via christi women's connection: breast reconstruction
DESCRIPTION
New kinds of treatment as well as improved reconstructive surgery mean that women who have breast cancer today have better choices.TRANSCRIPT
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BREAST RECONSTRUCTI
ONDr. Vanessa Voge
Wichita Surgical Specialists
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BREAST RECONSTRUCTION Brief overview Types of breast reconstruction available
after mastectomy Types of “reconstruction” that can be
combined with lumpectomy
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BREAST RECONSTRUCTION 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.
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BREAST RECONSTRUCTION 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.
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BREAST RECONSTRUCTION Often patients have many questions
Forefront is the cancer itselfWhat 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?
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BREAST RECONSTRUCTION Treating the breast cancer first Very patient dependent Cancer treatment dependent Individualize treatment plans
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BREAST RECONSTRUCTION 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
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BREAST RECONSTRUCTION Timing of Reconstruction
Time of Mastectomy- “immediate breast reconstruction”
After one has healed from mastectomy- “delayed reconstruction”
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BREAST RECONSTRUCTION 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
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BREAST RECONSTRUCTION Types of reconstruction- patient
dependentTissue Expander/Implant basedLatissimus flap/implantTRAM flapFree Flap- DIEP, free tram, S-GAP, etc…
Nipple and areolar reconstruction
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BREAST RECONSTRUCTION Tissue Expander/Implant
Makes up more than 75% of breast reconstructions in the United States
Requires minimum of two surgeriesAt the time of mastectomy the tissue
expander is placed--“first stage breast reconstruction”
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TISSUE EXPANDER
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TISSUE EXPANDER
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TISSUE EXPANDER WITH BIOLOGICAL MESH SUPPORT There is more use of a biological
support, such as alloderm.
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TISSUE EXPANDER/IMPLANT 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
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BREAST IMPLANTS
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TISSUE EXPANDER/IMPLANT
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TISSUE EXPANDER/IMPLANT 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
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TISSUE EXPANDER/IMPLANT
Cons: Foreign objects, not lifelong devices, capsular contracture, loss of implants, stay the same with time, asymmetry
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SINGLE STAGE BREAST RECONSTRUCTION WITH IMPLANT Placing the breast implant at the time of
mastectomyNot as commonOnly in certain patients with ideal anatomy
and cancersAlmost always with Alloderm or equivalent
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SINGLE STAGE RECONSTRUCTION WITH IMPLANT
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TRAM FLAP TRAM- Transverse Rectus Abdominus
Myocutaneous Rectus muscles- Abdominal “six pack”Core muscle
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TRAM FLAP
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TRAM FLAP 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
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TRAM FLAP 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…)
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LATISSIMUS FLAP Latissimus dorsi muscle is on back Activities for “lat pulls”, cross country
skiing, rock climbing, etc… can be affected.
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LATISSIMUS FLAP
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LATISSIMUS FLAP
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LATISSIMUS FLAP Pros: Own tissue, non-radiated tissue,
“covers” implant
Cons: larger/longer surgery, muscle weakness, fluid collection, often needs implant or tissue expander/implant
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FREE FLAPSDisconnecting the blood supply to an area
of tissue and “reconnecting” the tissue’s blood supply at a distant site
Often under a microscopeOnly at certain medical centers
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FREE FLAPS DIEP- Deep Inferior Epigastric Perforator
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FREE TRAM FLAP
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DIEP AND FREE TRAM FLAPS 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 bulgePotential decreased recovery timeCan use is some people who smoke or are
obeseLess chance partial flap loss and fat
necrosis
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FREE FLAPS Downside to free flaps
Higher risk complete flap lossOnly available at certain centersLonger Surgery
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GAP FLAP GAP: Gluteal Artery Perforator
S- Gap: Superior I- Gap: Inferior
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TUG FLAP TUG Flap: Transverse Upper Gracilis
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RADIATION NEEDED OR DELAYED RECONSTRUCTION Adapt reconstruction plan as needed Some reconstruction options not
available
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NIPPLE/AREOLAR RECONSTRUCTION Many different ways to create Choice to have performed or not
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NIPPLE CREATION
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NIPPLE AND AREOLAR CREATION
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NIPPLE/AREOLAR CREATION Tattoo only “Stick-ons” Temporary tattoos
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MATCHING PROCEDURE The non-operated breast may be
LargerSmallerHang lower
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MATCHING PROCEDURES Breast reduction Breast augmentation Breast lift
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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
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ONCOPLASTICS Incorporating breast tissue movement
at the time of lumpectomyTo decrease chance of defect or asymmetryOperating on radiated tissue has increased
risk of complications
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ONCOPLASTICS 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
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BREAST REDUCTION PATTERN
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ONCOPLASTIC Tissue rearrangement
To prevent or decrease the chance of a breast defect
Have to have tissue that can be moved into potential defect site
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ONCOPLASTIC Despite best devised surgical
treatments breast defects or distortion can occur after lumpectomy and radiation
Reconstruction options available
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BREAST RECONSTRUCTION Available options to reconstruct a breast Oncoplastic options during lumpectomy Future
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THANK YOU