Presentation on theme: "OPTIMISING BREAST AESTHETICS in reconstruction"— Presentation transcript:
1 OPTIMISING BREAST AESTHETICS in reconstruction Good morningIn this talk I wish to bring into focus the issue of economising grafts in rhinoplastyI will discuss alternative methods that are useful, as well as review techniques to make maximum use of harvested materialStuart JamesThe London Breast Clinic6th October 2011
2 General Guidance1st Realistic goal Balance and symmetry in clothing
3 General Guidance1st Realistic goal 2nd Two or more operations spaced over 12 months
4 General Guidance1st Realistic goal 2nd Two or more operations 3rd Risk of failure by any method approximately 1-2%
5 General Guidance1st Realistic goal 2nd Two or more operations 3rd Risk of failure by any method 4th Reconstructive Timing; Immediate or delayed
6 1 Selection of reconstruction Implant only reconstruction Combination implant/flap Flap reconstruction ‘autologous’
20 CT AngiographyAxial 50-mm section thickness maximum intensity projection (MIP) image obtained with abdominal wall CT angiography shows the labeled segments of a perforator originating from the right DIEA.
21 DIEP flapThree-dimensional graphic illustration of the course of a perforator (anterior musculocutaneous branch) from its origin at the DIEA between the posterior layer of the rectus sheath and the rectus muscle, its intramuscular segment within the rectus muscle, its subfascial segment (not always present) between the anterior aspect of the rectus muscle and the anterior layer of the rectus sheath, and its end branching (subcutaneous segment) within the subcutaneous fat of the anterior abdominal wall. (Image courtesy of Francesco Gaillard, MBBS, Royal Melbourne Hospital, Australia.)
22 Our results100 cases of abdominal based free flaps in breast reconstruction; The impact of pre-operative CT AngiographyGhattaura, N. Jalalli, Y. Rajapakse, J. Henton, A. Searle, P. Harris, C. Savidge, S. Allen, S. James(JPRAS)Single perforator use up fro 17% to 48%Double use of medial row perforatorsOver 1 hour saved on average
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