Breast Cancer Reconstruction

Transcription

1 Breast Cancer Jerome H. Liu, MD Tom S. Liu, MD Jerome H. Liu, MD Undergraduate: Brown University Medical School: University of California, Los Angeles Residency: UCLA Medical Center Fellowship:UCLA Medical Center Sub-Specialty Fellowship: University of Texas, Southwestern/Dallas Plastic Surgery Institute Practice Interests: Aesthetic (Cosmetic) Surgery, Breast, Free Flap Breast Microsurgery Tom S. Liu, MD Undergraduate: Northwestern University Medical School: University of Chicago, PritzkerSchool of Medicine Residency: UCLA Medical Center Fellowship: UCLA Medical Center Sub-Specialty Fellowship: California Pacific Medical Center Practice Interests: Aesthetic (Cosmetic) Surgery, Breast, Free Flap Breast Microsurgery Introduction to Breast Cancer and Treatment Lifetime Risk of Breast Cancer Currently, a woman living in the US has a 12.1%, or a 1 in 8, lifetime risk of being diagnosed with breast cancer. Teens 20s 30s 40s 50s 60s 70s 80s From , the median age at diagnosis for cancer of the breast was 61 yearsof age. Overview of Breast Cancer Treatments Generally a multi-step plan Localized treatments: Surgery Radiation therapy Systemic treatments: Chemotherapy Hormone therapy Biologic therapy Additional considerations: Breast reconstruction Contralateral breast surgery 1

2 Breast Overview Immediate vs. Delayed Breast Main goals of reconstruction: Restore breast mound Maintain/improve quality of life Process involves: Rebuilding the breast Autologous tissues Implants Reconstructing the nipple-areola complex Timing of reconstruction Immediate Delayed Immediate reconstruction is Usually preferred Regarded as the standard of care Not performed on all patients Benefits include: Preserves inframammary fold Maximizes available skin Psychological well-being Delayed reconstruction is an option for patients who: Need post-operative radiation Are undecided Types of Breast Procedures Breast Procedure Trends 2010 Total Implant-based reconstruction Autologous reconstruction Total 93,083 Tissue expander and implant 64,391 Implant alone 9,804 Introduction to Breast TRAM Flap Latissimus Dorsi Flap DIEP Flap 7,009 6,571 5, ,000 40,000 60,000 80, ,000 Breast : Implant (Two-Stage) Implant-Based Breast Stage 1: Tissue Expander Stage 2: Final Implant Source:Allergan 2

3 Stage 1: Tissue Expander Autologous Breast Source:Allergan and Lifecell Abdominal Flap Anatomy Free TRAM Flap Transverse Rectus Abdominus Myocutaneous TRAM Source:Microsurgeon.org Source:Microsurgeon.org Deep Inferior Epigastric Perforator (DIEP) Free Flap Microsurgical Breast (Video) Source:Microsurgeon.org 3

4 Microsurgical Breast Microsurgical Breast Microsurgical Breast The Challenging Breast Patient The Challenging Breast Patient Complications or failures of implant reconstruction Infection Capsular contracture Asymmetry / Malposition Post-operative radiation Post-lumpectomy contour defects Delayed mastectomy reconstruction Smoker Patient s who want a natural reconstruction Onco-Plastic Breast Image Source:The University of Chicago Hospitals 4

5 Onco-Plastic Breast Surgery Breast Cancer Safety and Patient Awareness Safety of Breast Safety of Breast Research shows reconstruction is oncologically safe No effect has been found on: Detection of cancer recurrence Delivery of adjuvant therapies Implants have not been linked to cancer or other diseases Higher 5-year survival than mastectomy alone, possibly due to: Increased follow-up Psychosocial benefits Access barriers for patients: Lack of knowledge Healthcare disparities by race Limited financial resources Physicians biases Favored patients Young Sexually active More educated Larger tumors Lack of access to plastic surgeons Other patient priorities: Focus on cancer treatment Lack of Patient Awareness about Breast Options Multidisciplinary Breast Care Heme-Onc Surg-Onc Rad-Onc Plastic Surgery A study found that 2 of 3 women with breast cancer were not told about their breast reconstruction options before surgery Genetics Social Work 5

6 Special Thanks Thank You ( 谢谢 )! Jerome H. Liu, MD, MSHS Tom S. Liu, MD, MBA Aesthetic and Reconstructive Plastic Surgery ( 整形外科 ) San Jose-Los Gatos / Los Altos