NEW TECHNIQUES IN BREAST RECONSTRUCTION

Transcription

1 NEW TECHNIQUES IN BREAST RECONSTRUCTION J Van Geertruyden and J-V Berthe Plastic Surgery Erasme University Hospital and Clinique Edith Cavell Brussels

2 What s new in breast reconstruction? New materials and new techniques Technical refinements. Better approach of the patients.

3 New techniques Systematic multidisciplinary team approach. Breast care units, including plastic surgeon. «Oncoplastic» surgery.

4 New techniques = new applications of old techniques Systematic multidisciplinary team approach. Breast care units, including plastic surgeon. «Oncoplastic» surgery.

5 These patients had a breast cancer

6 These patients had also a breast cancer

7 New techniques = new applications of old techniques Systematic multidisciplinary team approach. Breast care units, including plastic surgeon. «Oncoplastic» surgery.

8 New techniques = new applications of old techniques Systematic multidisciplinary team approach Immediate reconstruction.

9 Old techniques in new developments Systematic multidisciplinary team approach. Immediate reconstruction

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11 Old techniques in new developments Systematic multidisciplinary team approach. Breast care units, including plastic surgeon. «Oncoplastic» surgery.

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13 Old techniques in new developments «Oncoplastic» surgery. Better cosmetic (and functionnal) results Mammaplasty techniques Symetrisation Avoiding mastectomies Immediate reconstruction

14 Advances in autologous breast reconstruction Perforator free flaps. Less donor site morbidity Better blood supply

15 Advances in autologous breast reconstruction Perforator flaps. Less donor site morbidity Better blood supply

16 Advances in autologous breast reconstruction Perforator flaps. Less donor site morbidity Better blood supply

17 Advances in autologous breast reconstruction Perforator flaps. Less donor site morbidity Better blood supply Preoperative perforators imaging Reduce operative time Better blood supply

18 Advances in implant breast reconstruction Numerous shapes and volumes Cohesive gel Less capsular contracture Long lasting results

19 Advances in implant breast reconstruction Numerous shapes and volume Cohesive gel Less capsular contracture Long lasting results

20 Advances in implant breast reconstruction Numerous shapes and volume Cohesive gel Less capsular contracture Long lasting results

21 New techniques in breast reconstruction? Lipofilling = fat transfer

22 Breast lipofilling Old technique of fat transfer revisited Recent developments, several trials Controversial

23 Historic of fat injections Neuber (1893) : scar filling. Illouz (1977) : liposuccion Coleman (1997) : Lipostructure small quantities, multiple tunnels -> revascularisation

24 Technique Harvesting 10cc luer-lock syringe Canules 12G General vs local anaesthesia

25 Technique Preparation Centrifugation 3 minutes 3400 r / m 3 phases oil fat (80%) blood (xylocaïne)

26 Technique Injection Canules: 18G Syringes 1cc

27 Technique Injection Crossing tunnels Multiple plans Modeling

28 Breast lipofilling : indications Improving results of breast reconstructed by flap or implant. Reconstruction of mild lumpectomy defects.

29 Improving results

30 Improving results

31 Breast lipofilling

32 Breast lipofilling

33 Breast lipofilling

34 Lipofilling Controverses Donor site Local anaesthetics : Y or N Technique for harvesting : aspiration, syringe, canula Preparation and purification: washing, centrigugation.. Conservation (cryo, insulin, GF..)

35 Lipofilling Drawbacks and risks Graft survival variable : % Fat necrosis Irregularities, migration Mammographic findings?

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39 Lipofilling : what really happens?

40 Lipofilling : what really happens?

41 Adipose Stem Cells and Plastic Surgery

42 Adipose Stem Cells and Plastic Surgery Aspirated fat Adipose derived stem cell Stem cells Regeneration Differentiation Angiogenesis

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45 Breast lipofilling : indications Improving results of breast reconstructed by flap or implant. Reconstruction of mild lumpectomy defects. Breast augmentation. Improving radiotherapy damages.

46 Adipose Stem Cells and Plastic Surgery

47 Adipose Stem Cells and Plastic Surgery : A dream comes true? Studies in progress Controversial

48 Fat injections Stem Cells (SC) Futur?

49 FUTUR OF BREAST RECONSTRUCTION? Tissue engineering Tissue (re)generation on scaffold Ex vivo modeling Secondary implantation

50 CONCLUSIONS

51 NEW TECHNIQUES IN BREAST RECONSTRUCTION J Van Geertruyden and JV Berthe Plastic Surgery Erasme University Hospital and Clinique Edith Cavell Brussels Better team approach Surgical refinements Implants evolutions New technologies

52 BELGIAN BREAST MEETING 2018? NEW TECHNIQUES IN BREAST RECONSTRUCTION REGENERATION J Van Geertruyden and JV Berthe Plastic Surgery Erasme University Hospital and Clinique Edith Cavell Brussels

53 THANK YOU FOR YOUR ATTENTION