FAIZAL SHAHUL

Travancore Medical College,

Kollam,Kerala

BREAST RECONSTRUCTION

● Early stages of malignancies as well as in selected more advanced stages where the response to neoadjuvant chemo therapy has been good.Not advised in locally advanced disease.

● Advantages of immediate reconstruction are maximum amount of breast skin is preserved for reconstruction.It will not affect the long-term survival or recurrence rate.

♦ Delayed reconstruction ●3-9 months after surgery

♦ Immediate reconstruction

Indications ♦ Locally advanced disease

♦ Radiation needed in postoperative period

♦ Patient unfit for prolonged surgical procedure

Advantages

♦ Allows for postoperative radiation without prosthesis exposure

♦ Avoids fibrosis and fat necrosis where TRAM flap is used

Factors deciding the reconstruction

Amount of skin retainedStage of the carcinomaEarlier radiotherapyType of flap used

Oncoplastic techniques Insertion of breast implants or expanders.They

are best for small breasts.Healthy nonirradiated overlying skin is the requirement.

Flap with implant or expanders Flap reconstruction: ► Pedicled flap—TRAM flap

► Free flap—free TRAM flap into internal mammary artery

►Muscle preserving perforator abdominal flap

METHODS OF RECONSTRUCTION

Single Pedicle TRAM

TRAM

Silicon gel implant under pect major muscle Expandible saline prosthesis with prior tissue

expansion If there is less skin/after radiotherapy LD flap

or TRAM flap is used Sup: gluteal flap based on sup: gluteal vessels Ruben’s flap using soft tissue pad ovrlyng the

iliac crest based on deep crcmflx iliac vessels

TYPES

Latissimus Flap Planning

SGAP

Note: - Breast reconstruction is done in young

patients with early stage disease - Skin sparing mastectomy with removal of

nipple areola complex – better for this - Symmetry is the most imp factor in thisNipple created using: Local breast flaps 3mnths aftr breast

recnstrnNipple sharing from controlateral nipple

using composite graft

Skate flap: Local flap with de-epithelialised donor site around the periphery over which a full thickness graft is applied

Nipple prosthesis can be fitted

Areola pigmentation is created using (done 3 weeks after nipple creation)

Full thickness skin graft frm non-hairy skin lat to labia majora

From controlateral areolaTattooingSSG from retroauricular area/from thigh

Nipple Reconstruction

Areola Reconstruction

Thank you…