Editing Breast reconstruction (section)

== Techniques ==

=== '''Non-autologous''' ===

** Advantages/disadvantages
*** Shortest operating time, inpatient stay and fastest recovery
*** Hard to achieve symmetry, especially with large ptotic breasts, unless a contralateral augmentation or mastopexy is performed
*** Hard to do with radiotherapy - significantly increases complications
** Best technique for:
*** Small to moderate sized breasts
*** Minimal ptosis
*** No radiotherapy
*** Previously augmented patient
*** Bilateral mastectomy
** Tissue expander then change to implant
*** Often placed in submuscular plane
*** Six months after finishing radiotherapy, or 2-3 months later if no radiotherapy
** Direct-to-implant
*** One-stage may be appropriate in fit patients with minimal risk factors for healing

=== '''Autologous reconstruction''' ===

** More natural appearance, feel and durability
** Can be done immediate or delayed
** Best technique for:
*** Moderate to large breast size with ptosis
*** Suitable donor sites
*** Radiotherapy has been given or is planned
** Latissimus myocutaneous flap
*** Based on thoracodorsal vessels, tunnelled through axilla
*** Either muscle-only, or muculocutaneous
*** Technique
**** Dissect on LD anterior border, then find thoracodorsal pedicle
**** Fashion a high axillary tunnel
**** Transfer pedicle to mastectomy wound
*** Advantages - natural look, increases/decreases in proportion to body fat composition (more than TRAM and DIEP), ages with patient
*** Disadvantage - latissimus dorsi weakness, longer surgery, more than one scar
***
** TRAM - transverse rectus abdominis myocutaneous flap
*** Pedicled TRAM is just rotated through into chest
*** Free TRAM is detached, reattached to vascular supply in chest
*** Often requires mesh reconstruction of abdo wall
*** Blood supply from deep superior epigastric
*** Advantage - natural look, increases/decreases in proportion to body fat composition, ages with patient
*** Disadvantage - abdominal weakness, disrupts abdominal wall planes, increased risk of abdominal hernia
** DIEP - deep inferior epigastric perforator flap
*** Skin and fat of abdo wall
*** Blood supply off inferior epigastric vessels without removal/destruction of rectus muscle or fascia
*** Advantage - natural look, increases/decreases in proportion to body fat composition, ages with patient
*** Disadvantages - requires vascular anastomosis, risk of flap necrosis
**
** SIEA - superficial inferior epigastric artery flap
*** Higher failure rate than others
** Transverse upper gracilis flap (TUG)
*** Thigh free flap
*** Only works with small breasts
* Combination
* Symmetrising surgery
** Mastopexy
** Breast and skin reduction
** Augmentation mammoplasty