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