● Early stages of malignancies as well as in selected more advanced stages where the response to neoadjuvant chemo therapy has been good.Not advised in locally advanced disease.
● Advantages of immediate reconstruction are maximum amount of breast skin is preserved for reconstruction.It will not affect the long-term survival or recurrence rate.
♦ Delayed reconstruction ●3-9 months after surgery
♦ Immediate reconstruction
Indications ♦ Locally advanced disease
♦ Radiation needed in postoperative period
♦ Patient unfit for prolonged surgical procedure
Advantages
♦ Allows for postoperative radiation without prosthesis exposure
♦ Avoids fibrosis and fat necrosis where TRAM flap is used
Factors deciding the reconstruction
Amount of skin retainedStage of the carcinomaEarlier radiotherapyType of flap used
Oncoplastic techniques Insertion of breast implants or expanders.They
are best for small breasts.Healthy nonirradiated overlying skin is the requirement.
Flap with implant or expanders Flap reconstruction: ► Pedicled flap—TRAM flap
► Free flap—free TRAM flap into internal mammary artery
►Muscle preserving perforator abdominal flap
METHODS OF RECONSTRUCTION
Silicon gel implant under pect major muscle Expandible saline prosthesis with prior tissue
expansion If there is less skin/after radiotherapy LD flap
or TRAM flap is used Sup: gluteal flap based on sup: gluteal vessels Ruben’s flap using soft tissue pad ovrlyng the
iliac crest based on deep crcmflx iliac vessels
TYPES
Note: - Breast reconstruction is done in young
patients with early stage disease - Skin sparing mastectomy with removal of
nipple areola complex – better for this - Symmetry is the most imp factor in thisNipple created using: Local breast flaps 3mnths aftr breast
recnstrnNipple sharing from controlateral nipple
using composite graft
Skate flap: Local flap with de-epithelialised donor site around the periphery over which a full thickness graft is applied
Nipple prosthesis can be fitted
Areola pigmentation is created using (done 3 weeks after nipple creation)
Full thickness skin graft frm non-hairy skin lat to labia majora
From controlateral areolaTattooingSSG from retroauricular area/from thigh
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