Breast reconstruction

1. BREAST CONSERVATIVE
SURGERY & RECONSTRUCTION
AFTER MASTECTOMY
Dr. GANESHKUMAR M
POST GRADUATE
STUDENT
GENERAL SURGERY

2. BREAST CONSERVATIVE SURGERY
• REDUCTION / MASTOPEXY
• INTRINSIC TISSE REARRANGEMENT
• LOCO-REGIONAL FLAPS.

29. BATWING MASTOPEXY

32. HEMI BAT-WING MASTOPEXY

48. TRIANGLE RESECTION

49. SUPERIOR PEDICLE INVERTED T MAMMOPLASTY

65. MATRIX ROTATION

67. BREAST RECONSTRUCTION
SURGERY
• Breast reconstruction is a surgical procedure
that restores shape to your breast after
mastectomy.
• It can be done using
 Flaps
 Implants

68. BREAST RECONSTRUCTION WITH
IMPLANTS
• Breast reconstruction begins with placement
of a breast implant or tissue expander, either
at the time of mastectomy (immediate
reconstruction) or during a later procedure
(delayed reconstruction).
• A breast implant is a round or teardrop-
shaped silicone shell filled with salt water
(saline) or silicone gel.

69. TIMING OF RECONSTRUCTION
• DELAYED
• IMMEDIATE
• DELAYED IMMEDIATE

70. TISSUE EXPANDERS
• Tissue expansion is a process that stretches remaining
chest skin and soft tissues to make room for the breast
implant using saline injected through a valve.
• A newer type of tissue expander uses carbon dioxide.
Compared with the expansion using saline, the gradual
expansion using carbon dioxide may decrease the
amount of discomfort.
• After the tissue is adequately expanded, a second
surgery is performed to remove the tissue expander
and replace it with a permanent implant.

71. BREAST IMPLANTS

73. LOCATION OF IMPLANT
• SUB – PECTORAL IMPLANT
• Provides muscle coverage for tissue expander or
the final implant from radiation
• Less chance of wound dehiscence, infection,
wound healing complications.
• PRE- PECTORAL IMPLANT
• Less chance of post op pain, muscle spasm,
hematoma, reconstructive failure.
• Lesser operating time.
• More chance of infection.

74. TRAM FLAP
• Transverse Rectus
Abdominis Muscle flap.
• can be a free flap or a
pedicled flap.
• A pedicled TRAM flap uses
whole rectus muscle and it
receives blood supply from
SUPERIOR EPIGASTRIC
VESSELS

75. MUSCLE SPARING TRAM FLAP
• Muscle-sparing free TRAM flap,
only a portion of rectus
abdominis muscle, which may
help you retain abdominal
strength after surgery.

76. • INDICATIONS
• Breast of all sizes
• Breast ptosis
• CONTRA – INDICATIONS
• Previous abdominoplasty
• Patients who are unable to tolerate longer
procedure and long period of recovery

77. MUSCLE SPARING TRAM FLAP
• Muscle-sparing free TRAM flap,
only a portion of rectus
abdominis muscle, which may
help retain abdominal
strength after surgery.

78. Zones of TRAM
• Zone 1 TRAM on the
side of pedicle
• Zone 2 TRAM on
contralateral side
• Zone 3 lateral to
ipsilateral TRAM
• Zone 4 lateral to the
contralateral TRAM

79. LATISSMUS MUSCLE FLAP
• Includes skin, fat along with the LD muscle,
tunneling it under the skin to chest.
• It is a pedicled flap based on THORACO DORSAL
VESSELS.
• Can also be used as a free flap in case of
inadvertant inury to the pedicle
• Used for small and medium-sized breasts or for
creating a pocket for a breast implant.

80. LATISSMUS MUSCLE FLAP

81. DIEP FLAP
• Deep Inferior Epigastric Perforator (DIEP) flap
• Similar to TRAM flap, but only skin and fat are
removed. Minimal muscle tissue is taken to
form the new breast mound. It requires
expertise in microsurgery.
• Advantage:- retain more strength in
abdomen.
• Highest rate of well being and cost effective.

82. DIEP FLAP

83. SIEA FLAP
• Superficial Inferior Epigastric Artery (SIEA)
flap uses the same abdominal tissue as DIEP
flap but relies on blood vessels that aren't as
deep within the abdomen.
• Less invasive.
• Low success rate.

84. SIEA FLAP

85. THIGH BASED FLAPS
• Based on the PROFUNDA FEMORIS ARTERY
PERFORATOR.
• May be Transverse (TUG), Vertical (VUG),
Diagonal (DUG).
• Can be used as a staked flaps which may be
anastomosed separately to the recipient
vessels or as flow through design.

86. GLUTEAL BASED FLAPS
• Free flap based on SUPERIOR AND INFERIOR
GLUTEAL ARTERY AND VEIN.
• PRE- OP IMAGING
• CT angiogram or MR angiogram
• Useful in patients with high risk for flap failure
like obesity, h/o abdominoplasty, bilateral
reconstruction.

88. POST OP MONITORING
• FLUORESCENT ANGIOGRAPHY
• Using indocyanine green
• NEAR INFRA-RED SPECTROSCOPY
• Probe is placed on skin paddle to measure
oxygenation of superficial tissues.

89. AUTOLOGOUS FAT GRAFTING
• Uses liposuction to gather fat tissue from
thighs, abdomen or gluteal region to
reconstruct the breast or to improve the
appearance of breast after reconstruction.

90. NIPPLE RECONSTRUCTION
• Followed by medical tattooing

93. THANK YOU