Breast Reconstruction - Jane Rothwell

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Breast Reconstruction - Jane Rothwell

  1. 1. Breast ReconstructionSupporting People With BreastCancerJane RothwellSt. Vincent’s University Hospital
  2. 2. Outline The “Big Questions” How these decisions are made Reconstruction of the “conserved breast”
  3. 3. The Big Questions Mastectomy v Breast Conservation Immediate v Delayed Reconstruction Type of reconstruction
  4. 4. Mastectomy v Breast Conservation Patient factors Breast factors Tumour factors
  5. 5. Mastectomy v Breast Conservation Patient factors Patient choice General health Suitability for radiotherapy Dealing with “risk” Personal history Family history
  6. 6. Mastectomy v Breast Conservation Breast factors Size Shape Location of tumour in breast
  7. 7. Mastectomy v Breast Conservation“Tumour” factors Size – actual Size – relative to size of breast Single or multifocal Type of tumour Site within breast
  8. 8. Site of tumour
  9. 9. Immediate v Delayed Reconstruction Patient choice Radiotherapy Other medical conditions Smoking Extent of disease
  10. 10. Immediate v Delayed Reconstruction -Radiotherapy Tumour size Skin involvement Nodal disease Inflammatory cancer
  11. 11. Immediate v Delayed Reconstruction -Radiotherapy Pseudocapsule formation Capsular contracture Skin changes Infection Need for further surgery
  12. 12. Type of Reconstruction Patient choice Body size and shape Patient expectations Patient lifestyle Breast size and shape Potential for multiple procedures General condition
  13. 13. Type of Reconstruction Own tissue (autologous) Own tissue with implant or expander Implant or expander with “other tissue” Implant or expander alone
  14. 14. Type of reconstruction - Autologous DIEAP – Deep inferior epigastric artery perforator flap Tissue from tummy No implant needed Longer surgery
  15. 15. DIEAP Flap Reconstruction
  16. 16. DIEAP Flap Reconstruction
  17. 17. Latissimus Dorsi Flap Reconstruction
  18. 18. Latissimus Dorsi Flap Reconstruction
  19. 19. Tissue Expander Reconstruction
  20. 20. Tissue Expander Reconstruction
  21. 21. Restoration / Reconstruction of theconserved breast Reasons why “reconstruction” required:  Size  Shape  Nipple problems  Asymmetry  Site of scar / defect
  22. 22. Restoration / Reconstruction of theconserved breast
  23. 23. Restoration / Reconstruction of theconserved breast
  24. 24. Restoration / Reconstruction of theconserved breast - options Mastectomy and reconstruction Latissimus Dorsi flap Symmetry surgery on other breast Implant Fat injection
  25. 25. Summary The big questions:  Whether it is best to conserve the breast or have mastectomy  Is immediate or delayed reconstruction appropriate  What type of reconstruction is best for you
  26. 26. Conclusion Reconstruction is relevant for all women who have had surgery, even breast conservation The decision-making is complex, with all patients treated to best standard of care for them

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