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OPTIMISING BREAST AESTHETICS in reconstruction Stuart James The London Breast Clinic 6 th October 2011.

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Presentation on theme: "OPTIMISING BREAST AESTHETICS in reconstruction Stuart James The London Breast Clinic 6 th October 2011."— Presentation transcript:

1 OPTIMISING BREAST AESTHETICS in reconstruction Stuart James The London Breast Clinic 6 th October 2011

2 General Guidance 1 st Realistic goal Balance and symmetry in clothing

3 General Guidance 1 st Realistic goal 2 nd Two or more operations spaced over 12 months

4 General Guidance 1 st Realistic goal 2 nd Two or more operations 3 rd Risk of failure by any method approximately 1-2%

5 General Guidance 1 st Realistic goal 2 nd Two or more operations 3 rd Risk of failure by any method 4 th Reconstructive Timing; Immediate or delayed

6 1 Selection of reconstruction Implant only reconstruction Combination implant/flap Flap reconstruction ‘autologous’

7 Implant only reconstruction

8 Implant only Reconstruction -‘Augmented’ look -Inadequate autologous volumes -2 stages

9 Implant only One or Two stages I) Saline Expander II) Silicone Implant

10 Combination Implant and flap reconstruction + Improved result - Donor site scar and implant

11 Flap Reconstructions TRAM/DIEP + best cosmetically soft and warm ages well no late revisions - Complex longer recovery donor site scar

12 DIEP reconstruction; The first 12 months 2 months6 months12 months

13 2 Timing and Teamwork Immediate reconstruction optimises results Skilled mastectomy giving consideration to reconstructive requirements

14 Breast Reconstruction; Timing Immediate Delayed

15 3 Technical Advances Surgical Technique Imaging

16 Perforator flap reconstruction 1980’s TRAM flap –Transverse Rectus Abdominis Myocutaneous flap 2000’s DIEP flap –Deep Inferior Epigastric Artery perforator flap

17 DIEP or TRAM?

18 MS 0 - TRAM MS 1 MS 2 Nahabedian et al PRS 2002

19 CT Angiography

20

21 DIEP flap

22 Our results 100 cases of abdominal based free flaps in breast reconstruction; The impact of pre- operative CT Angiography Ghattaura, 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 perforators Over 1 hour saved on average

23 DIEP or TRAM?

24 4 Secondary adjustments LiposuctionAugmentation Fat transferScar revision Direct excision

25 Summary 1General guidance 2Selection of reconstruction 3Timing and Teamwork 4Technical advances 5Secondary adjustment

26 Thank you, Questions?


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