Breast Reconstruction

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Breast Reconstruction

• Hemant Singhal
• FRCSEd FRCS(Gen) FRCSC
• Consultant Surgeon
• Senior Lecturer (Hon) Imperial College School Of
  Medicine

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Breast Reconstruction

• Who should have it
• When
• How
• Who will do it
• What can we hope to achieve

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Who should have it?

• Everyone?
• What about the elderly
• Are there any disadvantages
• Costs
• Systemic disease
• Time of operation
• Pathology results
• Subsequent treatments

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When?

• Primary reconstruction
• One operation
• Patient goes home with a breast
• Full details of treatment not known
• Delayed reconstruction
• Can get a good comparison with an extrnal
  prosthesis

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How? Methods of reconstruction

• Volume displacement
• Volume replacement
• For wide local excision
• For mastectomy
• Flaps
• Lat dorsi
• Rectus abdominis
• Free flaps

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Who will do it?

• Breast Cancer Surgeon
• Issues with timing
• Numbers
• Training
• Plastic Surgeon
• Cosmetic Surgeon

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How?

• Lets have the mound
• Develop the ptosis
• Nipple areola reconstruction
• Getting symmetry
• Contralateral procedures

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Submuscular breast reconstruction This is a
straightforward method of breast reconstruction.
During the operation an implant is placed beneath
the muscles which cover the chest. The scar is
usually horizontal or oblique and in the same
place as a mastectomy scar. A submuscular
reconstruction may be offered to women who have a
fairly small breast with little natural droop.

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• The prosthesis
• Needs expansion
• Overinflation
• Correct size
• Remove the valve

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Subpectoral implant

• It is unsuitable for women
• with large breasts
• who have had a radical mastectomy with the
  removal of the chest wall muscles
• who have had radiotherapy, because the skin is
  unlikely to stretch enough to take an implant of
  the correct size.

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Subpectoral implant

• Gradual expansion
• May take 6 months
• Operation to remove port

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LD Flap
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Nipple reconstruction
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Nipple reconstruction
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The result
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Bilateral skin sparingImplants with LD flaps
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