This document discusses various breast reconstruction procedures after mastectomy. It describes breast-conserving surgeries like reduction, mastopexy, and flap techniques. Breast reconstruction can involve implants, tissue expanders, or flaps from the abdomen, back, thighs, or buttocks. The timing of reconstruction can be immediate, delayed, or delayed-immediate. Post-operative monitoring includes fluorescent angiography or near-infrared spectroscopy to check flap vascularity. Nipple reconstruction may also be performed along with tattooing.

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