乳房重建的新策略New avenues in Breast Reconstruction Surgery..pptVIP

The University of Hong Kong-Shenzhen Hospital New avenues in Breast Reconstruction Surgery 2014-09-10 Surgical evolution of breast cancer treatment Halsted (1898) Super radical mastectomy(1950) Patey (1965) Conservative surgery (1975) Sentinel lymph node (2000) Nipple Sparing Mastectomy(2003) Future ? ? ? Reconstruction surgery Immediate vs. Delayed Reconstruction Alloplastic reconstruction vs. Autologous reconstruction Tiffany Nicole S,Ballard,Adeyiza O,Momoh. Advances in Breast Reconstruction of Mastectomy and Lumpectomy Defects. Surg Oncol Clin N Am. 2014:23(3): 528-48 Basic algorithm for decisions on reconstructive options A great choice of techniques for immediate or delayed breast reconstruction Alloplastic reconstruction Silicone implants Saline implants Tissue expanders Reconstruction with a implant I Jatoi,M Kaufmann,J Y. Petit.Atlas of Breast Surgery.2006:90 Immediate reconstruction with a implant Tissue expanders Expander Catheter Port I Jatoi,M Kaufmann,J Y. Petit.Atlas of Breast Surgery.2006:91-92 Tissue expanders Injection of 50–100 ml of sterile saline / 1 to 2 weeks 1 to 2 months after the final expansion, the expander should be exchanged for the implant Frank J. DellaCroce, Emily T. Wolfe,Breast reconstruction. Surg Clin N Am. 2013:93(2):445-54 Reconstruction with expander technique Complications of tissue expander/implant reconstruction Seroma Infection Capsular contracture Skin flap necrosis Autologous flaps for breast reconstruction Abdomen Pedicled TRAM (transverse rectus abdominis myocutaneous ) Free TRAM Muscle-sparing free TRAM DIEP (deep inferior epigastric perforator) SIEA (superficial inferior epigastric artery) Back LD (latissimus dorsi) TDAP (thoracodorsal artery perforator ) Buttocks SGAP (superior gluteal artery perforator) IGAP (inferior gluteal artery perforator ) Thigh TUG (transverse upper gracilis) Anterolateral thigh Profunda artery p