Post- Mastectomy and TUG Flap Reconstruction Revision

Sarah Keilson

Procedure observed 2/16/12 Highland Hospital

Information available at cias.rit.edu/~srk5668/surgery2_112/breast.html

Objectives

After viewing this presentation, you will be able to:

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• Make incisions for a post-mastectomy/TUG flap reconstruction revision

• Remove necrotic tissue from previous TUG flap procedure, leaving anastomosed vessels behind

• Harvest and process fat from upper abdominal region

• Insert fat graft into the breast

• Suture close incisions with continuous running stitch

Orientation and Background

Failed TUG Flap Reconstruction

Healthy fat from upper abdomen will be used to replace necrotic fat graft.

Incisions:1. Lateral breast

2. Upper abdomen

3. Medial breast

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Patient previously had mastectomy with TUG Flap Breast Reconstruction (Transverse Upper Gracilis Flap).

Vasculature taken as part of the TUG flap graft was anastomosed to axillary vasculature, but graft tissue died.

Incision 1Incision 2

Incision 3

Step One

Incision 1: Remove Necrotic Tissue

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Dissect and remove necrotic tissue from previous reconstruction.

Do not remove vasculature anastomosed in previous reconstruction.

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Leave anastomosed vessels behind

Step Two

Incision 2: Harvest Abdominal Fat

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Harvest fat using a liposuction cannula.

Add Lactated Ringer’s to harvested fat and transfer to large syringes.Remove settled blood (blood cells in harvested fat stops angiogenesis).

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Step Three

Incision 3: Inject Harvested Fat

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Inject harvested fat into medial side of breast to replace necrotic tissue. 21

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Step Four

Suture Close Incisions

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Close all incisions with continuous running stitches. 21

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Works Cited 7

Works Cited

• “TUG Flap Breast Reconstruction “(Transverse Upper Gracilis Flap).” Prima of South Texas. N.p., 2012. Web. 25 Feb. 2012.<http://www.prma-enhance.com/>.

• “Breast.” Virtual Medical Centre. N.p., 21 Feb 2012. web. 25 Feb. 2012. <http://www.virtualmedicalcentre.com/>.

• “TUG Flap, Inner Thigh Flap Breast Reconstruction.” BreastReconstruction.org The Comprehensive Resource for Breast Reconstruction. N.p., n.d. Web. 25 Feb. 2012. <http://www.breastreconstruction.org/>.