Dr. Vanessa Voge discusses various breast reconstruction options available to women after mastectomy due to breast cancer, highlighting advancements that have improved patient choices. The document details different types of reconstructive surgeries, timing considerations, and challenges associated with each option, emphasizing the importance of individualized treatment plans. Additionally, it addresses the impact of cancer treatments on reconstruction and the psychological and emotional dimensions of undergoing these procedures.

1. Dr. Vanessa Voge
Wichita Surgical Specialists

2.  Briefoverview
 Types of breast reconstruction available after
mastectomy
 Types of “reconstruction” that can be
combined with lumpectomy

3.  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.

4.  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.

5.  Often patients have many questions
 Forefront is the cancer itself
 What 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?

6.  Treating the breast cancer first
 Very patient dependent
 Cancer treatment dependent
 Individualize treatment plans

7.  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

8.  Timing of Reconstruction
 Time of Mastectomy-
 “immediate breast reconstruction”
 After one has healed from mastectomy-
 “delayed reconstruction”

9.  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

10.  Types of reconstruction- patient dependent
 Tissue Expander/Implant based
 Latissimus flap/implant
 TRAM flap
 Free Flap- DIEP, free tram, S-GAP, etc…
 Nipple and areolar reconstruction

11.  Tissue Expander/Implant
 Makes up more than 75% of breast
reconstructions in the United States
 Requires minimum of two surgeries
 At the time of mastectomy the tissue expander is
placed--“first stage breast reconstruction”

14.  Thereis more use of a biological support,
such as alloderm.

15.  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

18.  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

19.  Cons:Foreign objects, not lifelong devices,
capsular contracture, loss of implants, stay
the same with time, asymmetry

20.  Placing
the breast implant at the time of
mastectomy
 Not as common
 Only in certain patients with ideal anatomy and
cancers
 Almost always with Alloderm or equivalent

23.  TRAM-Transverse Rectus Abdominus
Myocutaneous
 Rectus muscles- Abdominal “six pack”
 Core muscle

25.  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

26.  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…)

27.  Latissimus dorsi muscle is on back
 Activities for “lat pulls”, cross country skiing,
rock climbing, etc… can be affected.

30.  Pros:Own tissue, non-radiated tissue,
“covers” implant
 Cons:larger/longer surgery, muscle
weakness, fluid collection, often needs
implant or tissue expander/implant

31.  Disconnecting the blood supply to an area of
tissue and “reconnecting” the tissue’s blood
supply at a distant site
 Often under a microscope
 Only at certain medical centers

32.  DIEP- Deep Inferior Epigastric Perforator

34.  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 bulge
 Potential decreased recovery time
 Can use is some people who smoke or are obese
 Less chance partial flap loss and fat necrosis

35.  Downside to free flaps
 Higher risk complete flap loss
 Only available at certain centers
 Longer Surgery

36.  GAP: Gluteal Artery Perforator
 S- Gap: Superior
 I- Gap: Inferior

37.  TUG Flap: Transverse Upper Gracilis

38.  Adapt reconstruction plan as needed
 Some reconstruction options not available

39.  Many different ways to create
 Choice to have performed or not

42.  Tattoo only
 “Stick-ons”
 Temporary tattoos

43.  The non-operated breast may be
 Larger
 Smaller
 Hang lower

44.  Breast reduction
 Breast augmentation
 Breast lift

45.  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

46.  Incorporating
breast tissue movement at the
time of lumpectomy
 To decrease chance of defect or asymmetry
 Operating on radiated tissue has increased risk of
complications

47.  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

49.  Tissue rearrangement
 To prevent or decrease the chance of a breast
defect
 Have to have tissue that can be moved into
potential defect site

50.  Despite best devised surgical treatments
breast defects or distortion can occur after
lumpectomy and radiation
 Reconstruction options available

51.  Availableoptions to reconstruct a breast
 Oncoplastic options during lumpectomy
 Future