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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


Breast reconstruction
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





Breast reconstruction
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