Reconstructive Surgery

  • Offered to all patient having a mastectomy
  • Immediate reconstruction done at the same time as the mastectomy
  • Reconstruction can be delayed for years after initial mastectomy
  • May not be possible due to required chemo or radiotherapy or comorbidity

 

Implants

  • Simple procedure with minimal scarring
  • Reasonable appearance but less natural feel (cold, less mobile and static size and shape)
  • Long term problems include hardening, leakage, and shape change

 

Latissimus dorsi flap

  • Portion of the latissimus dorsi plus skin and fat tissue
  • Tunnelled under skin to the breast area
  • “Pedicled” refers to keeping the original blood supply and moving the tissue under the skin to a new location
  • “Free flap” refers to cutting the tissue away completely and transplanting it to a new location

 

Transverse rectus abdominis flap (TRAM flap)

  • Portion of rectus abdominis along with blood supply and skin
  • Either as pedicled flap (tunneled under skin) or free flap (transplanted)
  • Risk of abdominal hernia due to weakened abdominal wall

 

Deep Inferior Epigastric Perforator Flap (DIEP flap)

  • Skin and subcutaneous fat from abdomen (no muscle)
  • Transplanted from abdomen to breast
  • Transplant the Deep Inferior Epigastric Artery with fat and skin
  • Tissue transplanted to reconstruct breast
  • Vessels attached to branches of the internal mammary artery and vein
  • Very complex procedure with microsurgery
  • Less risk of abdominal wall hernia as muscle are intact
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