Breast Reconstruction Pankaj Tiwari, MD and James Boehmler, MD - - PDF document
Reconstructive Team Breast Reconstruction Pankaj Tiwari, MD and James Boehmler, MD James Ergun Michael Pankaj Boehmler, MD Kocak, MD Miller, MD Tiwari, MD Ohio State University Division of Plastic Surgery Comprehensive Reconstructive
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Pankaj Tiwari, MD and James Boehmler, MD
Ohio State University Division of Plastic Surgery
James Boehmler, MD Michael Miller, MD Ergun Kocak, MD Pankaj Tiwari, MD
Comprehensive Reconstructive Breast Surgeons
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1) Elective
2) Timing
3) Symmetry
4) Revisions
5) Complications
Timing Technique None Immediate Delayed Implants alone Tissue alone Implants and tissue
No further surgery Shorter hospital stay No additional risks
Scar on chest wall Asymmetry in clothing External prosthesis
www.breastform.com
1998 Federal Breast Reconstruction Law
(1) Reconstruction of the breast on which the mastectomy has been performed (2) Surgery and reconstruction of the other breast to produce a symmetrical appearance (3) Prostheses and physical complications all stages of mastectomy, including lymphedemas
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health status.
mastectomy + XRT
recurrence
asymmetry after BCS Poor psychosocial fxn Increased depressive symptoms Stigmatization by treatment
Waljee et al. J Clin Oncol
refer >75% patients Female surgeons High clinical breast volume, Work in cancer centers
Alderman et al. Cancer. 2007
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varies by race/ethnicity
Alderman et al. Cancer. 2009
with Immediate Reconstruction
Previous Scars Tumor Location
www.breastcancer.org
with Immediate Reconstruction
Previous Scars Tumor Location
www.breastcancer.org
with Immediate Reconstruction
Previous Scars Tumor Location
www.breastcancer.org
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Lowers psychosocial morbidity Lowers surgical morbidity Better cosmetic results Immediate breast mound present No need for external prosthesis No difference in detection of recurrence
Mastectomy skin flap necrosis More surgery, more pain Longer hospitalization/recovery Coordination required between surgeons
Immediate Tissue Expander with Silicone Implants
Advantages
causes no complications to reconstruction
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Disadvantages
time
reconstruction
Expander placement Outpatient expansion Expander/implant exchange
breast
Silicone - better feel Saline - easier rupture detection
Selected Readings Plastic Surgery
www.mentorcorp.com
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Skin Sparing Mastectomy
Placement of ADM along inframmary fold
Implant Exchange Mastopexy Post-Operative Appearance
Shorter surgery Shorter hospital stay Less technical surgery Less pain? Quicker recovery, return to work Bilateral cases Thin women
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Not permanent Implant material risks
Frequently need expansion Unilateral cases Radiation
Microscope Advanced training Specialized centers
commmon
Buttock Hip Inner Thigh
Selected Readings Plastic Surgery
Different amount of “six
pack” muscle taken
Full width of muscle
taken
– Free TRAM Some muscle taken,
some left behind
– Muscle sparing
TRAM
No muscle taken – DIEP Amount of muscle taken
is dependant on patient’s blood vessel anatomy
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Permanent reconstruction No implant material
contracture
“Tummy Tuck” Skin sparing mastectomy Physiologic Long term cost savings
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Longer surgery Longer hospitalization Total failure risk <5% More pain? Not everyone a candidate
surgeries
implant “Mixed reconstruction”
No microsurgery Reliable
Tightness in back Need implant
Selected Readings Plastic Surgery