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
