BREAST RECONSTRUCTION _______________________ T h e O p t i o n s

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Presentation transcript:

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

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

IMMEDIATE OR DELAYED Immediate: skin preservation possible Delayed: skin replacement required: Expansion Flap A B S BALL

IMMEDIATE OR DELAYED IMMEDIATE DELAYED 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 A B S BALL

IMMEDIATE Volume and skin replacement 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 A B S BALL

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

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. A B S BALL

IMPLANT AND FBADM (SurgiMendTM) A B S BALL

IMPLANT AND PADM (StratticeTM) A B S BALL

PEDICLED LD FLAP A B S BALL

pLD FLAP A B S BALL

TISSUE EXPANDER A B S BALL

FLAPS PEDICLED FLAPS FREE FLAPS LD +/- implant TRAM-DIEP Gluteal others A B S BALL

FREE TRAM FLAP A B S BALL

FREE TRAM-DIEP FLAP A B S BALL

PROBLEMS Flap failure Donor site problems Implant problems: immediate/delayed A B S BALL

QUESTIONS PLEASE

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. A B S BALL

Thank you