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Breast Reconstruction Using Your Own Tissue
Andrea Pusic, MD FACS
Associate Professor of Surgeon
Memorial Sloan-Kettering Cancer Center
Breast reconstruction is important!
Improvements in body image and
sexuality
Decreased anxiety and
depression
Avoid external prosthesis
Immediate reconstruction has
a number of benefits:
• Psychological
• Avoid multiple operations
• Smaller incisions
• Improved aesthetics
Reconstruction can be performed at the same
time as the mastectomy (or later)
Immediate Delayed
Timing of Reconstruction
Patient’s own tissues
(most commonly from lower
abdomen)
Implants
Combination of implants and
own tissue
Several different types of reconstruction available
Most women are candidates for reconstruction
Type of reconstruction guided by:
Medical risks and smoking
status
Previous radiation/surgery
Body habitus
Breast cancer stage
Motivations/goals
Implant Reconstruction has some Disadvantages
Not as natural feeling/looking as normal breast
Infection may require removal
May require replacement (leak)
Does not age with patient
Scar tissue can form (capsular contracture)
Satisfaction with Breasts
Hu et al, PRS 2009
Tissue reconstruction is useful in some patients
1. Previously radiation
2. Overweight patients
3. Large breasted patients
4. Patients having only one
breast removed
Pedicled TRAM flap
• Advantages
• Produce a softer, ptotic breast mound
• Better control in matching the
contralateral breast
• Greater volume of tissue transfer
• Enhanced flap perfusion
• Avoids disruption of the medial
inframammary fold
DIEP Free Flap Reconstruction
Unilateral TRAM flap
Can provide best match to the other breast
Nipple-sparing with DIEP
Less commonly performed but can provide
excellent results
Delayed TRAM Reconstruction
After nipple reconstruction and reduction of the
other breast
What are the main potential problems with TRAM and DIEP flaps?
• Longer surgery with longer recovery
• Flap loss (not enough blood flow)
• Abdominal problems
(Seroma, hernia or bulge, weakness, pain)
• Noticeable Scars
Initially the scars are very noticeable
But they fade considerably with time
Delayed TRAM flap Reconstruction
Note increased scarring and color differences
Questions?
www.breast-q.org