Mastectomy reconstruction with implants is a viable option in the non-radiated patient. The outcomes are variable and often depend on implant selection, implant size, and quality of the skin post mastectomy. We are seeing an increase in the number of patients who wish to remain the same size following their mastectomy or to go slightly smaller. I learn from my…
There are several inherited genetic mutations that may make a person more susceptible to breast cancer. Commonly encountered genetic mutations such as BRCA1, BRCA2, PALB2, and CHEK2 are identified in patient with breast cancer and those with DCIS. Frequently, these patients may wish to undergo contralateral prophylactic mastectomy. Prophylactic mastectomy is the removal of a normal breast to prevent the…
Abdominal wall reconstruction procedures are common. Abdominal wall hernias can occur after abdominal procedures. The components of the abdominal wall can be separated and biologic mesh can be used as a load sharing principle to repair the hernia. Protein intake is important before surgery and after surgery to prevent seroma formation post-surgery. We instruct many of our patients to eat…
Oncoplastic reconstruction is the combination of oncologic surgery and plastic surgery. The same techniques that are used to improve the appearance of the breast can be used to allow access to remove tumors from the breast while improving the overall shape and appearance. The tumors of the breast can be localized with either…
There are several oncoplastic techniques that are used to reconstruct the breast following lumpectomy for breast cancer. These oncoplastic techniques can be utilized in conjunction with DIEP flap reconstruction for mastectomy in sequence. Patients can undergo lumpectomy for breast cancer with oncoplastic reconstruction. The staging of the lumpectomy and oncoplastic reconstruction can place a ptotic nipple areola complex in a…
Occasionally, patients undergo mastectomy and then follow with radiation therapy. When these patients undergo breast reconstruction, we use the term delayed breast reconstruction. The term delayed reconstruction is utilized to characterize a reconstruction that occurs after a mastectomy and other treatments versus an immediate reconstruction that occurs in whole or in part simultaneously with the mastectomy. When the skin that…
The skin and fat from the lower abdomen can be used to reconstruct the breast following mastectomy. This type of reconstruction is called autologous breast reconstruction or flap reconstruction. The deep inferior epigastric artery perforator (DIEP) flap uses the skin and fat from the lower abdomen, and maintains a significant amount of abdominal wall musculature. The tissue that is transferred…
Deep inferior epigastric artery perforator flaps can be very helpful for unilateral breast reconstruction following mastectomy for breast cancer. Autologous breast reconstruction is a type of breast reconstruction where the patients own body tissue is used to reconstruct the breast. This is a different type of reconstruction from an implant based breast reconstruction. When a patient undergoes a unilateral mastectomy,…
There are several options to reconstruct the breast following mastectomy. Depending upon the degree of pre-operative ptosis of the breast, the patient may be a candidate for a nipple sparing mastectomy. A nipple sparing mastectomy may be performed through an inframamary incision. For a DIEP flap reconstruction, the operative surgeon often needs access to blood vessels in the chest, usually…
Ventral hernias can occur after previous abdominal surgery. Hernias can often occur from the presence of medical or surgical comorbidities. One of the most important factors that can be readily controlled is protein intake. We often tell patients that protein intake should be increased to 1-2 grams per kg of body weight so that patients have adequate protein stores to…
