otypes OF BREAST RECONSTRUCTION

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1 BREAST RECONSTRUCTION Disclosures No conflicts to disclose BRIAN J. KOBIENIA, MD, FACS PRIVATE PRACTICE, EDINA MN Breast Reconstruction: Objectives Plastic Surgery ostatistics OF BREAST RECONSTRUCTION otypes OF BREAST RECONSTRUCTION ounderstand OF TIMING OF RECONSTRUCTION o INDICATIONS/CONTRA TO RECONSTRUCTION Why Plastic Surgery? ouse PLASTIC FOR SURGERY? oplastikos GREEK: TO MOLD OR TO SHAPE AllinaHealthSystems 1

2 Breast Cancer ostatistics OF BREAST CANCER o12.4% OF US WOMEN WILL GET BREAST CANCER omore IS BETTER Traditional Treatment obreast CANCER (ACS STATISTICS 2013) o230,340 NEW DIAGNOSES invasive o64,640 non invasive o40,000 DEATHS otake AWAY THE BREAST AND EVERYTHING IN CONTACT WITH THE BREAST RADICAL MASTECTOMY Radical Mastectomy (Halstead Mastectomy) Radical Mastectomy oonly TREATMENT FOR CANCER REGARDLESS OF DISEASE S oremoval OF BREAST, AXILLARY CONTENTS AND PECTORALIS MUSCLES odisfiguring, DEFORMING, AND DISABLING olymphedema Lymphedema AllinaHealthSystems 2

3 Lymphedema Radical Mastectomy Results osurvivalnot WORSE WITH LESS INVASIVE OPERATIONS omodified RADICAL MASTECTOMY opreservation OF PECTORALIS MUSCLES olumpectomy osentinel NODE BIOPSY oleaving NODES ALONE IF DOESN T AFFECT TREATMENT Modified Radical Mastectomy Lumpectomy Breast Cancer Treatment osurgical THERAPY(REMOVE THE BREAST CANCER) omayo CLINIC, MASTECTOMY RATES FELL o45% IN 1997 o31% IN 2003 (LUMPECTOMIES INCREASED?) o , RATES INCREASED 37% TO 43%. orecurrence CONCERNS OR SYMMETRY oregional DIFFERENCES AllinaHealthSystems 3

4 Breast Reconstruction onot AVAILABLE BEFORE 1980 S ono SURGICALRECONSTRUCTION oexternal PROSTHESIS Breast Reconstruction obreast CANCER TREATMENT IS PARAMOUNT oreconstruction SHOULD NOT: ointerfere WITH SURVEILLANCE oincrease RISK FOR RECURRENCE ointerfere WITH ONCOLOGIC TREATMENT odo HARM Breast Reconstruction: Statistics Breast Reconstruction: Statistics o109,256 BREAST RECONSTRUCTION PROCEDURES IN 2016(29,000 IN 1992) o174% INCREASE SINCE WOMEN S HEALTH AND CANCER RIGHTS ACT 1998 o98% OF MASTECTOMY PATIENTS WOULD HAVEBREAST RECONSTRUCTION AGAIN PRS JULY, 2008 Breast Reconstruction: Options Breast Reconstruction: Options No Reconstruction 1. NO RECONSTRUCTION 2. DELAYED RECONSTRUCTION 3. TISSUE EXPANDER AND IMPLANT 4. AUTOLOGOUSTISSUE WITH IMPLANT 5. AUTOLOGOUSTISSUE ALONE oadvantages oeasiest oquickest RECOVERY odisadvantages oleast NATURAL oexternal PROSTHESIS AllinaHealthSystems 4

5 No Reconstruction External Prosthesis External Prosthesis External Prosthesis oadvantages oquick oeasy oless PAIN oless HOSPITAL TIME oreturn TO LIFE FAST oeasy SURVEILLANCE odisadvantages ono BREAST oprosthetic IS HOT osticky osweaty olocation? ospecial BRA$$ Tissue Expander and Implant Tissue Expander and Implant ostaged SURGERIES o1st EXPANDER osurgery ONLY AT BREAST oexpand A POCKET oleast INVASIVE oless NATURAL? AllinaHealthSystems 5

6 Tissue Expander and Implant Tissue Expander and Implant o2nd STAGE osaline OR GEL IMPLANT obalancing PROCEDURES olift oreduction oaugmentation onipple RECONSTRUCTION Tissue Expander and Implant AllinaHealthSystems 6

7 Nipple Reconstruction Nipple Reconstruction: Tattoo Tissue Expander and Implant oadvantages osurgery ONLY AT BREAST oleast INVASIVE oquicker RECOVERY odisadvantages omany OPERATIONS oleast NATURAL oanimation Acellular Dermal Matrix (ADM) ocollagen SCAFFOLD FROM CADAVER odevoid OF LIVING CELLS oincorporated INTO THE RECIPIENT ADM Advantages Tissue Expander and Acellular Dermal Matrix oless PAINFUL RECOVERY onearly DOUBLE THEINITIAL EXPANSION orapid EXPANSION POSSIBLE obetter BREASTAESTHETICS AllinaHealthSystems 7

8 Other ADM Uses Autologous Tissue and Implant Latissimus dorsi Flap with Implant ohide VISIBLE WRINKLES onipple PROJECTION ohernia REPAIR oendodontic USE Autologous Tissue and Implant Latissimus dorsi Flap with Implant Autologous Tissue & Implant Latissimus dorsi Flap with Implant omost COMMON REASONS FOR THIS TECHNIQUE oradiation THERAPY IN PAST omatch OPPOSITE BREAST oneed TO PATCH LARGE CHEST WALL DEFECT Radiation Effects on Skin Autologous Tissue & Implant Latissimus dorsi Flap with Implant omost COMMON REASONS FOR THIS TECHNIQUE oradiation THERAPY IN PAST omatch OPPOSITE BREAST oneed TO PATCH LARGE CHEST WALL DEFECT AllinaHealthSystems 8

9 QuickTime and a decompressor are needed to see this picture. 10/12/17 Latissimus Dorsi Flap with Implant Latissimus Dorsi Flap with Implant Latissimus Dorsi Flap with Implant oadvantages onatural RESULT optosis (DROOP) oless PALPABLE IMPLANT oless ANIMATION oused IN RADIATED FIELD odisadvantages obigger OPERATION omore SCAR onumbness otricolor SKIN oshoulder WEAKNESS? Breast Implants Breast Implants omost STUDIED MEDICAL DEVICE ofda RESTRICTED USE oclaims OF DISEASES: ARTHRITIS, AUTOIMMUNE, CANCERS, FATIGUE, ETC. AllinaHealthSystems 9

10 Breast Implants oyears OF STUDY ono HIGHERINCIDENCE OFDISEASE o2006 FDA LIFTED RESTRICTIONS ocomplications STILL OCCUR HUMAN MADE DEVICES oabout 300,000 CASES / YEAR Recent Controversy Texturing oanaplastic LARGE CELL LYMPHOMA (ALCL) o3:100 MILLION WOMEN WITHOUT IMPLANTS o60 CASES IN 5 10 MILLION WITH IMPLANTS orisk 1 IN 30,000 otextured IMPLANT CHRONIC IRRITATION LYMPHOCYTES BIOFILM TIME ALCL Autologous Tissue Breast Reconstruction Autologous Tissue Breast Reconstruction otram RECONSTRUCTION (TRANSVERSE RECTUS ABDOMINUS MYOCUTANEOUS) opedicle FLAP ofree FLAP operforator FLAPS otram RECONSTRUCTION opedicle FLAP AllinaHealthSystems 10

11 Autologous Tissue Breast Reconstruction Pedicle TRAM Autologous Tissue Breast Reconstruction Autologous Tissue: Free TRAM Flap otram RECONSTRUCTION ofree FLAP OR FREE TRAM AllinaHealthSystems 11

12 Autologous Tissue Breast Reconstruction Deep Inferior Epigastric Perforator Flap (DIEP) operforator FLAPS odiep osgap oigap otug DIEP Flap Superior Gluteal Artery Perforator Flap (SGAP) Autologous Tissue Reconstruction TUG Breast Reconstruction TRANSVERSE UPPER GRACILIS FLAP (TUG) AllinaHealthSystems 12

13 Autologous Tissue Breast Reconstruction Fat Grafting FAT USED TO REFINE AND REBUILD BREAST oadvantages ono ARTIFICIALDEVICE obetter MATCH optosis oweight CHANGE odisadvantages obig SURGERY obig RECOVERY oabdominal COMPLICATIONS ohernia oweakness What Are Women Choosing? oamerican SOCIETY OF PLASTIC SURGERY PROCEDURAL STATISTICS 2014 o68,607 Tissue expanders and Implants o7471 Implants alone o5098 TRAMS o7220 DIEP Flaps o6255 Latissimus Dorsi Flap Breast Reconstruction ContraIndications ochestwall DISEASE oimminent MORTALITY ono RECONSTRUCTIVE SURGEON osmoker? oemotional/physical EXHAUSTION AllinaHealthSystems 13

14 Timing of Breast Reconstruction Breast Reconstruction oimmediate ostart AT MASTECTOMY ooneless OPERATION odelayed oknown THERAPY o?greater SATISFACTION oindications oevery WOMAN SHOULDBE OFFERED RECONSTRUCTION ouncertain THERAPY (FINAL PATHOLOGY) oradiation THERAPY otissue SHORT olive WITHOUTBREAST Most Important Fact Most Important Determinant of Breast Reconstruction osimply BEING OFFERED A VISIT TO THE PLASTIC SURGEON THANK YOU! AllinaHealthSystems 14

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