BREAST RECONSTRUCTION

1
BREAST RECONSTRUCTION

• Mark S. Granick, MD, FACS
• Professor of Surgery, tenured
• Chief of Plastic Surgery

2
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.

3
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?

4
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?

5
Goals

• Mound reconstruction
• Size
• Skin coverage
• Nipple reconstruction
• Areola reconstruction
• Symmetry

6
Timing

• Immediate
• Delayed

7
Options

• Implant, with or without expansion
• Autogenous
• Combination

8
(No Transcript)
9
Implants

• 1 stage
• Skin deficiency uncorrected
• Facilitated by alloderm sling
• Good for small breasts with minimal ptosis
• Late capsular formation

10
(No Transcript)
11
(No Transcript)
12
(No Transcript)
13
(No Transcript)
14
Permanent Expander

• 1Step
• Corrects skin deficiency
• Multiple office visits

15
Expander - Implant

• 2 Stages
• Corrects skin deficiency
• Multiple office visits

16
(No Transcript)
17
(No Transcript)
18
(No Transcript)
19
Pre-op
20
Fully Expanded
21
Implant in Place
22
Nipple Areola Reconstruction
23
Autogenous Tissue

• Corrects skin deficiency
• Normal subcutaneous tissue
• No foreign material
• Longer operative time
• Higher morbidity

24
Latissimus Dorsi

• May require an implant
• Cannot be used if the thoracodorsal pedicle is
  damaged

25
Latissimus Dorsi
26
Latissimus Dorsi
27
Latissimus Flap Planning
28
(No Transcript)
29
(No Transcript)
30
(No Transcript)
31
TRAM

• Carl Hartrampf,MD
• Single or double pedicle
• Muscle sparing (perforator)
• Cannot use if the rectus muscle is divided
  superiorly (Kocher incision)
• Risks
• fat necrosis
• donor site slough
• flap failure
• hernia

32
(No Transcript)
33
(No Transcript)
34
(No Transcript)
35
Pre-op
36
Single Pedicle TRAM
37
Post-op
38
Pre-op
39
Intra-op
40
Post-op
41
Free Flap

• TRAM
• Gluteal
• Lateral Thigh
• DIEP

42
Pre-op
43
Intra-op
44
Microsurgery
45
Post-op
46
Nipple Reconstruction
47
Areola Reconstruction
48
NAC Reconstruction
49
Post Radical and Radiation
50
TRAM