Kocher incision)
Risks
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fat necrosis
donor site slough
flap failure
hernia
Pre-op
Single Pedicle TRAM
Post-op
Pre-op
Intra-op
Post-op
Free Flap
TRAM
Gluteal
Lateral Thigh
DIEP
Pre-op
Intra-op
Microsurgery
Post-op
Nipple Reconstruction
Areola Reconstruction
NAC Reconstruction
Post Radical and Radiation
TRAM