New kinds of treatment as well as improved reconstructive surgery mean that women who have breast cancer today have better choices.

1. Dr. Vanessa Voge
Wichita Surgical Specialists

2.  Briefoverview
 Types of breast reconstruction available after
mastectomy
 Types of “reconstruction” that can be
combined with lumpectomy

3.  Each year more than 250,000 American
women face breast cancer.
 Undergoing Mastectomy affects one in many
dimensions--emotionally, physically,
psychologically, etc…
 In the past, reconstructive options were not
available or not widely offered.

4.  New kinds of treatment as well as improved
reconstructive surgery mean that women
who have breast cancer today have better
choices.
 Breast reconstruction is a type of surgery for
women who have had a breast removed.
 The goal is to provide a treatment for breast
cancer and still provide shape and symmetry
to the breasts.

5.  Often patients have many questions
 Forefront is the cancer itself
 What will I look like after mastectomy?
 What are reconstruction options?
 What will my breast(s) look like after
reconstruction?
 How is reconstruction affected by additional
cancer treatments such as chemo or radiation?

6.  Treating the breast cancer first
 Very patient dependent
 Cancer treatment dependent
 Individualize treatment plans

7.  Reconstruction or not
 Some patients are not candidates
 Severe obesity, systemic disease,
psychological/emotional state
 Prosthesis
 Pros- decreased amount of surgery and surgery
sequela, can vary size, effect of water
 Cons- Can shift, weight, not a part of body

8.  Timing of Reconstruction
 Time of Mastectomy-
 “immediate breast reconstruction”
 After one has healed from mastectomy-
 “delayed reconstruction”

9.  At the time of mastectomy
 Currently most common way
 Pros: Save skin, better aesthetic result,
reconstruction started or possibly finished at
time of mastectomy
 Cons: Post-operative radiation, possible increase
in skin healing problems

10.  Types of reconstruction- patient dependent
 Tissue Expander/Implant based
 Latissimus flap/implant
 TRAM flap
 Free Flap- DIEP, free tram, S-GAP, etc…
 Nipple and areolar reconstruction

11.  Tissue Expander/Implant
 Makes up more than 75% of breast
reconstructions in the United States
 Requires minimum of two surgeries
 At the time of mastectomy the tissue expander is
placed--“first stage breast reconstruction”

14.  Thereis more use of a biological support,
such as alloderm.

15.  Second surgery involves the exchange of the
tissue expander for an implant-
“second stage breast reconstruction”
 Approximately 4 months from first surgery, but
varies greatly from patient to patient and
surgeon to surgeon

18.  Pros: Shorter surgery time, breasts remain
same size and overall position, If bilateral
symmetry possibly improved, less scarring,
less operative sites, decreased “overall”
complication rates

19.  Cons:Foreign objects, not lifelong devices,
capsular contracture, loss of implants, stay
the same with time, asymmetry

20.  Placing
the breast implant at the time of
mastectomy
 Not as common
 Only in certain patients with ideal anatomy and
cancers
 Almost always with Alloderm or equivalent

23.  TRAM-Transverse Rectus Abdominus
Myocutaneous
 Rectus muscles- Abdominal “six pack”
 Core muscle

25.  Pros:Own tissue (replacing like with like),
affected some by gravity, fluctuates with
weight, possibly no additional surgery except
nipple/areolar creation, matches other non
reconstructed breast, remove excess
abdominal tissue

26.  Cons: Larger/longer surgery, longer recovery,
not true abdominoplasty, risk
hernia/abdominal bulge, bulge upper
abdomen, weakness to abdomen, Full loss of
flap, partial loss of flap, fat necrosis,
specific candidates (previous surgeries,
weight, smoking, etc…)

27.  Latissimus dorsi muscle is on back
 Activities for “lat pulls”, cross country skiing,
rock climbing, etc… can be affected.

30.  Pros:Own tissue, non-radiated tissue,
“covers” implant
 Cons:larger/longer surgery, muscle
weakness, fluid collection, often needs
implant or tissue expander/implant

31.  Disconnecting the blood supply to an area of
tissue and “reconnecting” the tissue’s blood
supply at a distant site
 Often under a microscope
 Only at certain medical centers

32.  DIEP- Deep Inferior Epigastric Perforator

34.  Benefits over TRAM flap
 Rectus muscle remains in abdomen
 Debate on functionality of muscle as nerves may be
injured, different techniques, etc…
 Decreased risk of hernia or abdominal bulge
 Potential decreased recovery time
 Can use is some people who smoke or are obese
 Less chance partial flap loss and fat necrosis

35.  Downside to free flaps
 Higher risk complete flap loss
 Only available at certain centers
 Longer Surgery

36.  GAP: Gluteal Artery Perforator
 S- Gap: Superior
 I- Gap: Inferior

37.  TUG Flap: Transverse Upper Gracilis

38.  Adapt reconstruction plan as needed
 Some reconstruction options not available

39.  Many different ways to create
 Choice to have performed or not

42.  Tattoo only
 “Stick-ons”
 Temporary tattoos

43.  The non-operated breast may be
 Larger
 Smaller
 Hang lower

44.  Breast reduction
 Breast augmentation
 Breast lift

45.  Oh,my friend, it’s not what they take away
from you that counts- it’s what you do with
what you have left…..Hubert Humphrey

46.  Incorporating
breast tissue movement at the
time of lumpectomy
 To decrease chance of defect or asymmetry
 Operating on radiated tissue has increased risk of
complications

47.  Reduction at the same time as lumpectomy
 If you ever thought of a breast reduction, ask if
you are a candidate for a reduction with
lumpectomy
 Some breasts or cancers not amendable

49.  Tissue rearrangement
 To prevent or decrease the chance of a breast
defect
 Have to have tissue that can be moved into
potential defect site

50.  Despite best devised surgical treatments
breast defects or distortion can occur after
lumpectomy and radiation
 Reconstruction options available

51.  Availableoptions to reconstruct a breast
 Oncoplastic options during lumpectomy
 Future