Plastic Surgeon and Reconstructive Microsurgeon San Francisco, … Session... · Karen M. Horton,...
Transcript of Plastic Surgeon and Reconstructive Microsurgeon San Francisco, … Session... · Karen M. Horton,...
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG (INNER THIGH) FREE FLAP BREAST RECONSTRUCTION:
What Plastic Surgery Nurses Need to Know!
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.Plastic Surgeon and Reconstructive MicrosurgeonSan Francisco, California
American Society of Plastic Surgical Nurses 37th Annual ASPSN Convention
Denver, ColoradoSeptember 24, 2011
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
PRESENTATION OBJECTIVES
To introduce aesthetic goals and concepts in aesthetic breast reconstructionTo introduce the inner thigh (TUG) free flap as an option for Microsurgical breast reconstructionTo become familiar with intraoperative details of the TUG free flapTo view before and after images of immediate and delayed breast reconstruction using the TUG flap
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
INTRODUCTION
M.D. from University of TorontoMaster of Science, Cancer Research – Queen’s UniversityBoard Certified in Plastic Surgery Fellowship in Microsurgery – The Buncke Clinic, San FranciscoOne member of a unique all-women Plastic Surgery practice
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
WHY DO WE RECONSTRUCT THE BREAST?
By restoring the breast form and recreating symmetry, we can help reestablish:– Body image!– Self-esteem– Sense of femininity and
completeness– Ability to throw away an external
prosthesis!
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
GOALS OF BREAST RECONSTRUCTION
To recreate the breast form following removal, considering:
1. AESTHETICS 2. SYMMETRY3. LONGEVITY4. MINIMAL “MORBIDITY”
Without giving up FUNCTION = major muscles of the body
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
WHAT I ASK MY NEW PATIENTS
If we could wave a magic wand how would you WISH your breasts to be?– Larger?– Smaller?– Fuller?– Lifted?
Breast reconstruction should be viewed as an opportunity!– “Let’s make lemonade out of lemons!”
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
FROM A WOMAN’S PERSPECTIVE…
Finding the best fit of reconstruction procedure for the individual woman:– Body shape– Lifestyle– Details of cancer &
treatments
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TIMING OF BREAST RECONSTRUCTION
IMMEDIATEIMMEDIATEIMMEDIATE DELAYEDDELAYED– Same time as
mastectomy – Spares breast skin
+/- nipple– Preserves natural
breast shape
– Performed after mastectomy or other treatments
– Possible at any time (>6 months post-RT)
– Must expand or replace contracted skin
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
METHOD OF BREAST RECONSTRUCTION
IMPLANT FLAP(the body’s own tissue)
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
IMPLANTS FOR BREAST RECONSTRUCTION
ADVANTAGES– Shorter operation time (1-2 hours)– Slightly shorter recovery time (4 weeks)– Usually a single scar on/under the breast
DISADVANTAGES– Capsular contracture (hardening), infection,
rupture, deflation– Less natural shape– Usually augment other breast for symmetry– Radiation increases complication risk
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
“AUTOGENOUS” TISSUE = FLAP RECONSTRUCTION
ADVANTAGES– Permanent, warm, soft, living tissue– Move, grow and age with you– Last forever! (versus implants)– Often indicated after radiation
DISADVANTAGES– Creation of a “donor site”– Additional scars, another surgical site– Longer surgery (3-5 hours)– Slightly longer recovery time (4-6 weeks)
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
FLAP RECONSTRUCTION
“FLAP” – Tissue from the body that has its own blood supply– Living tissue– Permanent reconstruction– Soft, warm– Lasts forever!– Can counteract radiation damage
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
FLAP DEFINITIONS
“DONOR SITE” = the area where the tissue is taken from:– Abdomen (DIEP, SIEA, TRAM)– Inner thighs (TUG)– Buttocks– Back– Outer thighs
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
SO, HOW DO WE CHOOSE A RECONSTRUCTION METHOD?
Need to consider the following factors:– Patient preferences and aesthetic goals– Body habitus, fat distribution– Lifestyle issues
Work, family responsibilities– Cancer details– Urgency of treatment
Days or weeks/months to plan?– Adjuvant therapies – ongoing or expected
Chemotherapy, radiation
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
WHEN IS THE BODY’S OWN TISSUE USED?
1. After radiation of the breast or chest wall
2. High chance of postoperative irradiation
3. Failed implant reconstruction
4. Patient preference
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
WHAT IS MICROSURGERY?
MICROSURGERY involves magnification to reconnect blood vessels or nerves under the microscope to reestablish blood flow– Requires special training in
microsurgery– Specialized equipment– Postoperative monitoring of
circulation
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
MICROSURGICAL BREAST RECONSTRUCTION
Microsurgical breast reconstruction can involve many potential donor sites:– Abdomen – Buttocks – INNER THIGH – Anterolateral thigh– Back– Other
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
MICROSURGICAL BREAST RECONSTRUCTION
The abdomen is most often used for flap breast reconstructionsWhen unavailable for microsurgical transfer– Previous
DIEP/SIEA/TRAM flap– Previous abdominoplasty– Extremely low BMI– Refusing abdominal scar
The inner thigh is our next option!
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
INNER THIGH (TUG) FLAP
Transverse Upper Gracilis (TUG) flapCrescentic flap of skin, fat, and some underlying muscleSame distribution as cosmetic inner thigh lift
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
INTRODUCTION:THE TUG FLAP
Inner thigh skin and fat based on the transverse upper gracilis (TUG)musculocutaneous blood supply provides tissue favorable to microvascular breast reconstruction– Described in 19921 – transverse skin
paddle dominant, more reliable than vertical orientation2
1. Yousif, N. J., Matloub, H. S., Kolachalam, R., et al. Ann Plast Surg 29: 482-490, 1992.2. Heckler, F. R. Clin Plast Surg 7: 27-44, 1980.3. Schoeller, T., Wechselberger, G. Br J Plast Surg 57: 481-482, 2004.
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TRANSVERSE UPPER GRACILIS (TUG) FREE FLAP
The Transverse Upper Gracilis (TUG) flap was described by Yousif (1992)
– Single case of breast reconstruction1
Cutaneous territory of gracilis myocutaneous flap was demonstrated by anatomic and injection studies to lie perpendicular to the muscle in its proximal third, transverse and parallel to the medial groin crease
1Yousif NJ, Matloub HS, Kolachalam R, Grunert BK, Snager JR. The transverse gracilis musculocutaneous flap. Ann Plast Surg. 29: 482, 1992.
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TRANSVERSE UPPER GRACILIS (TUG) FLAP
Following this report, the classic vertical skin paddle harvest was largely abandoned in favor of the transverse upper skin paddle
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP DESIGN
Semi-lunar skin paddleSuperior aspect of flap just below groin crease, extending to gluteal crease
– Not placed immediately in crease to avoid distortion of labia majora4
4. Lockwood, T. Plast Reconstr Surg 92: 1112-1122; discussion 1123-1115, 1993.
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP SURGICAL TECHNIQUE
Crescent-shaped flapLength extends anteriorly from gracilis muscle, parallel and inferior to groin crease, posteriorly to just below gluteal foldWidth of flap 8-12 cm or maximum width easily closed without tension
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP INTRAOPERATIVE DESIGN
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP DESIGN
Pedicle length averages 6-8 cmExtent of gracilis muscle usually just immediately beneath flap
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP DESIGN
Flap folded to cone flap and enhance projection– Additional gracilis
muscle may be folded behind flap if additional volume desired
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP DESIGN
Flap weight usually corresponds to mastectomy specimen Flap projection often greater than native breast
496 g
488 g
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP “CONING”
Flap folded and ‘coned’ to give projection to the flapSkin deepithelialized to bury beneath mastectomy flaps
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP SHAPING
Deepithelialized with exception of areolar circle for immediate breast reconstructions
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP MICROSURGERY
End-to-end anastomosis with internal mammary vessels in 3rd or 4th intercostal interspace
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
MICROVASCULAR ANASTOMOSIS
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP INSET BENEATH MASTECTOMY SKIN
Deepithelialized portion of flap buried beneath mastectomy skinDelayed reconstructions –inner thigh skin used to reconstruct both lower pole of breast and NAC
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
IMMEDIATE NAC RECONSTRUCTION
Apex of standing cone accentuated using crossing horizontal mattress sutures to create nipple prominenceNaturally darker pigment of inner thigh defines areola
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG DONOR SITE CLOSURE
Layered closure of donor site superficial fascial system similar to medial thigh liftSuction drain exiting from the superior aspect of thigh wound
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP STUDY RESULTS
2004-2007: 35 inner thigh flaps in 21 patients
– 1 abdominoplasty/failed implant reconstruction
– 16 inadequate abdominal donor tissue
– 3 previous DIEP/TRAM– 5 chose TUG in lieu of
abdominal tissue
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP STUDY RESULTS
Patient age 32-64 years (average 49 years)All breast cancer or BRCA+6 previous radiation 18 patients (31 flaps) included immediate NAC reconstruction
– 20 immediate, 11 delayed cases
Median follow up 1 year
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP STUDY RESULTS
Flap weight 282-502 grams – Average 363 grams
Length 20-28 cm– Average 23.5 cm
Width 8-11 cm– Average 10 cm
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP STUDY RESULTS
All flaps survivedOne take-back at 12 hours for venous thrombosis– Thrombectomy and
vessel repair enabled complete flap survival without fat necrosis
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP STUDY RESULTS
6 donor site partial breakdowns (< 2 cm)– 3 healed by secondary intent– 3 debrided and closed under GA
4 patients (5 donors) seromasNo donor site functional lossAll patients resumed normal activity
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP - DISCUSSION
Like other flaps, inner thigh available if abdomen insufficent5– Unlike rectus abdominis,
gracilis muscle harvest not associated with hernia, bulge or functional loss
Only drawback is the inner thigh scar
– Hidden in all clothing except swim suits or underwear6
5. Granzow, J. W., Levine, J. L., Chiu, E. S., et al. J Plast Reconstr Aesthet Surg 59: 614-621, 2006.6. Hallock, G. G. Plast Reconstr Surg 113: 339-346, 2004.
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP - DISCUSSION
Patients are informed preoperatively of potential donor site complicationsAll women are satisfied with their final results
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP - DISCUSSION
Gracilis muscle and pedicle harvest extremely reliable and straightforward
– Familiar to most Microsurgeons
No intraoperative repositioning required as often for gluteal flaps
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
WHY NOT A TUG “PERFORATOR FLAP”?
Free gracilis perforator flaps have been describedPeek (2002) performed breast reconstruction in 6 patients8
– Included minor pedicle with flap to achieve bulk
Hallock (2004) reconstructed upper/lower extremity and scalp defects9
– Skin grafting of donor sites required in some cases
8Peek A, Muller M, Exner K. [The free gracilis perforator flap for autologous breast reconstruction]. Handchir Mikrochir Plast Chir. 34: 245, 2002.9Hallock GG. Further experience with the medial circumflex femoral (gracilis) perforator free flap. J Reconstr Microsurg. 20: 115, 2004.
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG “PERFORATOR FLAP”?
However, inclusion of gracilis muscle in TUG flap suggested to provide more tissue volume, increase safety and allow rapid flap harvest with minimal functional donor site morbidity6
Anatomic studies of the proximal cutaneous perforator vessels show variability in number, size and symmetry of perforators10
– Inclusion of some muscle recommended for reliable TUG flap transfer
6Wechselberger G, Schoeller T. The transverse myocutaneous gracilis free flap: a valuable tissue source in autologous breast reconstruction. Plast Reconstr Surg. 114: 69, 2004.10Kappler UA, Constantinescu MA, Buchler U, Vogelin E. Anatomy of the proximal cutaneous perforator vessels of the gracilis muscle. Br J Plast Surg. 58: 445, 2005.
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP - DISCUSSION
Inner thigh can be harvested as perforator flap7-10
Anatomic study of TUG perforators recommends including muscle in flap11:
– Functional advantages to sparing gracilis unclear– Potential increased risk to circulation– Increased operating time – No clear benefit of perforator flap
7. Peek, A., Muller, M., Exner, K. Handchir Mikrochir Plast Chir 34: 245-250, 2002.8. Hallock, G. G. Ann Plast Surg 51: 623-626, 2003. 9. Hallock, G. G. J Reconstr Microsurg 20: 115-122, 2004.10. Wechselberger, G., Schoeller, T.Plast Reconstr Surg 114: 69-73, 2004.11. Kappler, U. A., Constantinescu, M. A., Buchler, U., et al. Br J Plast Surg 58: 445-448, 2005.
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP - DISCUSSION
For some patients, medial thigh lift an aesthetic perkImmediate NAC reconstruction obviates local flaps, skin grafting, tattooing
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP STUDY CONCLUSIONS
The inner thigh flap is an alternative to the abdomen for immediate and delayed breast reconstructionEnables immediate NAC reconstruction
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP STUDY CONCLUSIONS
TUG flap breast reconstruction is an excellent option in:– Women desiring
autologous microsurgical reconstruction
– Lacking adequate abdominal donor tissue
– Do not desire abdominal scars
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
ADVANTAGES OF THE TUG FLAP
1. Good flap projection and volume2. No functional consequences
from gracilis muscle harvest3. Benefit of medial thigh lift4. Patient position supine
throughout surgery5. Two-team reconstruction
possible 6. Scar position and quality
favorable and often hidden
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP CANDIDATES
1. Patients desiring autologous breast reconstruction
2. Sufficient superomedial thigh tissue3. Previous abdominoplasty4. Previous DIEP / SIEA / TRAM flap harvest5. Previous abdominal surgery precluding use
of abdominal tissue for reconstruction6. Very thin or athletic patients without
sufficient abdominal donor tissue
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
CASE EXAMPLE 1
BILATERAL IMMEDIATE TUG FLAP RECONSTRUCTION
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP STEP-BY-STEP CASE EXAMPLE
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP PREOPERATIVE PLANNING
Breast boundaries marked preoperatively Inframammary folds and lateral border of breasts stapled before surgical prep
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP INTRAOPERATIVE MARKINGS
Anterior and posterior borders of gracilis muscleWidth that is easily closed without tension (8-12 cm)Hand-held Doppler helps locate perforators
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP INTRAOPERATIVE POSITIONING
Patient is positioned supine with leg(s) abducted, and hips and knees flexed
Contralateral flap commonly harvested to facilitate a two-team approach
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP STEP-BY-STEP CASE EXAMPLE
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP STEP-BY-STEP CASE EXAMPLE
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP MICROSURGICAL DISSECTION
Subfascial elevation begins anteriorlyProceeds to intermuscular septum between adductor longus and anterior border of gracilisGreater saphenous vein identified and preservedUndermining of subcutaneous adipose maximizes bulk of tissue taken with flap
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP MICROSURGICAL DISSECTION
Musculocutaneous or septocutaneous perforators entering flap identifiedPedicle dissection proceeds proximally to origin from superficial femoral artery to suit required pedicle length
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP STEP-BY-STEP CASE EXAMPLE
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP STEP-BY-STEP CASE EXAMPLE
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP STEP-BY-STEP CASE EXAMPLE
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP STEP-BY-STEP CASE EXAMPLE
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP STEP-BY-STEP CASE EXAMPLE
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP STEP-BY-STEP CASE EXAMPLE
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP STEP-BY-STEP CASE EXAMPLE
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP STEP-BY-STEP CASE EXAMPLE
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP STEP-BY-STEP CASE EXAMPLE
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
CASE EXAMPLE 2
BILATERAL IMMEDIATE TUG FLAP RECONSTRUCTION
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
BEFORE AND AFTERBilateral Immediate TUG Flap Reconstruction
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
BEFORE AND AFTERBilateral Immediate TUG Flap Reconstruction
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
BEFORE AND AFTERBilateral Immediate TUG Flap Reconstruction
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
BEFORE AND AFTERBilateral Immediate TUG Flap Reconstruction
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
BEFORE AND AFTERBilateral Immediate TUG Flap Reconstruction
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
CASE EXAMPLE 3
BILATERAL DELAYED TUG FLAP RECONSTRUCTION
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
MATCH PATIENT ISSUES TO THE RECONSTRUCTIVE METHOD
Radiated, flat, stiff chest skin:– Implants too risky
Washboard stomach but inner thighs available:– TUG flap first choice
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
BEFORE AND AFTERTUG Flap Reconstruction
Preop 3 Months Postop
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
BEFORE AND AFTERTUG Flap Reconstruction
Preop 3 Months Postop
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
BEFORE AND AFTERTUG Flap Reconstruction
Preop 3 Months Postop
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
BEFORE AND AFTERTUG Flap Reconstruction
Preop 3 Months Postop
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
BEFORE AND AFTERTUG Flap Reconstruction
Preop 3 Months Postop
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP DONOR SITE
6 Months Postop
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
CASE EXAMPLE 4
BILATERAL TUG FLAP RECONSTRUCTION –ONE IMMEDIATE, ONE DELAYED
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
MATCH PATIENT ISSUES TO RECONSTRUCTION METHOD
Bilateral reconstructionWants to be smaller & liftedMore inner thigh than abdominal tissue:– TUG flap
Radiated chest skin:– Implant too risky
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
BEFORE AND AFTERBilateral TUG Flap Reconstruction
Preoperative 7 Months Postop
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
BEFORE AND AFTERBilateral TUG Flap Reconstruction
Preoperative 7 Months Postop
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
BEFORE AND AFTERBilateral TUG Flap Reconstruction
Preoperative 7 Months Postop
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
BEFORE AND AFTERBilateral TUG Flap Reconstruction
Preoperative 7 Months Postop
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
BEFORE AND AFTERBilateral TUG Flap Reconstruction
Preoperative 7 Months Postop
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
BEFORE AND AFTERBilateral TUG Flap Reconstruction
Preoperative 7 Months Postop
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
BEFORE AND AFTERTUG Flap Donor Site
Preoperative 3 Months Postop
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
BEFORE AND AFTERTUG Flap Donor Site
Preoperative 3 Months Postop
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
CASE EXAMPLE 5
BILATERAL NIPPLE-SPARING MASTECTOMY AND TUG FLAPS WITH A LIFT
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
MATCH PATIENT ISSUES TO RECONSTRUCTION METHOD
Does NOT want implants:
– Flap is an optionWants to be smaller & liftedBILATERAL reconstruction planned:
– TUG flaps the best option
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
BEFORE AND AFTERNSM & Immediate Bilateral TUG Flap Reconstruction
Preoperative 6 Weeks Postop
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
BEFORE AND AFTERBilateral TUG Flap Reconstruction
Preoperative 6 Weeks Postop
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
BEFORE AND AFTERBilateral TUG Flap Reconstruction
6 Weeks Postop 6 Weeks Postop
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP DONOR SITE OPTIMIZATION
Place scars to fall within undergarments if possible
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP DONOR SITE
6 Months Postop
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
SUMMARY – THE BREAST RECONSTRUCTION EXPERIENCEReconstruction of the breast can be a positiveexperience that can help restore self-image and self-esteem!
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
TUG FLAP BREAST RECONSTRUCTION
Breast reconstruction can and should be a positive experience, preserving body image and facilitating emotional recoveryThe TUG flap is an excellent reconstructive option for selected women facing breast cancer
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.www.drkarenhorton.com
ARTISTRY IN BREAST RECONSTRUCTION
Reconstruction of the breast is an individualized procedureNo single procedure is right for everyoneEach woman’s lifestyle and anatomy differsThe best reconstructive option takes into account a woman’s goals, the way she uses her body, and her unique situation