optimising breast aesthetics in reconstruction stuart james the london breast clinic 6 th october...
TRANSCRIPT
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OPTIMISING BREAST AESTHETICSin reconstruction
Stuart JamesThe London Breast Clinic6th October 2011
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General Guidance
1st Realistic goal Balance and symmetry in clothing
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General Guidance
1st Realistic goal
2nd Two or more operationsspaced over 12 months
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General Guidance
1st Realistic goal
2nd Two or more operations
3rd Risk of failure by any methodapproximately 1-2%
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General Guidance
1st Realistic goal
2nd Two or more operations
3rd Risk of failure by any method
4th Reconstructive Timing;Immediate or delayed
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1 Selection of reconstruction
Implant only reconstruction
Combination implant/flap
Flap reconstruction ‘autologous’
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Implant only reconstruction
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Implant only Reconstruction
- ‘Augmented’ look- Inadequate autologous
volumes- 2 stages
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Implant only
One or Two stagesI) Saline ExpanderII) Silicone Implant
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Combination Implant and flap reconstruction
+ Improved result - Donor site scar and implant
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Flap ReconstructionsTRAM/DIEP
+ best cosmeticallysoft and warm ages wellno late revisions
- Complexlonger recoverydonor site scar
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DIEP reconstruction;The first 12 months
2 months 6 months 12 months
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2 Timing and Teamwork
• Immediate reconstruction optimises results
• Skilled mastectomy giving consideration to reconstructive requirements
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Breast Reconstruction; Timing Immediate Delayed
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3 Technical Advances
• Surgical Technique
• Imaging
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Perforator flap reconstruction• 1980’s TRAM flap
– Transverse Rectus Abdominis Myocutaneous flap
• 2000’s DIEP flap– Deep Inferior Epigastric Artery
perforator flap
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DIEP or TRAM?
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MS 0 - TRAM
MS 1
MS 2
Nahabedian et al PRS 2002
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CT Angiography
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CT Angiography
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DIEP flap
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Our results• 100 cases of abdominal based free flaps in
breast reconstruction; The impact of pre-operative CT Angiography
Ghattaura, N. Jalalli, Y. Rajapakse, J. Henton, A. Searle, P. Harris, C. Savidge, S. Allen, S. James (JPRAS)
• Single perforator use up fro 17% to 48%
• Double use of medial row perforators
• Over 1 hour saved on average
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DIEP or TRAM?
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4 Secondary adjustments
Liposuction AugmentationFat transfer Scar revisionDirect excision
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Summary1 General guidance
2 Selection of reconstruction
3 Timing and Teamwork
4 Technical advances
5 Secondary adjustment
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Thank you, Questions?