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BREAST RECONSTRUCTION _______________________ T h e O p t i o n s Adrian Ball Consultant Surgeon 12 June 2013.

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Presentation on theme: "BREAST RECONSTRUCTION _______________________ T h e O p t i o n s Adrian Ball Consultant Surgeon 12 June 2013."— Presentation transcript:

1 BREAST RECONSTRUCTION _______________________ T h e O p t i o n s Adrian Ball Consultant Surgeon 12 June 2013

2 A B S BALL2 TOPICS  Immediate or delayed reconstruction  Skin replacement by expansion or flaps  Acellular dermal matrix  Volume replacement by implants or flaps  Importance of radiotherapy  Problems

3 A B S BALL3 IMMEDIATE OR DELAYED  Immediate: skin preservation possible  Delayed: skin replacement required: –Expansion –Flap

4 A B S BALL4 IMMEDIATE OR DELAYED  IMMEDIATE –Extensive DCIS –Multifocal lesions –Lesion involving nipple –Local recurrence  DELAYED –Radiotherapy (~ same indications as mastectomy) Tumour >5 cm SLN involvement (SLNB part of workup) Skin/muscle involvement

5 A B S BALL5 IMMEDIATE  SKIN PRESERVATION Volume replacement with: – Implant and ADM –Myo-subcutaneous flap +/- implant  NO SKIN PRESERVATION (smoker/DXT) Volume and skin replacement –Tissue expansion (bilateral) –Myocutaneous flap +/- implant

6 A B S BALL6 ACELLULAR DERMAL MATRIX  Alloderm – allograft human dermis  Strattice – porcine dermis  Surgimend – fetal bovine dermis

7 A B S BALL7 FBADM  Acellular biologic matrix derived from fetal bovine dermis, a rich source of Type III collagen.  Type III collagen mediates tissue healing and growth while inhibiting scarring.  No detrimental foreign body inflammatory response  Provides support for rapid healing without inflammation.  Seeded with the patient’s tissue building cells and growth factors.  Microporous matrix rapidly revascularized to support tissue building and healing.

8 A B S BALL8 IMPLANT AND FBADM (SurgiMend TM )

9 A B S BALL9 IMPLANT AND PADM (Strattice TM )

10 A B S BALL10 PEDICLED LD FLAP

11 A B S BALL11 pLD FLAP

12 A B S BALL12 TISSUE EXPANDER

13 A B S BALL13 FLAPS PEDICLED FLAPS –LD +/- implant FREE FLAPS –TRAM-DIEP –Gluteal –others

14 A B S BALL14 FREE TRAM FLAP

15 A B S BALL15 FREE TRAM-DIEP FLAP

16 A B S BALL16 PROBLEMS  Flap failure  Donor site problems  Implant problems: immediate/delayed

17 QUESTIONS PLEASE

18 A B S BALL18 SUMMARY  Immediate or delayed reconstruction depends on need for post mastectomy radiotherapy.  Skin-preservation is possible in immediate reconstruction.  Volume replacement using implants and ADM or flaps.  Skin replacement by expansion or flaps.  No technique is free from problems.

19 Thank you


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