BREAST RECONSTRUCTION

1. BREAST RECONSTRUCTION Mark S. Granick, MD, FACS Professor of Surgery, tenured Chief of Plastic Surgery

2. Why? “I have a long life to live and I want to live it whole.” “I wanted to once again put on a beautiful nightgown and fill it all out.” “”I was gardening one day when I bent over and my prosthesis fell out. Crying I picked it out of the muddy water. The next day I called a Plastic Surgeon.”

3. Patient Questions • Who is a candidate for surgery? • Will breast reconstruction interfere with cancer treatment or detection? • Are there some women who should not have a reconstruction? • Does the type of cancer make a difference? • How does adjuvant therapy impact on reconstruction?

4. Patient Questions • How do you get the breasts symmetric? • If a patients gains or loses weight, how does it affect the reconstruction? • Does a breast reconstruction look and feel natural? • Are there psychological implications concerning breast reconstruction?

5. Goals • Mound reconstruction • Size • Skin coverage • Nipple reconstruction • Areola reconstruction • Symmetry

6. Timing • Immediate • Delayed

7. Options • Implant, with or without expansion • Autogenous • Combination

9. Implants • 1 stage • Skin deficiency uncorrected • Facilitated by alloderm sling • Good for small breasts with minimal ptosis • Late capsular formation

14. Permanent Expander • 1Step • Corrects skin deficiency • Multiple office visits

15. Expander - Implant • 2 Stages • Corrects skin deficiency • Multiple office visits

19. Pre-op

20. Fully Expanded

21. Implant in Place

22. Nipple Areola Reconstruction

23. Autogenous Tissue • Corrects skin deficiency • Normal subcutaneous tissue • No foreign material • Longer operative time • Higher morbidity

24. Latissimus Dorsi • May require an implant • Cannot be used if the thoracodorsal pedicle is damaged

25. Latissimus Dorsi

26. Latissimus Dorsi

27. Latissimus Flap Planning

31. TRAM • Carl Hartrampf,MD • Single or double pedicle • Muscle sparing (perforator) • Cannot use if the rectus muscle is divided superiorly (Kocher incision) • Risks • fat necrosis • donor site slough • flap failure • hernia

35. Pre-op

36. Single Pedicle TRAM

37. Post-op

38. Pre-op

39. Intra-op

40. Post-op

41. Free Flap • TRAM • Gluteal • Lateral Thigh • DIEP

42. Pre-op

43. Intra-op

44. Microsurgery

45. Post-op

46. Nipple Reconstruction

47. Areola Reconstruction

48. NAC Reconstruction

49. Post Radical and Radiation

50. TRAM