PATHWAYS OF BREAST RECONSTRUCTION

Tissue expanders

• • • Tissue expander is a specialized type of implant that has a port located inside of it that allows fluid to be injected (Tissue Expander Expansion Completed In Office) so that
      the size of the expander can slowly increase over time which will stretch the skin to create a “pocket” for the implant or the reconstructed breast under the skin. This
      creates space so that eventually in a second stage at a later date, it is possible to put a larger Implant into the breast or to perform Autologous Based Reconstruction to
      complete the reconstruction.
    • Immediate tissue expander placement
      • • To IMPLANT based reconstruction
        • To AUTOLOGOUS based reconstruction

Implants

• • • Direct to implant
    • A breast implant is a round, flexible silicone shell filled with either saline (salt water) or silicone gel. Breast implants can either be placed over the chest muscle
      (pectoralis) or underneath part or all of the chest muscle. The implant replaces the breast tissue that is removed during the mastectomy, restoring the shape and
      volume of the breast.

Pedicled flaps

Majority of pedicled flaps classically utilized in breast reconstruction are the latissimus dorsi (from back) or rectus abdominus (from abdomen). A flap is tissue preserved on its blood supply. In pedicled flaps, the blood supply is not disrupted and reestablished. The disadvantage of the commonly used pedicled flaps are related to donor site when rectus abdominus is used and partial flap loss. Disadvantages of latissimus dorsi flap is mild weakness in arm flexion (or downward force) and this flap generally does not have ample tissue to recreate an adequate breast mound by itself.

• • • Muscle
      • • Latissimus Dorsi Flap
        • TRAM Flap
    • Muscle sparing
      • • Muscle Sparing TRAM Flap

Perforator free flaps

Botched Breast Reconstruction Repair

Oncoplastic Reduction

• • • Larger breasts that do not require a mastectomy and only a portion of the breast needs to be removed, a reduction can be performed. Generally reduction techniques are used to lift the nipple position and to remove excess breast tissue and overlying skin.