1. Understanding Your Breast Reconstruction Options: Pedicled Flaps Frederick J. Duffy, Jr. M.D., F.A.C.S. Clinical Assistant Professor UT-Southwestern Medical School Dallas, Texas LBBC C4YM February 22, 2014

2. 22 year old african-american college student with newly diagnosed breast cancer 22 year old african-american college student with newly diagnosed breast cancer Prior history of Hodgkin ’ s Disease Prior history of Hodgkin ’ s Disease Factors: college, eventual children, sexuality, scars Factors: college, eventual children, sexuality, scars Chose tissue expander, eventual latissimus flap Chose tissue expander, eventual latissimus flap The real world…

3. Even more complicated… 40 year old diagnosed with breast cancer early in her second trimester of pregnancy 40 year old diagnosed with breast cancer early in her second trimester of pregnancy Chose to remain pregnant…received taxol through pregnancy and eventual mastectomy Chose to remain pregnant…received taxol through pregnancy and eventual mastectomy Subsequent prophylactic contralateral mastectomy and bilateral DIEP flaps Subsequent prophylactic contralateral mastectomy and bilateral DIEP flaps

4. Breast CA in Younger Women Why is the battle tougher? Less information Less information Less same age peer support Less same age peer support Concerns about sexuality, fertility, family, career are greatly heightened Concerns about sexuality, fertility, family, career are greatly heightened

5. Questions Should I reconstruct my breast? Should I reconstruct my breast? Am I a candidate? Am I a candidate? When (immediate or delayed)? When (immediate or delayed)? How many operations will be needed? How many operations will be needed? Will I need surgery on the other breast? Will I need surgery on the other breast? Will breast reconstruction impact on the ability to detect recurrent or other cancers? Will breast reconstruction impact on the ability to detect recurrent or other cancers? Reconstructive options Reconstructive options

6. TRAM Flap

7. Latissimus Flap

9. My Advice Stay informed…you are your own best advocate Stay informed…you are your own best advocate Ask to see patient photos and talk with a patient who has had the procedure you are considering Ask to see patient photos and talk with a patient who has had the procedure you are considering Choose a surgeon who can offer you all the options Choose a surgeon who can offer you all the options I believe it is important for each patient to feel comfortable with their surgeon…trust your instincts! I believe it is important for each patient to feel comfortable with their surgeon…trust your instincts!

10. Resources www.texaspsa.com www.dallasbreastreconstruction.com drduffy@texaspsa.com drmckane@texaspsa.com