Transcript
Breast Reconstruction
Supporting People With Breast Cancer
Jane RothwellSt. Vincent’s University Hospital
Outline
The “Big Questions” How these decisions are made Reconstruction of the “conserved
breast”
The Big Questions
Mastectomy v Breast Conservation Immediate v Delayed
Reconstruction Type of reconstruction
Mastectomy v Breast Conservation
Patient factors Breast factors Tumour factors
Mastectomy v Breast ConservationPatient factors
Patient choice General health Suitability for radiotherapy Dealing with “risk” Personal history Family history
Mastectomy v Breast ConservationBreast factors
Size Shape Location of tumour in breast
Mastectomy v Breast Conservation“Tumour” factors
Size – actual Size – relative to size of breast Single or multifocal Type of tumour Site within breast
Site of tumour
Immediate v Delayed Reconstruction
Patient choice Radiotherapy Other medical conditions Smoking Extent of disease
Immediate v Delayed Reconstruction - Radiotherapy
Tumour size Skin involvement Nodal disease Inflammatory cancer
Immediate v Delayed Reconstruction - Radiotherapy
Pseudocapsule formation Capsular contracture Skin changes Infection Need for further surgery
Type of Reconstruction
Patient choice Body size and shape Patient expectations Patient lifestyle Breast size and shape Potential for multiple procedures General condition
Type of Reconstruction
Own tissue (autologous) Own tissue with implant or
expander Implant or expander with “other
tissue” Implant or expander alone
Type of reconstruction - Autologous
DIEAP – Deep inferior epigastric artery perforator flap
Tissue from tummy No implant needed Longer surgery
DIEAP Flap Reconstruction
DIEAP Flap Reconstruction
Latissimus Dorsi Flap Reconstruction
Latissimus Dorsi Flap Reconstruction
Tissue Expander Reconstruction
Tissue Expander Reconstruction
Restoration / Reconstruction of the conserved breast
Reasons why “reconstruction” required: Size Shape Nipple problems Asymmetry Site of scar / defect
Restoration / Reconstruction of the conserved breast
Restoration / Reconstruction of the conserved breast
Restoration / Reconstruction of the conserved breast - options
Mastectomy and reconstruction Latissimus Dorsi flap Symmetry surgery on other breast Implant Fat injection
Summary
The big questions: Whether it is best to conserve the
breast or have mastectomy Is immediate or delayed reconstruction
appropriate What type of reconstruction is best for
you
Conclusion
Reconstruction is relevant for all women who have had surgery, even breast conservation
The decision-making is complex, with all patients treated to best standard of care for them
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