Plastic Surgery: Breast Reconstruction Pankaj Tiwari, MD Assistant Professor The Ohio State University Medical Center Depa...
Gaspar Tagliacozzi (1545-1599) “ We restore, repair, and make whole  those parts . . .  which nature has given  but which ...
Plastic Surgery <ul><li>Cosmetic vs. Reconstructive </li></ul><ul><li>Multidisciplinary </li></ul><ul><li>Combined procedu...
Oncologic Defects <ul><li>Breast  </li></ul><ul><ul><li>Lumpectomy </li></ul></ul><ul><ul><li>Mastectomy  </li></ul></ul>
Mastectomy Defect
Lumpectomy Defect
Tissue Expander/Implant Reconstruction <ul><li>Tissue expanders placed initially </li></ul><ul><li>Serial expansions </li>...
Silicone Implant Reconstruction
12/13/2010
 
 
 
Free TRAM Flap
Microvascular Tissue Transfer
 
The Ohio State University Medical Center
The Ohio State University Medical Center
The Ohio State University Medical Center
The Ohio State University Medical Center
 
The Ohio State University Medical Center
The Ohio State University Medical Center
The Ohio State University Medical Center
The Ohio State University Medical Center
The Ohio State University Medical Center
The Ohio State University Medical Center
The Ohio State University Medical Center
The Ohio State University Medical Center
 
The Ohio State University Medical Center
 
 
The Ohio State University Medical Center
The Ohio State University Medical Center
 
 
 
Superior Gluteal Artery Perforator Flap
Inferior Gluteal Artery Perforator Flap
 
 
 
 
Thank You! [email_address] Mobile 614-202-7468
References <ul><li>Thorne CH.  Grabb & Smith ’s Plastic Surgery 6 th  Edition . Philadelphia, PA: Lippincott Williams &  W...
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BreastReconTiwari

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  • Italian surgeon, professor of surgery and professor of anatomy Dubbed the founder of modern day plastic surgery Developed the Italian method of plastic surgery (first to describe the use of distant pedicled flaps for the use of reconstructive surgery in the 16 th century)
  • Surgical oncology, orthopedic surgery, general surgery, neurosurgery
  • Prosthesis Concavity Contracture s/p radiation Evolution of Mastectomy: Radical – all lymph nodes, pectoralis major and minor muscles Modified radical – both pect left, but all nodes taken Skin sparing – pect left, more skin preserved Sentinel node biopsy – preservation of nodes Breast conservation – lumpectomy with radiation
  • Breast lumpectomy or breast conservation therapy is most used for Stage I and II cancers, survival rates for breast conservation with radiation similar to those with total mastectomy. Lumpectomy – removal of the cancer with negative margins, then remaining breast treated with 50Gy radiation. Cosmetic outcome can vary with size and location of tumor. A breast reduction can also be performed at the time of the lumpectomy for better aesthetic outcomes.
  • (should you show a TE placed then followed by an implant here?)
  • Some muscle is taken (muscle-sparing) or no muscle (bottom photo). This pt is a free TRAM, pre and post op photos for immediate reconstruction after mastectomy.
  • Vessel (artery and vein) anastomosis under microscope, suture used for anastomosis. Veins are usually coupled with a coupler device, arteries are sewn together with 9-0 nylon sutures, interrupted. Have video at end if desired.
  • One Pattern of SGAP flap
  • Patient info: (Previous abdominal surgery, no excess abdominal tissue. Right chest wall treated with radiation therapy. She underwent delayed reconstruction of right breast with IGAP, then 6 months later had prophylactic left mastectomy with immediate recon using IGAP flap), she then had a breast revision, followed by NAR.
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  • Transcript of "BreastReconTiwari"

    1. 1. Plastic Surgery: Breast Reconstruction Pankaj Tiwari, MD Assistant Professor The Ohio State University Medical Center Department of Plastic Surgery
    2. 2. Gaspar Tagliacozzi (1545-1599) “ We restore, repair, and make whole those parts . . . which nature has given but which fortune has taken away. ”
    3. 3. Plastic Surgery <ul><li>Cosmetic vs. Reconstructive </li></ul><ul><li>Multidisciplinary </li></ul><ul><li>Combined procedures </li></ul><ul><ul><li>Delayed </li></ul></ul><ul><ul><li>Immediate </li></ul></ul><ul><li>Head to Toe </li></ul><ul><li>Young to Old </li></ul>
    4. 4. Oncologic Defects <ul><li>Breast </li></ul><ul><ul><li>Lumpectomy </li></ul></ul><ul><ul><li>Mastectomy </li></ul></ul>
    5. 5. Mastectomy Defect
    6. 6. Lumpectomy Defect
    7. 7. Tissue Expander/Implant Reconstruction <ul><li>Tissue expanders placed initially </li></ul><ul><li>Serial expansions </li></ul><ul><ul><li>Average 5-6 visits </li></ul></ul><ul><li>Exchange for permanent implants </li></ul><ul><ul><li>Saline </li></ul></ul><ul><ul><li>Silicone </li></ul></ul>
    8. 8. Silicone Implant Reconstruction
    9. 9. 12/13/2010
    10. 13. Free TRAM Flap
    11. 14. Microvascular Tissue Transfer
    12. 16. The Ohio State University Medical Center
    13. 17. The Ohio State University Medical Center
    14. 18. The Ohio State University Medical Center
    15. 19. The Ohio State University Medical Center
    16. 21. The Ohio State University Medical Center
    17. 22. The Ohio State University Medical Center
    18. 23. The Ohio State University Medical Center
    19. 24. The Ohio State University Medical Center
    20. 25. The Ohio State University Medical Center
    21. 26. The Ohio State University Medical Center
    22. 27. The Ohio State University Medical Center
    23. 28. The Ohio State University Medical Center
    24. 30. The Ohio State University Medical Center
    25. 33. The Ohio State University Medical Center
    26. 34. The Ohio State University Medical Center
    27. 38. Superior Gluteal Artery Perforator Flap
    28. 39. Inferior Gluteal Artery Perforator Flap
    29. 44. Thank You! [email_address] Mobile 614-202-7468
    30. 45. References <ul><li>Thorne CH. Grabb & Smith ’s Plastic Surgery 6 th Edition . Philadelphia, PA: Lippincott Williams & Wilkins; 2007. </li></ul><ul><li>Brown DL, Borschel GH. Michigan Manual of Plastic Surgery. Philadelphia, PA: Lippincott Williams & Wilkins; 2004. </li></ul><ul><li>Kroll S, Sharma S, Koutz C, et al. Postoperative Morphine Requirements of Free TRAM and DIEP Flaps. Plast. Reconstr. Surg. 107: 338-341, 2001. </li></ul><ul><li>Bajaj A, Chevray P, Chang D. Comparison of Donor-Site Complications and Functional Outcomes in Free Muscle-Sparing TRAM Flap and Free DIEP Flap Breast Reconstruction. Plast. Reconstr. Surg. 117: 737-745, 2006. </li></ul><ul><li>National Cancer Institute. BRCA1 and BRCA2: Cancer Risk and Genetic Testing. Available at: http://www.cancer.gov/cancertopics/factsheet/Risk/BRCA . Accessed April 7 th , 2010. </li></ul><ul><li>FP Cammisa, DB Glasser, JC Otis, MA Kroll, JM Lane and JH Healey. J Bone Joint Surg Am. 1990;72:1541-1547. </li></ul>
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