Breast reconstruction can be done immediately during mastectomy or delayed after adjuvant therapy completion. Immediate reconstruction provides better cosmetic outcomes and early psychological benefits, while delayed allows more time for consideration and ensures therapy is done. Techniques include expanders/implants, latissimus dorsi flaps, TRAM/DIEP flaps, and fat grafting. Each option has pros and cons like operating time, recovery duration, and risks of complications or donor site morbidity that require considering patient factors and desires. A multidisciplinary team can help personalize the optimal reconstructive approach.
2. Breast ReconstructionBreast Reconstruction
Immediate (with mastectomy)Immediate (with mastectomy)
Better cosmetic outcomesBetter cosmetic outcomes
CheaperCheaper
Early Psychological benefitEarly Psychological benefit
DelayedDelayed
Patient has more time to consider optionsPatient has more time to consider options
Adjuvant therapy completedAdjuvant therapy completed
Higher long term patient satisfaction ratesHigher long term patient satisfaction rates
3. Skin sparing mastectomy for immediate reconstructionSkin sparing mastectomy for immediate reconstruction
4. Techniques in BreastTechniques in Breast
ReconstructionReconstruction
Expander/ImplantExpander/Implant
Latissimus Dorsi (LD)Latissimus Dorsi (LD)
TRAM / DIEPTRAM / DIEP
Other free flaps – SGAP, IGAP, TUGOther free flaps – SGAP, IGAP, TUG
lipomodelinglipomodeling
5. Implant ReconstructionImplant Reconstruction
2 stage:2 stage:
Tissue expander then permanent siliconTissue expander then permanent silicon
implantimplant
1 stage:1 stage:
Permanent expander-implantPermanent expander-implant
Permanent implant with dermal sling orPermanent implant with dermal sling or
Acellular dermal matrixAcellular dermal matrix
6. 2 stage implant reconstruction2 stage implant reconstruction
Delayed and immediateDelayed and immediate
Submuscular tissueSubmuscular tissue
expanderexpander
Serial expansionSerial expansion
Change to permanentChange to permanent
silicone implantsilicone implant
9. AAdvantagesdvantages
Short operating timeShort operating time
and recoveryand recovery
Low complication rateLow complication rate
No donor siteNo donor site
morbiditymorbidity
Normal appearance inNormal appearance in
clothingclothing
10. DDisadvantagesisadvantages
2 operations2 operations
No ptosisNo ptosis
No change with bodyNo change with body
weight/ageweight/age
Feels coldFeels cold
Late complicationsLate complications
RadiotherapyRadiotherapy
11. Immediate implant with dermal slingImmediate implant with dermal sling
Wise pattern mastectomyWise pattern mastectomy
Lower pole skin de-Lower pole skin de-
epithelialised & sutured toepithelialised & sutured to
lower edge pectoralislower edge pectoralis
Ptotic breastsPtotic breasts
Patients requestingPatients requesting
reductionreduction
Risk reductionRisk reduction
mastectomymastectomy
20. Pros and ConsPros and Cons
Operating time 4-5Operating time 4-5
hourshours
Stay 4 daysStay 4 days
Recovery 4-5 weekRecovery 4-5 week
Safe and reliable flapSafe and reliable flap
Can be irradiated ifCan be irradiated if
autologousautologous
Donor site scar andDonor site scar and
morbiditymorbidity
TwitchingTwitching
SeromaSeroma
Flap failureFlap failure
Flap atrophyFlap atrophy
21. LD with implantLD with implant
Preop immediate LD + Implant 2 years postop
Preop delayed LD + Implant 2 years postop
25. Pros and ConsPros and Cons
Larger reconstructionLarger reconstruction
Muscle sparingMuscle sparing
Natural feel &Natural feel &
consistencyconsistency
““tummy tuck”tummy tuck”
longer operating timelonger operating time
higher risk of flap losshigher risk of flap loss
donor site morbiditydonor site morbidity
donor site scardonor site scar
26.
27.
28. Fat graftingFat grafting
Autologous fat transfer / LipomodelingAutologous fat transfer / Lipomodeling
Fat removed by liposuction from areas of excessFat removed by liposuction from areas of excess
Centrifuged in theatre to remove blood and deadCentrifuged in theatre to remove blood and dead
cellscells
Injected into breastInjected into breast
Can be used with other types of reconstructionCan be used with other types of reconstruction
Can be used to correct defects after breastCan be used to correct defects after breast
conserving surgery or failed reconstructionconserving surgery or failed reconstruction
Low morbidityLow morbidity
32. Fat transfer for breast conserving surgery defectFat transfer for breast conserving surgery defect
33. Fat transfer alone for reconstructionFat transfer alone for reconstruction
34. SummarySummary
Reconstruction benefits patientsReconstruction benefits patients
Wide range of optionsWide range of options
Patient selection is keyPatient selection is key
““Reconstructive ladder”Reconstructive ladder”