Breast Reconstruction surgery

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Immediate and Delayed Breast Reconstruction
Following mastectomy for breast cancer, reconstructive surgery reduces anxiety and thereby improves the quality of life for many women. Breast reconstruction can be done at the time of the mastectomy (immediate breast reconstruction), or at any time after the mastectomy (delayed breast reconstruction). In recent years, immediate breast reconstruction has gained wider acceptance. Breast reconstruction can be performed using either prostheses or autogenous tissue. There are several options available for those patients choosing prostheses. A permanent prosthesis can be placed at the time of mastectomy.Alternatively, an expander can be placed, and inflated gradually over a period of several weeks by injecting solution through a port.This results in the creation of a ptosis. The injectable port and expander are then removed and replaced with a permanent prosthesis, or, in some cases, the expander is left in place as the permanent prosthesis.

Placement of Definitive Prosthesis
Immediate breast reconstruction following mastectomy can be achieved with placement of a definitive prosthesis within the muscular pocket This pocket is comprised of the pectoralis and serratus anterior muscles. Once the prosthesis is placed in the muscular pocket, the pocket should be closed with absorbable stitches.However, if the pectoralis muscle is wide enough, and if the lateral aspect of the skin is well supplied with blood, the muscular pocket can be left open laterally after placement of the prosthesis. Two Jackson-Pratt drains are generally left in the muscular pocket and brought out laterally after closure of the wound These drains are hooked to bulb suction, and removed postoperatively once drainage is minimal (about 30 ml/day from each drain).

Breast Reconstruction with Expander
A muscular pocket is created, as described previously for placement of a definitive prosthesis. The pocket is comprised of the pectoralis major and serratus anterior muscles. The expander is placed in the muscular pocket and the catheter and port are tunneled and brought to a position under the skin in the axilla.

Suspension Technique
If a permanent prosthesis is to be placed following a mastectomy, the cosmetic appearance can often be improved with the "suspension technique."

Nipple Reconstruction

The creation of a nipple-areola complex following breast reconstruction improves the cosmetic outcome, and many patients may request such a procedure. The most popular technique for nipple reconstruction combines a tattoo procedure with a small triangular skin flap that is often referred to as a skate flap.

Excerpts from Atlas of Breast Surgery

Tips and tricks

Position of the definitive prothesis. After definitive substitution with a definitive prothesis same stiches in the sulcus improve the natural ptosis.

The ptosis is achieved with gradual inflation of the prosthesis by injecting saline solution through the port once or twice each week over a period of several weeks. An over-expansion is recommended by many surgeons, in order to gain the additional tissue required for a more natural ptosis.

Latissimus Dorsi Flap to Repair Glandular Defects Following Quadrantectomy
Following breast-conserving surgery, a large glandular defect in the upper outer quadrant can be repaired with a latissimus dorsi flap tunneled into the wound. The tissue bulk provided by the latissimus flap improves the cosmetic outcome following breast-conserving surgery

Mastopexy
A mastopexy, also referred to as a "breast lift,". This technique often produces an immediate good result, but the mastopexy is generally not stable, and long-term results are often not good.

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	Suspension technique Immediate breast reconstruction using the "suspension technique". A new mammary fold is created to bring tissue up before putting in a prosthesis. Serratus muscle is brought up and pectoralis muscle brought down to create a pocket for a prosthesis.
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