Plastic Surgery:Plastic Surgery:Breast ReconstructionBreast Reconstruction

Pankaj Tiwari, MDPankaj Tiwari, MDAssistant ProfessorAssistant Professor

The Ohio State University Medical CenterDepartment of Plastic Surgery

Gaspar Tagliacozzi (1545-1599)

“We restore, repair, and make whole those parts . . . which nature has given but which fortune has taken away.”

Plastic SurgeryPlastic Surgery

Cosmetic vs. ReconstructiveCosmetic vs. Reconstructive MultidisciplinaryMultidisciplinary Combined proceduresCombined procedures

DelayedDelayed ImmediateImmediate

Head to ToeHead to Toe Young to OldYoung to Old

Oncologic DefectsOncologic Defects

Breast Breast LumpectomyLumpectomy Mastectomy Mastectomy

Mastectomy

Defect

Lumpectomy DefectLumpectomy Defect

Tissue Expander/Implant Tissue Expander/Implant ReconstructionReconstruction

Tissue expanders placed initiallyTissue expanders placed initially Serial expansionsSerial expansions

Average 5-6 visitsAverage 5-6 visits Exchange for permanent implantsExchange for permanent implants

SalineSaline Silicone Silicone

Silicone Implant Silicone Implant ReconstructionReconstruction

12/13/2010

Free TRAM FlapFree TRAM Flap

MicrovasculaMicrovascular Tissue r Tissue TransferTransfer

The Ohio State University Medical Center

The Ohio State University Medical Center

The Ohio State University Medical Center

The Ohio State University Medical Center

The Ohio State University Medical Center

The Ohio State University Medical Center

The Ohio State University Medical Center

The Ohio State University Medical Center

The Ohio State University Medical Center

The Ohio State University Medical Center

The Ohio State University Medical Center

The Ohio State University Medical Center

The Ohio State University Medical Center

The Ohio State University Medical Center

The Ohio State University Medical Center

Superior Gluteal Artery Superior Gluteal Artery Perforator FlapPerforator Flap

Inferior Gluteal Artery Inferior Gluteal Artery Perforator FlapPerforator Flap

Thank You!Thank You!Pankaj.tiwari@osumc.edu

Mobile 614-202-7468Mobile 614-202-7468

ReferencesReferences

Thorne CH. Thorne CH. Grabb & SmithGrabb & Smith’’s Plastic Surgery 6s Plastic Surgery 6thth Edition Edition. Philadelphia, PA: Lippincott . Philadelphia, PA: Lippincott Williams & Wilkins; 2007.Williams & Wilkins; 2007.

Brown DL, Borschel GH. Brown DL, Borschel GH. Michigan Manual of Plastic Surgery. Michigan Manual of Plastic Surgery. Philadelphia, PA: Lippincott Philadelphia, PA: Lippincott Williams & Wilkins; 2004.Williams & Wilkins; 2004.

Kroll S, Sharma S, Koutz C, et al. Postoperative Morphine Requirements of Free TRAM and Kroll S, Sharma S, Koutz C, et al. Postoperative Morphine Requirements of Free TRAM and DIEP Flaps. DIEP Flaps. Plast. Reconstr. Surg. Plast. Reconstr. Surg. 107: 338-341, 2001.107: 338-341, 2001.

Bajaj A, Chevray P, Chang D. Comparison of Donor-Site Complications and Functional Bajaj A, Chevray P, Chang D. Comparison of Donor-Site Complications and Functional Outcomes in Free Muscle-Sparing TRAM Flap and Free DIEP Flap Breast Reconstruction. Outcomes in Free Muscle-Sparing TRAM Flap and Free DIEP Flap Breast Reconstruction. Plast. Reconstr. Surg. Plast. Reconstr. Surg. 117: 737-745, 2006.117: 737-745, 2006.

National Cancer Institute. BRCA1 and BRCA2: Cancer Risk and Genetic Testing. Available National Cancer Institute. BRCA1 and BRCA2: Cancer Risk and Genetic Testing. Available at: at: http://www.cancer.gov/cancertopics/factsheet/Risk/BRCA. Accessed April 7. Accessed April 7thth, 2010., 2010.

FP Cammisa, DB Glasser, JC Otis, MA Kroll, JM Lane and JH Healey. FP Cammisa, DB Glasser, JC Otis, MA Kroll, JM Lane and JH Healey. J Bone Joint Surg Am. J Bone Joint Surg Am. 1990;72:1541-1547.1990;72:1541-1547.