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Autologous breast reconstruction with the profunda artery perforator (PAP) flap

Synopsis ■ The profunda artery perforator (PAP) flap is a favorable flap for autologous breast reconstruction, leaving a donor scar in the upper medial thigh, depending on design. ■ Preoperative imaging with computed tomography angiography or magnetic resonance angiography is a useful adjunct in surgical planning and efficiency. ■ The dissection of the PAP flap is straightforward through the adductor magnus muscle, providing a mean pedicle…

Autologous breast reconstruction with medial thigh flaps

Access video and video lecture content for this chapter online at Elsevier eBooks+ Introduction The transverse upper gracilis (TUG) flap, also known as the transverse musculocutaneous gracilis (TMG) flap, with the variations in flap design, is a useful donor site when abdominal flaps are not an option. Careful patient selection is essential for optimal breast and donor site outcomes. This flap can be harvested in the…

Gluteal free flaps for breast reconstruction

Access video and video lecture content for this chapter online at Elsevier eBooks+ Introduction Replacing tissue loses in kind is essential to achieve functionally and aesthetically pleasing outcomes in all aspects of plastic surgery; therefore, the ideal tissue for breast reconstruction is fat with or without skin. In the last two decades, with advancement in microsurgical techniques, perforator flaps have allowed the transfer of a patient’s…

Introduction to autologous reconstruction with alternative free flaps

Introduction As autologous breast reconstruction increases in demand, alternative flaps continue to evolve. For the majority of patients, the abdomen is the preferred donor site primarily because patients often benefit from the improvement in contour and the relative ease of harvesting abdominal flaps. In addition, the abdomen provides the option of pedicle flaps and free tissue transfer. In some patient, the abdomen may not be available…

Autologous breast reconstruction with the superficial inferior epigastric artery (SIEA) flap

Introduction The superficial inferior epigastric artery (SIEA) flap is very attractive for breast reconstruction because it provides the soft, pliable, and often abundant, skin and subcutaneous tissue from the lower abdominal donor site, just like the free or pedicled transverse rectus abdominis (TRAM) flap, and the deep inferior epigastric artery (DIEP) flap (see Figs. 32.1F & 32.2D ). The advantage of the SIEA flap over the…

Autologous breast reconstruction with the free TRAM flap

Access video content for this chapter online at Elsevier eBooks+ Introduction The free transverse rectus abdominis myocutaneous (TRAM) flap is derived from the lower abdominal soft tissues and evolved from the pedicle TRAM flap and is the precursor to the deep inferior epigastric perforator (DIEP) flap. The success of the free TRAM flap has been the basis for microsurgical success and demonstrated to be extremely useful…

Autologous breast reconstruction with the DIEP flap

Access video content for this chapter online at Elsevier eBooks+ Introduction The deep inferior epigastric perforator (DIEP) flap was first introduced by Koshima and Soeda in 1989 and popularized for postmastectomy reconstruction by Treece and Allen in 1994. It has become the most recognized perforator flap today, and although it has been described for reconstruction of a wide variety of defects, including those of the head…

Breast reconstruction with the latissimus dorsi flap

Access video and video lecture content for this chapter online at Elsevier eBooks+ Introduction Breast reconstruction has undergone a transformation over the past 40 years. Techniques in soft tissue management and improvements in tissue expander and implant design have advanced to the point where the subtle and artistic forms that define the female breast can be preserved and even improved upon after mastectomy. Central to the…

Breast reconstruction with the pedicle TRAM flap

Access video content for this chapter online at Elsevier eBooks+ Introduction The goal of breast reconstruction is to give patients the opportunity to move beyond breast cancer and mastectomy by creating symmetric and naturally appearing breasts. One method of reconstruction that has been utilized for decades is the transverse rectus abdominis myocutaneous (TRAM) flap. This method of reconstruction, when utilized as a pedicled flap, is based…

Secondary refinement procedures following prosthetic breast reconstruction

Access video content for this chapter online at Elsevier eBooks+ Introduction In the last few years, an increased demand for improvement in aesthetic results of breast reconstruction has pushed plastic and oncological surgeons to find new strategies. A turning point in breast reconstruction was represented by Angelina Jolie’s New York Times article in May 2013, because from then on a growing number of patients were aware…

Management of complications of prosthetic breast reconstruction

Access video content for this chapter online at Elsevier eBooks+ Introduction Each year over 2 million women are diagnosed with breast cancer, the single-most common cancer diagnosis. Fortunately it is also among the most treatable with survival rates as high as 84% in 10 years. Nonetheless, definitive treatment, including mastectomy or breast-conserving therapy, may come at the cost of often significant psychosocial distress. Between 30% and…

Skin reduction using “smile mastopexy” technique in breast reconstruction

Access video content for this chapter online at Elsevier eBooks+ Introduction Implant-based immediate breast reconstruction continues to gain popularity with patients due to the improved cosmesis. Contributing to this improvement is the preservation of most, if not all, of the skin envelope and the nipple–areolar complex (NAC). In 1991, Toth and Lappert introduced the idea of preoperative plastic surgery planning and skin-saving techniques in patients undergoing…

Two-stage prosthetic reconstruction with total muscle coverage

Introduction In reconstructive breast surgery, the surgeon strives to recreate a breast that looks and feels like a natural breast. Thus, the ideal reconstructive technique will create a breast mound with a natural contour, natural consistency, and minimal scarring. Ideally symmetry, with respect to the size and shape of the contralateral breast, will be achieved. Implant reconstruction has the distinct advantage of combining a lesser operative…

Two-stage dual-plane reconstruction with prosthetic devices

History Current state of alloplastic breast reconstruction The current standard of care in alloplastic breast reconstruction has been developed over several decades to encompass a variety of different techniques. Despite significant variation in procedures today, several principles remain steadfast across the spectrum of implant-based breast reconstruction. These critical factors include the quality of the mastectomy and vascularity of the skin flaps, prosthesis choice and handling, pocket…

One-stage dual-plane reconstruction with prosthetic devices

Access video and video lecture content for this chapter online at Elsevier eBooks+ Introduction Background Recent innovations in surgical technique and technology have expanded the breast reconstruction options available to plastic surgeons. There are often numerous suitable modalities for a given patient. To select the optimal treatment, one must have a thorough understanding of the advantages and disadvantages of each technique within the context of individualized…

One- and two-stage prepectoral reconstruction with prosthetic devices

Access video lecture content for this chapter online at Elsevier eBooks+ One-stage prepectoral reconstruction Breast cancer is among the most common cancers diagnosed in women, affecting one in eight women per year. Immediate implant-based breast reconstruction is the leading technique for postmastectomy reconstruction, trending toward direct-to-implant (DTI) as the preferred method when compared with the traditional tissue expander method. Although implants are generally placed beneath the…

Introduction to prosthetic breast reconstruction

Introduction Since the previous edition of this text, there have been significant advancements and setbacks when it comes to prosthetic breast reconstruction. One of the most notable advancements has been the technique of prepectoral placement of prosthetic devices that has now become an acceptable option for prosthetic breast reconstruction. On the other hand, a significant setback has occurred when it comes to the availability of certain…

Perfusion assessment techniques following mastectomy and reconstruction

Access video content for this chapter online at Elsevier eBooks+ Introduction The benefits of breast reconstruction after mastectomy can be profound, and often include improved quality of life, self-perceived body image, and sexuality. Coupled with recent data from the American Cancer Society demonstrating that breast cancer has now become the most commonly diagnosed cancer in the world, with 2.3 million people receiving new diagnoses in 2020…

Preoperative evaluation and planning for breast reconstruction following mastectomy

Introduction Breast cancer is the most common malignancy in women, and it is estimated that 1 in 8 women (13%) will be diagnosed with invasive breast cancer during their lifetime. Surgery, either breast conservation (lumpectomy and radiation) or mastectomy, is part of the treatment algorithm for breast cancer. Despite equivalent survival, patients with breast cancer are increasingly electing for mastectomy due to a desire for symmetry,…