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BREAST RECONSTRUCTION. Mark S. Granick, MD, FACS Professor of Surgery, tenured Chief of Plastic Surgery. Why?. “I have a long life to live and I want to live it whole.” “I wanted to once again put on a beautiful nightgown and fill it all out.”

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breast reconstruction

BREAST RECONSTRUCTION

Mark S. Granick, MD, FACS

Professor of Surgery, tenured

Chief of Plastic Surgery

slide2
Why?

“I have a long life to live and I want to live it whole.”

“I wanted to once again put on a beautiful nightgown and fill it all out.”

“”I was gardening one day when I bent over and my prosthesis fell out. Crying I picked it out of the muddy water. The next day I called a Plastic Surgeon.”

patient questions
Patient Questions
  • Who is a candidate for surgery?
  • Will breast reconstruction interfere with cancer treatment or detection?
  • Are there some women who should not have a reconstruction?
  • Does the type of cancer make a difference?
  • How does adjuvant therapy impact on reconstruction?
patient questions1
Patient Questions
  • How do you get the breasts symmetric?
  • If a patients gains or loses weight, how does it affect the reconstruction?
  • Does a breast reconstruction look and feel natural?
  • Are there psychological implications concerning breast reconstruction?
goals
Goals
  • Mound reconstruction
    • Size
    • Skin coverage
  • Nipple reconstruction
  • Areola reconstruction
  • Symmetry
timing
Timing
  • Immediate
  • Delayed
options
Options
  • Implant, with or without expansion
  • Autogenous
  • Combination
implants
Implants
  • 1 stage
  • Skin deficiency uncorrected
  • Facilitated by alloderm sling
  • Good for small breasts with minimal ptosis
  • Late capsular formation
permanent expander
Permanent Expander
  • 1Step
  • Corrects skin deficiency
  • Multiple office visits
expander implant
Expander - Implant
  • 2 Stages
  • Corrects skin deficiency
  • Multiple office visits
autogenous tissue
Autogenous Tissue
  • Corrects skin deficiency
  • Normal subcutaneous tissue
  • No foreign material
  • Longer operative time
  • Higher morbidity
latissimus dorsi
Latissimus Dorsi
  • May require an implant
  • Cannot be used if the thoracodorsal pedicle is damaged
slide31
TRAM
  • Carl Hartrampf,MD
  • Single or double pedicle
  • Muscle sparing (perforator)
  • Cannot use if the rectus muscle is divided superiorly (Kocher incision)
  • Risks
    • fat necrosis
    • donor site slough
    • flap failure
    • hernia
free flap
Free Flap
  • TRAM
  • Gluteal
  • Lateral Thigh
  • DIEP
ad