Upload
felipe-sabin
View
227
Download
4
Tags:
Embed Size (px)
Citation preview
OPTIMISING BREAST AESTHETICSin reconstruction
Stuart JamesThe London Breast Clinic6th October 2011
General Guidance
1st Realistic goal Balance and symmetry in clothing
General Guidance
1st Realistic goal
2nd Two or more operationsspaced over 12 months
General Guidance
1st Realistic goal
2nd Two or more operations
3rd Risk of failure by any methodapproximately 1-2%
General Guidance
1st Realistic goal
2nd Two or more operations
3rd Risk of failure by any method
4th Reconstructive Timing;Immediate or delayed
1 Selection of reconstruction
Implant only reconstruction
Combination implant/flap
Flap reconstruction ‘autologous’
Implant only reconstruction
Implant only Reconstruction
- ‘Augmented’ look- Inadequate autologous
volumes- 2 stages
Implant only
One or Two stagesI) Saline ExpanderII) Silicone Implant
Combination Implant and flap reconstruction
+ Improved result - Donor site scar and implant
Flap ReconstructionsTRAM/DIEP
+ best cosmeticallysoft and warm ages wellno late revisions
- Complexlonger recoverydonor site scar
DIEP reconstruction;The first 12 months
2 months 6 months 12 months
2 Timing and Teamwork
• Immediate reconstruction optimises results
• Skilled mastectomy giving consideration to reconstructive requirements
Breast Reconstruction; Timing Immediate Delayed
3 Technical Advances
• Surgical Technique
• Imaging
Perforator flap reconstruction• 1980’s TRAM flap
– Transverse Rectus Abdominis Myocutaneous flap
• 2000’s DIEP flap– Deep Inferior Epigastric Artery
perforator flap
DIEP or TRAM?
MS 0 - TRAM
MS 1
MS 2
Nahabedian et al PRS 2002
CT Angiography
CT Angiography
DIEP flap
Our results• 100 cases of abdominal based free flaps in
breast reconstruction; The impact of pre-operative CT Angiography
Ghattaura, N. Jalalli, Y. Rajapakse, J. Henton, A. Searle, P. Harris, C. Savidge, S. Allen, S. James (JPRAS)
• Single perforator use up fro 17% to 48%
• Double use of medial row perforators
• Over 1 hour saved on average
DIEP or TRAM?
4 Secondary adjustments
Liposuction AugmentationFat transfer Scar revisionDirect excision
Summary1 General guidance
2 Selection of reconstruction
3 Timing and Teamwork
4 Technical advances
5 Secondary adjustment
Thank you, Questions?