[ Up ] [ Drainage of superficial and deep abscesses ] [ Abdominal trauma ] [ Splenic trauma ] [ Abdominal pain ] [ Abdominal incisions ] [ Abdominal masses ] [ Ovarian cysts ] [ Appendicitis ] [ Perforated peptic ulcer ] [ Mesenteric ischaemia ] [ Small bowel obstruction ] [ Large bowel obstruction ] [ Pseudo-obstruction ] [ Sigmoid and caecal volvulus ] [ Peritonitis ] [ Upper GI haemorrhage ] [ Lower GI haemorrhage ] [ Groin hernias ] [ Other hernias ] [ Enterocutaneous fistulae ] [ Stomas ] [ GORD ] [ Achalasia ] [ Oesophageal carcinoma ] [ Oesophageal perforation ] [ Gastric carcinoma ] [ Peptic ulcer disease ] [ Gastric volvulus ] [ Coeliac disease ] [ Jaundice ] [ Gall stones ] [ Acute pancreatitis ] [ Chronic pancreatitis ] [ Pancreatic cancer ] [ Pancreatic endrocrine tumours ] [ Hepatocellular carcinoma ] [ Cholangiocarcinoma ] [ Liver metastases ] [ Portal hypertension ] [ Ascites ] [ Pyogenic liver abscess ] [ Amoebic liver abscess ] [ Hydatid disease ] [ Inflammatory bowel disease ] [ Colonic polyps ] [ Colorectal carcinoma ] [ Pseudomyxoma ] [ Diverticular disease ] [ Rectal prolapse ] [ Haemorrhoids ] [ Anal fissure ] [ Perianal sepsis ] [ Anal carcinoma ] [ Pilonidal sinus ] [ Breast assessment ] [ Breast imaging ] [ Benign breast disease ] [ Breast pain ] [ Fibroadenoma ] [ Breast cysts ] [ Breast sepsis ] [ Nipple discharge ] [ Gynaecomastia ] [ Breast cancer ] [ Breast reconstruction ] [ Cancer genetics ] [ Hypercalcaemia ] [ Parathyroid ] [ Multiple endocrine neoplasia syndromes ] [ Carcinoid tumours ] [ Arterial assessment ] [ Abdominal aortic aneurysm ] [ Aortic dissection ] [ Peripheral vascular disease ] [ Acute limb ischaemia ] [ Diabetic foot ] [ Amputations ] [ Carotid artery disease ] [ Vascular trauma ] [ Varicose veins ] [ Venous hypertension ] [ Venous thrombosis ] [ Raynaud's disease ] [ Lymphoedema ] [ Lymphadenopathy ] [ Hodgkin's disease ] [ The spleen ] [ Thyroglossal cysts ] [ Cushing's syndrome ] [ Thyrotoxicosis ] [ Goitre ] [ Thyroiditis ] [ Thyroid nodules ] [ Thyroid tumours ] [ Hypertension ] [ Conn's syndrome ] [ Phaeochromocytoma ] [ Adrenal incidentalomas ]

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 counselling 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
  • Either can be performed as an immediate or delayed procedure
  • 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

Immediate LD reconstruction

Bilateral delayed LD reconstructions

TRAM flap markings TRAM flap postoperative

Free flaps

  • Several flaps have been described based on perforator vessels
  • Most commonly used is the Deep Inferior Epigastric Perforator (DIEP) flap
  • Other flaps have been described based on:
    • Superficial Inferior Epigastric Artery
    • Gluteal artery
  • Free flaps allow tissue transfer with reduced risk of donor site morbidity
  • Flap failure rates are higher than with pedicled flaps

Nipple reconstruction

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

Nipple reconstruction

Bibliography

Ahmed S,  Snelling A,  Bains M et al.  Breast reconstruction.  BMJ 2005;  330:  943-948.

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

Choi J Y,  Alderman A K,  Newman L A.  Aesthetic and reconstructive considerations in oncologic breast surgery.  J Am Coll Surg 2006;  202:  943-952.

Disa J J,  McCarthy C M.  Breast reconstruction: a comparison of autogenous and prosthetic techniques.  Advances in Surgery 2005:  39:  97-119.

Granzow J W.  Levine J L.  Chiu E S et al.  Breast reconstruction with the deep inferior epigastric perforator flap:  History and an update on current technique.  J Plast Recon Aesth Surg 2006;  59:  571-579.

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

Pennington D G.  Breast reconstruction after mastectomy:  current state of the art.  Aus NZ J Surg 2005;  75;  454-458
Last modified:
 
 

Copyright © 1997- 2013 Surgical-tutor.org.uk