Via Christi Women's Connection: Breast Reconstruction
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Transcript of Via Christi Women's Connection: Breast Reconstruction
BREAST RECONSTRUCTI
ONDr. Vanessa Voge
Wichita Surgical Specialists
BREAST RECONSTRUCTION Brief overview Types of breast reconstruction available
after mastectomy Types of “reconstruction” that can be
combined with lumpectomy
BREAST RECONSTRUCTION Each year more than 250,000 American
women face breast cancer. Undergoing Mastectomy affects one in
many dimensions--emotionally, physically, psychologically, etc…
In the past, reconstructive options were not available or not widely offered.
BREAST RECONSTRUCTION New kinds of treatment as well as
improved reconstructive surgery mean that women who have breast cancer today have better choices.
Breast reconstruction is a type of surgery for women who have had a breast removed.
The goal is to provide a treatment for breast cancer and still provide shape and symmetry to the breasts.
BREAST RECONSTRUCTION Often patients have many questions
Forefront is the cancer itselfWhat will I look like after mastectomy?What are reconstruction options?What will my breast(s) look like after
reconstruction?How is reconstruction affected by additional
cancer treatments such as chemo or radiation?
BREAST RECONSTRUCTION Treating the breast cancer first Very patient dependent Cancer treatment dependent Individualize treatment plans
BREAST RECONSTRUCTION Reconstruction or not
Some patients are not candidates Severe obesity, systemic disease,
psychological/emotional state
Prosthesis Pros- decreased amount of surgery and surgery
sequela, can vary size, effect of water Cons- Can shift, weight, not a part of body
BREAST RECONSTRUCTION Timing of Reconstruction
Time of Mastectomy- “immediate breast reconstruction”
After one has healed from mastectomy- “delayed reconstruction”
BREAST RECONSTRUCTION At the time of mastectomy
Currently most common way
Pros: Save skin, better aesthetic result, reconstruction started or possibly finished at time of mastectomy
Cons: Post-operative radiation, possible increase in skin healing problems
BREAST RECONSTRUCTION Types of reconstruction- patient
dependentTissue Expander/Implant basedLatissimus flap/implantTRAM flapFree Flap- DIEP, free tram, S-GAP, etc…
Nipple and areolar reconstruction
BREAST RECONSTRUCTION Tissue Expander/Implant
Makes up more than 75% of breast reconstructions in the United States
Requires minimum of two surgeriesAt the time of mastectomy the tissue
expander is placed--“first stage breast reconstruction”
TISSUE EXPANDER
TISSUE EXPANDER
TISSUE EXPANDER WITH BIOLOGICAL MESH SUPPORT There is more use of a biological
support, such as alloderm.
TISSUE EXPANDER/IMPLANT Second surgery involves the exchange
of the tissue expander for an implant- “second stage breast reconstruction”
Approximately 4 months from first surgery, but varies greatly from patient to patient and surgeon to surgeon
BREAST IMPLANTS
TISSUE EXPANDER/IMPLANT
TISSUE EXPANDER/IMPLANT Pros: Shorter surgery time, breasts
remain same size and overall position, If bilateral symmetry possibly improved, less scarring, less operative sites, decreased “overall” complication rates
TISSUE EXPANDER/IMPLANT
Cons: Foreign objects, not lifelong devices, capsular contracture, loss of implants, stay the same with time, asymmetry
SINGLE STAGE BREAST RECONSTRUCTION WITH IMPLANT Placing the breast implant at the time of
mastectomyNot as commonOnly in certain patients with ideal anatomy
and cancersAlmost always with Alloderm or equivalent
SINGLE STAGE RECONSTRUCTION WITH IMPLANT
TRAM FLAP TRAM- Transverse Rectus Abdominus
Myocutaneous Rectus muscles- Abdominal “six pack”Core muscle
TRAM FLAP
TRAM FLAP Pros: Own tissue (replacing like with
like), affected some by gravity, fluctuates with weight, possibly no additional surgery except nipple/areolar creation, matches other non reconstructed breast, remove excess abdominal tissue
TRAM FLAP Cons: Larger/longer surgery, longer
recovery, not true abdominoplasty, risk hernia/abdominal bulge, bulge upper abdomen, weakness to abdomen, Full loss of flap, partial loss of flap, fat necrosis, specific candidates (previous surgeries, weight, smoking, etc…)
LATISSIMUS FLAP Latissimus dorsi muscle is on back Activities for “lat pulls”, cross country
skiing, rock climbing, etc… can be affected.
LATISSIMUS FLAP
LATISSIMUS FLAP
LATISSIMUS FLAP Pros: Own tissue, non-radiated tissue,
“covers” implant
Cons: larger/longer surgery, muscle weakness, fluid collection, often needs implant or tissue expander/implant
FREE FLAPSDisconnecting the blood supply to an area
of tissue and “reconnecting” the tissue’s blood supply at a distant site
Often under a microscopeOnly at certain medical centers
FREE FLAPS DIEP- Deep Inferior Epigastric Perforator
FREE TRAM FLAP
DIEP AND FREE TRAM FLAPS Benefits over TRAM flap
Rectus muscle remains in abdomen Debate on functionality of muscle as nerves may
be injured, different techniques, etc…Decreased risk of hernia or abdominal bulgePotential decreased recovery timeCan use is some people who smoke or are
obeseLess chance partial flap loss and fat
necrosis
FREE FLAPS Downside to free flaps
Higher risk complete flap lossOnly available at certain centersLonger Surgery
GAP FLAP GAP: Gluteal Artery Perforator
S- Gap: Superior I- Gap: Inferior
TUG FLAP TUG Flap: Transverse Upper Gracilis
RADIATION NEEDED OR DELAYED RECONSTRUCTION Adapt reconstruction plan as needed Some reconstruction options not
available
NIPPLE/AREOLAR RECONSTRUCTION Many different ways to create Choice to have performed or not
NIPPLE CREATION
NIPPLE AND AREOLAR CREATION
NIPPLE/AREOLAR CREATION Tattoo only “Stick-ons” Temporary tattoos
MATCHING PROCEDURE The non-operated breast may be
LargerSmallerHang lower
MATCHING PROCEDURES Breast reduction Breast augmentation Breast lift
Oh, my friend, it’s not what they take away from you that counts- it’s what you do with what you have left…..Hubert Humphrey
ONCOPLASTICS Incorporating breast tissue movement
at the time of lumpectomyTo decrease chance of defect or asymmetryOperating on radiated tissue has increased
risk of complications
ONCOPLASTICS Reduction at the same time as
lumpectomy If you ever thought of a breast reduction,
ask if you are a candidate for a reduction with lumpectomy
Some breasts or cancers not amendable
BREAST REDUCTION PATTERN
ONCOPLASTIC Tissue rearrangement
To prevent or decrease the chance of a breast defect
Have to have tissue that can be moved into potential defect site
ONCOPLASTIC Despite best devised surgical
treatments breast defects or distortion can occur after lumpectomy and radiation
Reconstruction options available
BREAST RECONSTRUCTION Available options to reconstruct a breast Oncoplastic options during lumpectomy Future
THANK YOU