1. Autologous Free Flap Methods of Reconstruction Aldona J. Spiegel, MD February 22, 2014

2. Nipple Sparing Mastectomy

3. Once the NSM is performed how should the defect be reconstructed? – TE/ Implant – Autologous – Autologous + Implant Combination

4. Pec. Major muscle Tissue expander filled Alloderm sling Needle injecting saline Pec. Major muscle Implant (textured) Alloderm sling Fat injected behind nipple and all the way around Needle injecting fat Stages of Implant Reconstruction Fat Pec. Major muscle Tissue expander not filled Alloderm sling

5. Breast Reconstruction Flap Options TUG IGAP SGAPDIEP/SIEA

6. Innervated SIEA Flap Breast Reconstruction

7. Flap Comparison Flap Shape Tissue Characteristics AdvantagesDisadvantages SIEA Ample skin Soft fat Flat shape Easy dissection Minimal donor site morbidity Variable anatomy Vessel size mismatch Issues with arterial inflow DIEP Ample skin Soft fat Flat shape Reliable anatomy Good vessel match Issues with venous outflow SGAP Limited skin Firm Fat Elliptical shape Fat can be sculpted to improve projection Difficult dissection Vessel size mismatch especially vein

8. Stages of Flap Reconstruction Needle injecting fat Flap Artery and vein Injected fat

9. Composite Method| Post- Mastectomy Flap Pec. Major muscle Implant Fla p Artery and vein Injected fat Flap skin removed Stages of Flap and Implant Reconstruction Artery and vein