1. Breast Reconstruction Hemant Singhal FRCSEd FRCS(Gen) FRCSC Consultant Surgeon Senior Lecturer (Hon) Imperial College School Of Medicine These PowerPoint presentations are free to download only for academic purposes, with due acknowledgements to authors and this website.

2. March 2005 HEMANT SINGHAL Breast Reconstruction  Who should have it  When  How  Who will do it  What can we hope to achieve

3. March 2005 HEMANT SINGHAL Who should have it?  Everyone?  What about the elderly  Are there any disadvantages Costs Systemic disease Time of operation Pathology results Subsequent treatments

4. March 2005 HEMANT SINGHAL When?  Primary reconstruction One operation Patient goes home with a breast Full details of treatment not known  Delayed reconstruction Can get a good comparison with an extrnal prosthesis

5. March 2005 HEMANT SINGHAL How? Methods of reconstruction  Volume displacement  Volume replacement For wide local excision For mastectomy  Flaps Lat dorsi Rectus abdominis Free flaps

6. March 2005 HEMANT SINGHAL Who will do it?  Breast & Cancer Surgeon Issues with timing Numbers Training  Plastic Surgeon  Cosmetic Surgeon

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15. March 2005 HEMANT SINGHAL How?  Lets have the mound  Develop the ptosis  Nipple areola reconstruction  Getting symmetry  Contralateral procedures

16. March 2005 HEMANT SINGHAL Submuscular breast reconstruction This is a straightforward method of breast reconstruction. During the operation an implant is placed beneath the muscles which cover the chest. The scar is usually horizontal or oblique and in the same place as a mastectomy scar. A submuscular reconstruction may be offered to women who have a fairly small breast with little natural droop.

17. March 2005 HEMANT SINGHAL  The prosthesis  Needs expansion  Overinflation  Correct size  Remove the valve

18. March 2005 HEMANT SINGHAL Subpectoral implant It is unsuitable for women: with large breasts who have had a radical mastectomy with the removal of the chest wall muscles who have had radiotherapy, because the skin is unlikely to stretch enough to take an implant of the correct size.

19. March 2005 HEMANT SINGHAL Subpectoral implant  Gradual expansion  May take 6 months  Operation to remove port

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21. March 2005 HEMANT SINGHAL LD Flap

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32. March 2005 HEMANT SINGHAL Nipple reconstruction

33. March 2005 HEMANT SINGHAL Nipple reconstruction

34. March 2005 HEMANT SINGHAL The result

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36. March 2005 HEMANT SINGHAL Bilateral skin sparing Implants with LD flaps

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