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Via Christi Women's Connection: Breast Reconstruction

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New kinds of treatment as well as improved reconstructive surgery mean that women who have breast cancer today have better choices.

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Via Christi Women's Connection: Breast Reconstruction

  1. 1. Dr. Vanessa VogeWichita Surgical Specialists
  2. 2.  Briefoverview Types of breast reconstruction available after mastectomy Types of “reconstruction” that can be combined with lumpectomy
  3. 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. 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. 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. 6.  Treating the breast cancer first Very patient dependent Cancer treatment dependent Individualize treatment plans
  7. 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. 8.  Timing of Reconstruction  Time of Mastectomy-  “immediate breast reconstruction”  After one has healed from mastectomy-  “delayed reconstruction”
  9. 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. 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. 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”
  12. 12.  Thereis more use of a biological support, such as alloderm.
  13. 13.  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
  14. 14.  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
  15. 15.  Cons:Foreign objects, not lifelong devices, capsular contracture, loss of implants, stay the same with time, asymmetry
  16. 16.  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
  17. 17.  TRAM-Transverse Rectus Abdominus Myocutaneous  Rectus muscles- Abdominal “six pack”  Core muscle
  18. 18.  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
  19. 19.  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…)
  20. 20.  Latissimus dorsi muscle is on back Activities for “lat pulls”, cross country skiing, rock climbing, etc… can be affected.
  21. 21.  Pros:Own tissue, non-radiated tissue, “covers” implant Cons:larger/longer surgery, muscle weakness, fluid collection, often needs implant or tissue expander/implant
  22. 22.  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
  23. 23.  DIEP- Deep Inferior Epigastric Perforator
  24. 24.  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
  25. 25.  Downside to free flaps  Higher risk complete flap loss  Only available at certain centers  Longer Surgery
  26. 26.  GAP: Gluteal Artery Perforator  S- Gap: Superior  I- Gap: Inferior
  27. 27.  TUG Flap: Transverse Upper Gracilis
  28. 28.  Adapt reconstruction plan as needed Some reconstruction options not available
  29. 29.  Many different ways to create Choice to have performed or not
  30. 30.  Tattoo only “Stick-ons” Temporary tattoos
  31. 31.  The non-operated breast may be  Larger  Smaller  Hang lower
  32. 32.  Breast reduction Breast augmentation Breast lift
  33. 33.  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
  34. 34.  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
  35. 35.  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
  36. 36.  Tissue rearrangement  To prevent or decrease the chance of a breast defect  Have to have tissue that can be moved into potential defect site
  37. 37.  Despite best devised surgical treatments breast defects or distortion can occur after lumpectomy and radiation Reconstruction options available
  38. 38.  Availableoptions to reconstruct a breast Oncoplastic options during lumpectomy Future

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