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Breast reconstruction

  • Breast reconstruction is increasing in popularity
  • Can be performed as immediate or delayed procedure
  • Breast reconstruction is oncologically safe
  • Does not delay adjuvant therapy
  • Does not delay the detection of recurrent disease
  • There are no absolute contraindications
  • Relative contraindications are old age, diabetes, smoker, collagen diseases
  • Preoperative counseling is essential

Reconstructive options

  • There are three types of breast reconstruction
    • Tissue expanders
    • Pedicled myocutaneous flaps 
    • Free tissue transfer
  • Each has specific uses and complications
  • The contralateral breast may require surgery to produce symmetry

Tissue expanders

  • A simple and reliable technique
  • When used alone often produce a poor cosmetic result
  • Capsular contracture can result in firmness and discomfort
  • Capsulectomy and replacement of the implant may be required
  • Radiotherapy may increase the risk of capsular contracture
  • Textured implants reduce the risk of capsule formation

Pedicled myocutaneous flaps

  • The two commonest flaps are:
    • The latissimus dorsi flap based on the thoracodorsal vessels
    • The pedical transverse rectus abdominis based on the superior epigastric vessels
  • Pedicled flaps produce a better cosmetic result
  • Use of an LD flap is often combined with tissue expander or prosthesis
  • TRAM flaps often provide enough autologous tissue to avoid the need for a tissue expander
  • General complications associated with flaps include necrosis and flap loss
  • The LD flap leaves a scar on the back and some shoulder weakness
  • TRAM flaps can result in abdominal donor site hernia and weakness
TRAM flap markings TRAM flap postoperative

Nipple reconstruction

  • Nipples can be reconstructed by:
    • Nipple sharing
    • Skate flaps
    • Labial grafts
    • Nipple tattooing
    • Prosthetic nipples

Nipple reconstruction

Bibliography

Antoniuk P M.  Breast reconstruction.  Obstet Gynecol Clin North Am 2002;  29:  209-223.

Patel R J, Webster D J T, Mansel R E, Hughes L E. Is immediate post-mastectomy reconstruction safe in the long-term? Eur J Surg Oncol 1993; 19: 372-375.

Corral C J, Mustoe T A. Controversy in breast reconstruction. Surg Clin North Am 1996; 76: 309-326.

Malata C M, McIntosh S A, Purushotham A D. Immediate breast reconstruction after mastectomy for cancer. Br J Surg 2000; 87: 1455-1472.

Rainsbury R M. Breast reconstruction - new techniques. In: Taylor I, Johnson C D eds. Recent advances in surgery 22. Churchill Livingstone, Edinburgh 1999. 17-30.

 

 
 

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