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Breast reconstruction

Approach

Expose the patient as for breast examination

Inspect
- Note asymmetry of the chest wall
- Prosthesis can be identified by the presence of surgical scars and by a different shape from the normal breast contour
- Flap reconstruction
  TRAM flap
  
  Latissimus dorsi flap
  
  DIEP free flap
- Implant reconstruction: rounder, lie of breast usually higher; Becker implant may have a palpable subcutaneous filling port in the axilla
Palpate
Percuss
Auscultate

Types of Breast Reconstruction

Subcutaneous prosthesis
Submuscular implant
Tissue expander
Myocutaneous flap
- TRAM - transverse rectus abdominis
- LD - latissimus dorsi
- DIEP - deep inferior epigastric artery pedicle graft

	*Advantages*	*Disadvantages*
Implant	Simpler technique than flaps Place under pectoralis muscle to reduce incidence of contraction of capsule Can be performd at time of mastectomy or at a later date	Cosmetic results less satisfactory than using a flap Requires plenty of available skin following surgery Lies above the natural inframammary fold leaving breast higher than the other one
Myocutaneous flaps	Useful where remaining skin and muscle in short supply Cosmetic results can be very good Suitable for use post-mastectomy Suitable for salvage after local recurrence	May need to be performed in combination with plastic surgeon Greater blood loss Greater operating time and operative complications Use of rectus abdominis may be impossible if the patient has had previous abdominal surgery Late complications include flap necrosis and infection

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