1. Breast Reconstruction
Supporting People With Breast
Cancer
Jane Rothwell
St. Vincent’s University Hospital

4. Outline
 The “Big Questions”
 How these decisions are made
 Reconstruction of the “conserved
breast”

5. The Big Questions
 Mastectomy v Breast Conservation
 Immediate v Delayed
Reconstruction
 Type of reconstruction

6. Mastectomy v Breast Conservation
 Patient factors
 Breast factors
 Tumour factors

7. Mastectomy v Breast Conservation
Patient factors
 Patient choice
 General health
 Suitability for radiotherapy
 Dealing with “risk”
 Personal history
 Family history

8. Mastectomy v Breast Conservation
Breast factors
 Size
 Shape
 Location of tumour in breast

9. Mastectomy v Breast Conservation
“Tumour” factors
 Size – actual
 Size – relative to size of breast
 Single or multifocal
 Type of tumour
 Site within breast

10. Site of tumour

11. Immediate v Delayed Reconstruction
 Patient choice
 Radiotherapy
 Other medical conditions
 Smoking
 Extent of disease

12. Immediate v Delayed Reconstruction -
Radiotherapy
 Tumour size
 Skin involvement
 Nodal disease
 Inflammatory cancer

13. Immediate v Delayed Reconstruction -
Radiotherapy
 Pseudocapsule formation
 Capsular contracture
 Skin changes
 Infection
 Need for further surgery

14. Type of Reconstruction
 Patient choice
 Body size and shape
 Patient expectations
 Patient lifestyle
 Breast size and shape
 Potential for multiple procedures
 General condition

15. Type of Reconstruction
 Own tissue (autologous)
 Own tissue with implant or
expander
 Implant or expander with “other
tissue”
 Implant or expander alone

16. Type of reconstruction - Autologous
 DIEAP – Deep inferior epigastric
artery perforator flap
 Tissue from tummy
 No implant needed
 Longer surgery

17. DIEAP Flap Reconstruction

18. DIEAP Flap Reconstruction

19. Latissimus Dorsi Flap Reconstruction

20. Latissimus Dorsi Flap Reconstruction

21. Tissue Expander Reconstruction

22. Tissue Expander Reconstruction

23. Restoration / Reconstruction of the
conserved breast
 Reasons why “reconstruction”
required:
 Size
 Shape
 Nipple problems
 Asymmetry
 Site of scar / defect

24. Restoration / Reconstruction of the
conserved breast

25. Restoration / Reconstruction of the
conserved breast

26. Restoration / Reconstruction of the
conserved breast - options
 Mastectomy and reconstruction
 Latissimus Dorsi flap
 Symmetry surgery on other breast
 Implant
 Fat injection

27. Summary
 The big questions:
 Whether it is best to conserve the
breast or have mastectomy
 Is immediate or delayed reconstruction
appropriate
 What type of reconstruction is best for
you

28. Conclusion
 Reconstruction is relevant for all
women who have had surgery, even
breast conservation
 The decision-making is complex,
with all patients treated to best
standard of care for them