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2008 breast reconstruction (aust)
- 1. Breast Reconstruction: Decision Making Surgical Planning Michael J. Miller, M.D. Professor of Surgery Director, Division of Plastic Surgery The Ohio State University
- 2. Lifetime Probability of Developing Cancer Source:DevCan: Probability of Developing or Dying of Cancer Soft ware, Version 5.1 Statistical Research and Applications Branch, NCI, 2003. http://srab.cancer.gov/devcan 1 in 59 Ovary 1 in 57 NH-Lymphoma 1 in38 Uterine corpus 1 in 18 Colon and rectum 1 in 17 Lung and bronchus 1 in 7 Breast 1 in 3 All Sites Risk Site
- 6. Reconstruction Options Immediate Delayed Timing Technique Tissue Tissue + Implant Implants alone
- 10. Reconstruction Options Immediate Delayed Timing Technique Tissue Tissue + Implant Implants alone
- 11. Breast Reconstruction Methods UTMDACC 1990 - 2000
- 14. Two-Stage Implant Reconstruction Pre-op Full Expansion Final Result
- 15. Acellular Dermal Matrix (AlloDerm ® ) Zienowicz RJ. Karacaoglu E. Plastic & Reconstructive Surgery . 120(2):373-81, 2007
- 16. Zienowicz RJ. Karacaoglu E. Plastic & Reconstructive Surgery . 120(2):373-81, 2007
- 17. Preminger BA. et. al. Annals of Plastic Surgery. 60(5):510-3, 2008.
- 18. “ Well, this is a fine mess …”
- 28. Prior to 1970’s: little regulation or oversight…
- 30. Clinical Value + = ?
- 34. Clinical Value
- 35. Medical Device Safety Risk Benefit
- 38. Reconstruction Options Immediate Delayed Timing Technique Tissue Tissue + Implant Implants alone
- 40. Skin Sparing Mastectomy The ablative surgeon begins the reconstruction!
- 41. Skin-Sparing Mastectomy Incisions only for: - Nipple and Areola - Access to the axilla - Biopsy scars - Skin areas “at risk”
- 43. Pre-op Post-op Skin Sparing Mastectomy
- 44. Skin Sparing Mastectomy Mastectomy skin flap necrosis
- 46. Oncologic Safety of SSM vs. CM Local Recurrence Rate (T2 tumors) Kroll 104/SSM 271/CM Carlson 327/SSM 188/CM Simmons 77/SSM 154/CM SSM CM 15% 12% 9% 6% 3% 0%
- 49. Latissimus Dorsi + Implant
- 51. Latissimus Dorsi Flap + Implant Pre-op Post-op Donor site scar
- 52. LD flap- Endoscopic Harvest Post-op. ( 3/1/2005) Pre-op. ( 1/13/2004)
- 53. LD flap- Endoscopic Harvest Pre-op Post-op
- 54. Reconstruction Options Immediate Delayed Timing Technique Tissue Tissue + Implant Implants alone
- 56. Pedicled TRAM
- 61. 5/13/2008
- 62. 5/29/2008
- 66. CT Angiogram Analysis: Vessel Selection
- 67. 9/2/2008 9/2/2008 Autologous Reconstruction: I-Gap Candidate
- 68. CT Angiogram Analysis: I-Gap Planning
- 69. 9/18/2008
- 76. Nipple Reconstruction 3 cm 4 cm
- 77. Nipple Reconstruction 3 cm 4 cm
- 81. Thank you! University Hospital James Cancer Hospital The Ohio State University Plastic Surgery … to restore and make whole
- 83. Skin-Sparing Mastectomy Frozen section control of margins
- 85. Local/Regional Recurrence*after Skin-Sparing Mastectomy Immediate Flap Reconstruction (Stage ll) * Median follow-up 5.4 years ** None with stage 0 or stage I breast cancer
- 86. Oncologic Safety of SSM vs. CM Local Recurrence Rate (T2 tumors) Kroll 104/SSM 271/CM Carlson 327/SSM 188/CM Simmons 77/SSM 154/CM SSM CM 15% 12% 9% 6% 3% 0%
- 87. Local Recurrences after Skin-Sparing Mastectomy and Immediate Reconstruction Group Number Pts. Local Recurrences (%) All 104 6.7 T1 61 3.3 T2 43 11.6 Black’s grade I* 31 12.9 Black’s grade II 48 6.3 Black’s grade III 6 0.0 *The lower the grade, the more anaplastic the tumor Ann Surg Oncol 4:193-197,1997
- 88. Regional recurrence after skin-spring mastectomy is a function of the biology of the tumor and stage of disease
- 94. Local Control and Outcome by Treatment Treatment # Pts. Local Control Alive, NED Local only 3 100% 100% (Surgery or Surgery + RT) Systemic only 5 60% 40% Local and 15 86% 71% Systemic
- 95. Local Control and Outcome by Treatment Local Only Systemic Only Local & Systemic Local Control Alive, NED 100% 80% 60% 40% 20% 0%
Editor's Notes
- They are able to achieve wonderful results in reconstruction like these patients who have had breast reconstruction following mastectomy, where patient quality of life is markedly increased from an emotional, physical, and cosmesis standpoint. Despite results like these , clinical limitations in reconstruction following tumor removal are often realized.
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