The document discusses breast reconstruction options for women with breast cancer. It outlines the key decisions around mastectomy versus breast conservation, immediate versus delayed reconstruction, and types of reconstruction including autologous techniques using the patient's own tissue or implants/expanders. Reasons for reconstructing the conserved breast are also reviewed, such as achieving symmetry or correcting shape/nipple issues. Patient factors, tumor characteristics, treatment plans, and lifestyle/expectations must all be considered in personalized decision making around reconstruction.

1. Breast Reconstruction
Supporting People With Breast
Cancer
Jane Rothwell
St. Vincent’s University Hospital

4. Outline
 The “Big Questions”
 How these decisions are made
 Reconstruction of the “conserved
breast”

5. The Big Questions
 Mastectomy v Breast Conservation
 Immediate v Delayed
Reconstruction
 Type of reconstruction

6. Mastectomy v Breast Conservation
 Patient factors
 Breast factors
 Tumour factors

7. Mastectomy v Breast Conservation
Patient factors
 Patient choice
 General health
 Suitability for radiotherapy
 Dealing with “risk”
 Personal history
 Family history

8. Mastectomy v Breast Conservation
Breast factors
 Size
 Shape
 Location of tumour in breast

9. Mastectomy v Breast Conservation
“Tumour” factors
 Size – actual
 Size – relative to size of breast
 Single or multifocal
 Type of tumour
 Site within breast

10. Site of tumour

11. Immediate v Delayed Reconstruction
 Patient choice
 Radiotherapy
 Other medical conditions
 Smoking
 Extent of disease

12. Immediate v Delayed Reconstruction -
Radiotherapy
 Tumour size
 Skin involvement
 Nodal disease
 Inflammatory cancer

13. Immediate v Delayed Reconstruction -
Radiotherapy
 Pseudocapsule formation
 Capsular contracture
 Skin changes
 Infection
 Need for further surgery

14. Type of Reconstruction
 Patient choice
 Body size and shape
 Patient expectations
 Patient lifestyle
 Breast size and shape
 Potential for multiple procedures
 General condition

15. Type of Reconstruction
 Own tissue (autologous)
 Own tissue with implant or
expander
 Implant or expander with “other
tissue”
 Implant or expander alone

16. Type of reconstruction - Autologous
 DIEAP – Deep inferior epigastric
artery perforator flap
 Tissue from tummy
 No implant needed
 Longer surgery

17. DIEAP Flap Reconstruction

18. DIEAP Flap Reconstruction

19. Latissimus Dorsi Flap Reconstruction

20. Latissimus Dorsi Flap Reconstruction

21. Tissue Expander Reconstruction

22. Tissue Expander Reconstruction

23. Restoration / Reconstruction of the
conserved breast
 Reasons why “reconstruction”
required:
 Size
 Shape
 Nipple problems
 Asymmetry
 Site of scar / defect

24. Restoration / Reconstruction of the
conserved breast

25. Restoration / Reconstruction of the
conserved breast

26. Restoration / Reconstruction of the
conserved breast - options
 Mastectomy and reconstruction
 Latissimus Dorsi flap
 Symmetry surgery on other breast
 Implant
 Fat injection

27. 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

28. 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