J Korean Med Assoc.  2006 Dec;49(12):1141-1153. 10.5124/jkma.2006.49.12.1141.

Recent Knowledge of Breast Reconstruction

• Lee PK

• KMID: 2184744
• DOI: http://doi.org/10.5124/jkma.2006.49.12.1141

Abstract

Breast is one of the most important organ which characterize the femininity and the maternity. As growing not only in numbers of breast cancer patients but also concerns about the quality of life, breast reconstruction after mastectomy turns into hot topics in the area of plastic surgery. Historically, numerous operation techniques have been introduced for breast reconstruction using prosthesis (tissue expander and breast implant) and autologous tissues (various pedicled flaps and free flaps). The most ideal method for breast reconstruction is to make a natural soft breast with less complications and morbidities, and no single technique can be universally accepted in every cases. However, in terms of making a natural, good-looking breast autologous tissue is more superior to tissue expander and breast implant in breast reconstruction. Usually a breast reconstruction is performed in 3 stages; 1st stage is breast mound reconstruction using autologous tissue or tissue expander and implant. 2nd stage is revision of the reconstructed breast and donor site such as abdomen (scar revision, volume adjustment using suction-assisted lipectomy and excision), nipple reconstruction, and surgery of the opposite normal breast (augmentation, mastopexy, or reduction) for maximizing cosmetic results. 3rd stage is a intradermal tattooing for nipple-areolar complex. In this article, various techniques are presented with their indications, methods, advantages and disadvantages. For the choice of best modality, many factors should be considered including an extent of mastectomy, the size and shape of opposite breast, the condition of possible donor sites, postoperative adjuvant therapy (radiation, chemotherapy), patient's age, and patient's preferance.

Keyword

Breast reconstruction; 3 stages; Autologous tissue

MeSH Terms

Abdomen
Breast Implants
Breast Neoplasms
Breast*
Female
Femininity
Humans
Lipectomy
Mammaplasty*
Mastectomy
Nipples
Prostheses and Implants
Quality of Life
Surgery, Plastic
Surgical Flaps
Tattooing
Tissue Donors
Tissue Expansion Devices

Figure

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  Figure 1 Expander insertion below pectoralis major muscle(left) and after expansion(right)(23)

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  Figure 2 Varions donor cites for antologous tissue breast reconstruction

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  Figure 3 Harvest of latissumus dorsi musculocutanous flap(left) and transposition of flap (right)(23)

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  Figure 4 Harvest and rotation of transverse rectus abdomis musculocutaneous (TRAM) pedicled flap(23)

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  Figure 5 Free TRAM flap harvesting and insetting(23)

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  Figure 6 Superficial inferior epigastric artery as a dominant pedicle(D) and flap territory of SIEA(23)

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  Figure 7 Harvest of superior gluteal flap based on superior gluteal artery (14)

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  Figure 8 Dotted line denotes proposed fat takeout. Solid line with circle denotes proposed skin incision and skin island(16) n=lateral cutaneous nerve of thigh; a=lateral circumflex femoral artery; s=sartorius; RF=rectus femoris; VL=vastus lateralis; TFL=tensor fasciae latae

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  Figure 9 Deep circumflex iliac artery as a dominant pedicle(D) and flap territory of Rubens flap(23)

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  Figure 10 A 59-year-old woman had a fascia-sparing free TRAM flap Breast reconstruction on her left breast and periareolar mastopexy on her right breast (A) preoperative frontal view (B) postoperative 4 years frontal view (C) preoperative lateral view (D) postoperative 4 years lateral view

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