BREAST RECONSTRUCTION BREAST AUGMENTATION AND REDUCTION

BREAST RECONSTRUCTION Flap reconstruction: Pg 306 Tissue from back, butt, thigh or: Transverse Rectus Abdominus Myocutaneous (TRAM) flap More extensive surgery; leaves defect at donor site May be the only alternative if major scarring resulted from radiation Skin Expansion Tissue Expander placed under muscle Several months of injections then replaced with permanent implants No new incision – use original mastectomy scar Glut Maximus, Lat Dorsi, Transverse Rectus Abd myocutaneous (TRAM) flap, (most popular)

Nipple Reconstruction Graft may be taken from groin, axilla or other nipple. Can cause problems Advanced procedure: cut skin in shape of a Skate, twist and mold in shape of nipple Areola done at tattoo parlor

PROBLEMS WITH RECONSTRUCTION IMPLANT Implant leakage Capsule formation Change in position of implant FLAP SURGERY Loss of flap Weakness of donor site Hernia formation Irregularity of breast and blood loss Two scars

BREAST AUGMENTATION Pocket created under breast tissue/muscle Refer to table pg 303 Subglandular Capsular hardening of implant in the past Now textured; also round or pear Submuscular Change in shape when pectoral muscle contracted Implant remains high (Snoopy Breast)

BREAST AUGMENTATION Risks: Post-op: 1-2 weeks Bleeding, infection, scar and numbness or change in feeling Hardening of capsule Leakage Post-op: 1-2 weeks

BREAST REDUCTION Scarring Extensive Less painful since nerves and breast skin already stretched due to weight 1-2 week recovery; no strenuous activity for 6 weeks 3-5 hr procedure Keyhole incision around nipple, extends downward, follows natural curve of crease beneath breast Fat, skin, glandular removed and nipple and areola re-positioned.

MASTOPEXY Skin tightening, no implant Upside down T; similar to Breast Reduction 1-2 week recovery

POLAND’S SYNDROME

POLAND’S SYNDROME

PRE-PECTORAL SPONGES PLACED 40 YRS EARLIER

DIRECT INJECTION OF SILICONE

DIRECT INJECTION OF SILICONE

Percutaneous Silicone Injections: Siliconegranulomas/Rim Calcification

FIBROUS ENCAPSULATION

CAPSULAR CONTRACTION OF LT SILICONE IMPLANT

DEFLATED

HERNIA

SILICONE LEAK

INTACT IMPLANT

WRINKLES OR BULGES

SILICONE INTRACAPSULAR LEAK

SILICONE RUPTURE NOT IDENTIFIED ON US