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Breast reconstruction

Introduction

Authors: Mia Demant, MD, Mia Wagsmo Steffensen, MD

Introduction

Breast reconstruction contains both surgical therapy and prophylaxis of breast cancer and can profoundly help a woman’s healing and self-image during her treatment. During the last decades, advancements in reconstruction techniques have greatly expanded the options patients have for breast reconstruction. In this chapter, we introduce relevant anatomy, indications, contraindications, and an overview of the variety of reconstruction options.

Definitions

Breast reconstruction covers a series of surgical procedures when recreating a breast, most commonly done after one or both breasts are removed in breast cancer treatment. The breast may also need to be rebuilt after traumas, or abnormalities that occur during breast development.

  • LD flap = Latissimus dorsi flap
  • TAP flap = Thoracodorsal artery perforator flap
  • DIEP flap = Deep inferior epigastric perforator flap
  • TMG flap = Transverse musculocutaneous gracilis flap
  • Primary = immediate 
  • Secondary = delayed

Background

Breast reconstruction dates back to 1895, where Vincent Czerny, a professor of surgery at Heidelberg, tried to transplant a lipoma to a mastectomy site (1). A few years later in 1906, the Italian surgeon Tanzini developed a pedicled flap of skin and underlying latissimus dorsi muscle, when he had difficulty closing large wounds after radical mastectomy – being the first in history to use a musculocutaneous flap in breast reconstruction. Sir Harold Gilles developed a tubed abdominal flap method in 1919 and performed his first breast reconstruction in 1942 (2). The modern reconstruction techniques were founded by Cronin and Gerow with the introduction of the silicone gel implant in 1963 (3), and the typical method was through a delayed insertion following mastectomy. In 1971, a case of immediate reconstruction was reported by Snyderman and Guthrie and this approach was now adopted and prevailed (4). Holmstrom was the first surgeon to use the tissue from an abdominoplasty as a free flap in breast reconstruction in 1979 (5).

References

  1. Uroskie TW, Colen LB. History of Breast Reconstruction. Semin Plast Surg. 2004 May;18(2):65–9.
  2. Gilles HD, Millard DR. Principles and Art of Plastic Surgery. In Boston: Little Brown & Company; 1957.
  3. Cronin TD, Gerow FJ. Augmentation mammaplasty: a new “natural feel” prosthesis. Excerpta Medica. Transactions of the Third International Congress of Plastic and Reconstructive Surgery. 1963;
  4. Snyderman RK, Guthrie RH. Reconstruction of the female breast following radical mastectomy. Plast Reconstr Surg. 1971 Jun;47(6):565–7.
  5. Holmström H. The free abdominoplasty flap and its use in breast reconstruction. An experimental study and clinical case report. Scand J Plast Reconstr Surg. 1979;13(3):423–7.
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Procedures

Procedures