Breast Reconstruction Options

Question 1

Reconstruction Options Breast Cancer

Answer 1

• Tissue expander/permanent implant
• Autologous Reconstruction (Skin Graft/Flaps)

Question 2

Tissue Expander/Permanent Implant

Answer 2

Balloon like expander under skin

• Saline injected weekly over 6-8 weeks
• Permanent implant placed
• Potential complications are hemtoma, infection, implant leakage

Question 3

Skin Grafts/Flaps

Answer 3

A technique in which tissue is partially or completely detached from its blood supply at the donor site and reattached by micro-vascular anastomosis to arteries and veins at the recipient site

• Skin
• Subcutaneous tissues
• Muscle
• Omentum (tissue surrounding abdominal organs)
• Bone
• Combination of tissues

Question 4

Priority nursing diagnosis for a pt. with skin graft/flap

Answer 4

Risk for peripheral neurovascular dysfunction r/t vascular obstruction

Circulation*

Question 5

Priority outcomes for skin graft/flap

Answer 5

Doppler at all times (circulation)

Question 6

Nursing Interventions for skin graft/flap

Answer 6

1. Assess circulatory status to graft site (***PRIORITY***)- per protocol
   
   1. Pulses (doppler)
   2. Skin Color
   3. Temperature
   4. Edema
   5. Capillary Refill
2. Maintain adequate circulatory volume to promote circulation
   
   1. Liters/day PO/IV fluids
   2. Assess I/O, BP
   3. Keep patient and environment warm
3. Maintain graft patency and prevent clot formation in flap vasculatrue
   
   1. avoid pressure on the site with proper positioning
   2. maintain JP patency, empty 1/3 full
   3. Administer prophylactic anticoagulants as ordered
4. Prevent infection
5. Medicate for pain
6. Teach signs and symptoms to report

Donor Site: prevent infection and medicate for pain

Question 7

Types of Autologous Reconstruction

Answer 7

1. Deep Inferior Epigastric Reconstruction
2. Transverse Rectus Abdominis Myocutaneous (TRAM)
   
   1. Pedicled Flap
   2. Free Flap

Question 8

Deep Inferior Epigastric Reconstruction

Answer 8

only skin, fat, and blood vessels transplanted. No abdominal muscle is used

Question 9

Transverse Rectus Abdominis Myocutaneous

Answer 9

Patient’s own skin, fat, and muscle are transfered to create breast mound.

Question 10

Free Flap

Answer 10

Smaller portion of muscle removed along with blood vessels which are reconnected by micro vasculary surgery

Question 11

Pedicled Flap

Answer 11

Skin, fat, and entire rectus abdominis muscle are tunneled under the skin while remaining attached to its blood supply

Question 12

Potential post-op problems r/t graft/flap reconstruction procedures

Answer 12

total or patial flap loss due to seroma, hematoma, vascular obstruction, infection, abdominal hernia

Question 13

Which autologous reconstruction procedure has the highest risk for clot development and why?

Answer 13

Free flap because the blood vessels have been severed and reattached

Question 14

Nursing implications due to abdominal incision and removal of transrectus abdominal muscle

Answer 14

1. Assess incision and drains, pain
2. abdominal binder
3. ambulate with stooped position (walker may be used)
4. splint during TCDB exercises every 1-2 hours