NEW TECHNIQUES IN BREAST RECONSTRUCTION J Van Geertruyden and J-V Berthe Plastic Surgery Erasme University Hospital and Clinique Edith Cavell Brussels
What s new in breast reconstruction? New materials and new techniques Technical refinements. Better approach of the patients.
New techniques Systematic multidisciplinary team approach. Breast care units, including plastic surgeon. «Oncoplastic» surgery.
New techniques = new applications of old techniques Systematic multidisciplinary team approach. Breast care units, including plastic surgeon. «Oncoplastic» surgery.
These patients had a breast cancer
These patients had also a breast cancer
New techniques = new applications of old techniques Systematic multidisciplinary team approach. Breast care units, including plastic surgeon. «Oncoplastic» surgery.
New techniques = new applications of old techniques Systematic multidisciplinary team approach Immediate reconstruction.
Old techniques in new developments Systematic multidisciplinary team approach. Immediate reconstruction
Old techniques in new developments Systematic multidisciplinary team approach. Breast care units, including plastic surgeon. «Oncoplastic» surgery.
Old techniques in new developments «Oncoplastic» surgery. Better cosmetic (and functionnal) results Mammaplasty techniques Symetrisation Avoiding mastectomies Immediate reconstruction
Advances in autologous breast reconstruction Perforator free flaps. Less donor site morbidity Better blood supply
Advances in autologous breast reconstruction Perforator flaps. Less donor site morbidity Better blood supply
Advances in autologous breast reconstruction Perforator flaps. Less donor site morbidity Better blood supply
Advances in autologous breast reconstruction Perforator flaps. Less donor site morbidity Better blood supply Preoperative perforators imaging Reduce operative time Better blood supply
Advances in implant breast reconstruction Numerous shapes and volumes Cohesive gel Less capsular contracture Long lasting results
Advances in implant breast reconstruction Numerous shapes and volume Cohesive gel Less capsular contracture Long lasting results
Advances in implant breast reconstruction Numerous shapes and volume Cohesive gel Less capsular contracture Long lasting results
New techniques in breast reconstruction? Lipofilling = fat transfer
Breast lipofilling Old technique of fat transfer revisited Recent developments, several trials Controversial
Historic of fat injections Neuber (1893) : scar filling. Illouz (1977) : liposuccion Coleman (1997) : Lipostructure small quantities, multiple tunnels -> revascularisation
Technique Harvesting 10cc luer-lock syringe Canules 12G General vs local anaesthesia
Technique Preparation Centrifugation 3 minutes 3400 r / m 3 phases oil fat (80%) blood (xylocaïne)
Technique Injection Canules: 18G Syringes 1cc
Technique Injection Crossing tunnels Multiple plans Modeling
Breast lipofilling : indications Improving results of breast reconstructed by flap or implant. Reconstruction of mild lumpectomy defects.
Improving results
Improving results
Breast lipofilling
Breast lipofilling
Breast lipofilling
Lipofilling Controverses Donor site Local anaesthetics : Y or N Technique for harvesting : aspiration, syringe, canula Preparation and purification: washing, centrigugation.. Conservation (cryo, insulin, GF..)
Lipofilling Drawbacks and risks Graft survival variable : 40 100 % Fat necrosis Irregularities, migration Mammographic findings?
Lipofilling : what really happens?
Lipofilling : what really happens?
Adipose Stem Cells and Plastic Surgery
Adipose Stem Cells and Plastic Surgery Aspirated fat Adipose derived stem cell Stem cells Regeneration Differentiation Angiogenesis
Breast lipofilling : indications Improving results of breast reconstructed by flap or implant. Reconstruction of mild lumpectomy defects. Breast augmentation. Improving radiotherapy damages.
Adipose Stem Cells and Plastic Surgery
Adipose Stem Cells and Plastic Surgery : A dream comes true? Studies in progress Controversial
Fat injections Stem Cells (SC) Futur?
FUTUR OF BREAST RECONSTRUCTION? Tissue engineering Tissue (re)generation on scaffold Ex vivo modeling Secondary implantation
CONCLUSIONS
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
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
THANK YOU FOR YOUR ATTENTION jvangeer@ulb.ac.be