35 - Breast reconstruction Flashcards
Brest reconstruction is usually made at the same __ its resected, beside when __ is necessary or high risk for complications.
surgery
adjuvant radiation
What are the 5 methods of breast reconstruction?
- tissue expander placement with later exchange for an implant
- immediate permanent implant placement
- latissimus dorsi with implant
- autologous tissue (pedicle)
- autologous tissue (free)
What are the contraindication for breast reconstruction? 4
very old age
severe comorbidity (e.g. cardiac)
morbid obesity
advanced breast disease
Implant based reconstruction requires enough __. It is __ and has __ complications.
skin
fast
few
What are the indications for implant based reconstruction? 3
bilateral reconstruction
desired breast enlargement
lack of abdominal tissue/less scars
What are the contraindications for implant based reconstruction? 6
young age (implants need replacement) refusal for follow-up tissue insufficiency (large/loose) silicone allergy previous implant failure adjuvant radiation
Combination reconstruction involves __ skin transplantation + permanent __. We use a muscle flap from the __.
autologous
implant
latissimus dorsi
What are the indications for combination reconstruction? 2
small/loose breast
after breast reconstruction failure
Autologous reconstruction- use the TRAM (__).
transversus abdominis myocutaneous flap
Pedicle TRAM involves the __ muscles on one side. The blood supply continues to arrive from the __ artery.
rectus abdominis
inferior epigastric
What are the disadvantages of pedicle TRAM procedure? 3
high metabolic requirement leading to flap necrosis
long recovery
increased risk for abdominal hernia (leave mesh)
Free TRAM procedure involves completely removing the __ tissue together with __ and __, raising them to the breast area. Using microsurgery we connect the vessels to the __ artery. Less flap __.
lower abdomen rectus inferior epigastric arteries internal thoracic necrosis
DIEP (__) flap has less risk for __.
deep inferior epigastric artery perforator
hernia
SIEP (__) does not involve the __ or its __.
superficial inferior epigastric artery perforator
muscle
fascia
Which women usually go through gluteal based flap?
thin
What are the risk factors for breast reconstruction?
radiation
smoking
obesity
implant based
Name the main breast reconstruction complications: 4
implant (infection/seroma)
flap loss/necrosis
latissimus dorsi flap seroma
hernia/fat necrosis
