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BREAST RECONSTRUCTION _______________________ T h e O p t i o n s

BREAST RECONSTRUCTION _______________________ T h e O p t i o n s. Adrian Ball Consultant Surgeon 12 June 2013. TOPICS. Immediate or delayed reconstruction Skin replacement by expansion or flaps Acellular dermal matrix Volume replacement by implants or flaps

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BREAST RECONSTRUCTION _______________________ T h e O p t i o n s

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  1. BREAST RECONSTRUCTION_______________________T h e O p t i o n s Adrian Ball Consultant Surgeon 12 June 2013

  2. TOPICS • Immediate or delayed reconstruction • Skin replacement by expansion or flaps • Acellular dermal matrix • Volume replacement by implants or flaps • Importance of radiotherapy • Problems A B S BALL

  3. IMMEDIATE OR DELAYED • Immediate: skin preservationpossible • Delayed: skin replacementrequired: • Expansion • Flap A B S BALL

  4. IMMEDIATE OR DELAYED • IMMEDIATE • Extensive DCIS • Multifocal lesions • Lesion involving nipple • Local recurrence • DELAYED • Radiotherapy (~ same indications as mastectomy) • Tumour >5 cm • SLN involvement (SLNB part of workup) • Skin/muscle involvement A B S BALL

  5. IMMEDIATE • SKIN PRESERVATION Volume replacement with: • Implant and ADM • Myo-subcutaneous flap +/- implant • NO SKIN PRESERVATION (smoker/DXT) Volume and skin replacement • Tissue expansion (bilateral) • Myocutaneous flap +/- implant A B S BALL

  6. ACELLULAR DERMAL MATRIX • Alloderm – allograft human dermis • Strattice – porcine dermis • Surgimend – fetal bovine dermis A B S BALL

  7. FBADM • Acellular biologic matrix derived from fetal bovine dermis, a rich source of Type III collagen. • Type III collagen mediates tissue healing and growth while inhibiting scarring. • No detrimental foreign body inflammatory response • Provides support for rapid healing without inflammation. • Seeded with the patient’s tissue building cells and growth factors. • Microporous matrix rapidly revascularized to support tissue building and healing. A B S BALL

  8. IMPLANT AND FBADM (SurgiMendTM) A B S BALL

  9. IMPLANT AND PADM (StratticeTM) A B S BALL

  10. PEDICLED LD FLAP A B S BALL

  11. pLD FLAP A B S BALL

  12. TISSUE EXPANDER A B S BALL

  13. PEDICLED FLAPS LD +/- implant FREE FLAPS TRAM-DIEP Gluteal others FLAPS A B S BALL

  14. FREE TRAM FLAP A B S BALL

  15. FREE TRAM-DIEP FLAP A B S BALL

  16. PROBLEMS • Flap failure • Donor site problems • Implant problems: immediate/delayed A B S BALL

  17. QUESTIONS PLEASE

  18. SUMMARY • Immediate or delayed reconstruction depends on need for post mastectomy radiotherapy. • Skin-preservation is possible in immediate reconstruction. • Volume replacement using implants and ADM or flaps. • Skin replacement by expansion or flaps. • No technique is free from problems. A B S BALL

  19. Thank you

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