Prepectoral Techniques in Reconstructive Breast Surgery

Description:

The practice of tissue expander/implant based pre-pectoral breast reconstruction holds great promise for superior cosmetic results, less pain, and a shorter recovery period. Pre-Pectoral Techniques in Reconstructive Breast Surgery is the first reference to cover this timely area in depth, offering step-by-step descriptions of current procedures.

Table of Contents:

CHAPTER 1 THE EVOLUTION OF PROSTHETIC BREAST RECONSTRUCTION: FROM SUBPECTORAL TO PREPECTORAL UTILIZING THE BIOENGINEERED CONCEPT

INTRODUCTION

HISTORY OF SUBPECTORAL PLACEMENT

RATIONALE FOR PREPECTORAL PLACEMENT

DISCUSSION

SUMMARY

CHAPTER 2 THE SCIENCE OF ACELLULAR DERMAL MATRIX INCORPORATION

THE INTRODUCTION OF ACELLULAR DERMAL MATRICES

EVOLUTION OF ACELLULAR DERMAL MATRIX UNDERSTANDING AND SURGICAL USAGE

PHASES OF ACELLULAR DERMAL MATRIX INCORPORATION

Cohesion

Engraftment

Integration

Remodeling

FACTORS AFFECTING ACELLULAR DERMAL MATRIX INCORPORATION

HUMAN VERSUS XENOGENEIC ACELLULAR DERMAL MATRICES

SUMMARY

CHAPTER 3 GUIDING PRINCIPLES OF ONCOLOGIC APPROPRIATE MASTECTOMIES: NIPPLE-SPARING MASTECTOMY VERSUS SKIN-SPARING MASTECTOMY VERSUS MASTECTOMY WITHOUT RECONSTRUCTION

INTRODUCTION

ONCOLOGIC SAFETY OF NIPPLE- AND SKIN-SPARING MASTECTOMIES

ONCOLOGIC SAFETY AND SELECTION CRITERIA FOR PREPECTORAL RECONSTRUCTION FOLLOWING MASTECTOMY

CHAPTER 4 THE MASTECTOMY AND INCISION PLACEMENT

INTRODUCTION

BLOOD SUPPLY AND ANATOMY OF THE BREAST

SENSORY INNERVATION TO THE BREAST AND NIPPLE

ROLE OF BLUE DYE FOR SENTINEL LYMPH NODE BIOPSY

MASTECTOMY FLAP MAXIMIZATION

CONTRAINDICATIONS TO NIPPLE-SPARING MASTECTOMY WITH IMMEDIATE RECONSTRUCTION

INCISION PLACEMENT

SUMMARY

CHAPTER 5 ASSESSING TISSUE VIABILITY

INTRODUCTION

OXYGENATION ASSESSMENT DEVICES

Bioengineering Background

KD203 (Kent Imaging; Calgary, AB, Canada)

HyperView (HyperMed; Memphis, TN)

PERFUSION ASSESSMENT DEVICES

SPY (Stryker; Mississauga, ON, Canada/Kalamazoo, MI)

PhotonVue (Invuity; San Francisco, CA)

PDE Neo-II (Hamamatsu; Hamamatsu, Japan)

Other Systems

SUMMARY

CHAPTER 6 THE ROLE OF ACELLULAR DERMAL MATRIX AND PREPECTORAL BREAST RECONSTRUCTION

INTRODUCTION

ACELLULAR DERMAL MATRIX

Rationale for Prepectoral Reconstruction

TECHNIQUE

TWO-STAGE PROSTHETIC RECONSTRUCTION

ONE-STAGE PROSTHETIC RECONSTRUCTION

SUMMARY

CHAPTER 7 PREPECTORAL BREAST RECONSTRUCTION: WHAT IS THE DATA?

PROOF OF CONCEPT: MOVING FROM PARTIAL MUSCLE COVERAGE TO NO MUSCLE COVERAGE

REQUISITES FOR A NEW SURGICAL TECHNIQUE

THE IMPACT AND TREATMENT OF PECTORALIS DETACHMENT AND ANIMATION DEFORMITY

EARLY READOPTERS OF THE PREPECTORAL TECHNIQUE

WHAT ARE THE OUTCOMES OF PREPECTORAL BREAST RECONSTRUCTION BEYOND ACUTE COMPLICATIONS?

ARE ACELLULAR DERMAL MATRICES NECESSARY FOR THE SUCCESS OF THE PREPECTORAL TECHNIQUE?

SUMMARY

CHAPTER 8 PREPECTORAL RECONSTRUCTION WITHOUT ACELLULAR DERMAL MATRIX

INTRODUCTION

NSM: THIN VERSUS THICK FLAPS

TISSUE EXPANDER IN TWO-STAGE PREPECTORAL NSM RECONSTRUCTION

PREPECTORAL RECONSTRUCTION OF LARGE PTOTIC BREASTS WITHOUT ADM

SECONDARY MASTOPEXY AFTER PREPECTORAL RECONSTRUCTION WITHOUT ADM

SURGICAL COLLABORATION

DISCUSSION

SUMMARY

CHAPTER 9 THE ROLE OF FAT GRAFTING IN PREPECTORAL BREAST RECONSTRUCTION

INTRODUCTION

PREOPERATIVE PLANNING

SURGICAL MANAGEMENT

Recipient Site Preparation

Fat Harvest

Fat Processing

Fat Injection

CLINICAL OUTCOMES

SUMMARY

CHAPTER 10 PATIENT SELECTION FOR PREPECTORAL RECONSTRUCTION

INTRODUCTION

INDICATIONS FOR PREPECTORAL PLACEMENT

Reconstructive Indications

Oncologic Guidelines and Indications

SUMMARY

CHAPTER 11 PREPECTORAL RECONSTRUCTION IN THE HIGH BODY MASS INDEX PATIENT

INTRODUCTION

OBESITY AND INCREASED RISK OF POSTOPERATIVE COMPLICATIONS

IMMEDIATE VERSUS DELAYED PREPECTORAL RECONSTRUCTION

RECONSTRUCTIVE CONSIDERATIONS

FAT GRAFTING

BENEFIT OF PREPECTORAL RECONSTRUCTION IN OBESE PATIENTS

SUMMARY

CHAPTER 12 TWO-STAGE PREPECTORAL RECONSTRUCTION USING TISSUE EXPANDERS

INTRODUCTION

PREOPERATIVE PLANNING

SURGICAL MANAGEMENT

PREPECTORAL RECONSTRUCTION WITH BIOPROSTHETIC MESH

PREPECTORAL RECONSTRUCTION WITH BIOPROSTHETIC MESH (STAGE 1)

Technique—Getting Started

Tissue Expander Insertion—The Off-Label Technique

Tissue Expander Insertion—The On-Label Technique

Technique—Preparing to Close

PREPECTORAL RECONSTRUCTION WITHOUT BIOPROSTHETIC MESH (STAGE 1)

POSTOPERATIVE MANAGEMENT OF THE PREPECTORAL TISSUE EXPANDER

PREPECTORAL RECONSTRUCTION WITH THE IMPLANT (STAGE 2)

OUTCOMES

SUMMARY

CHAPTER 13 DIRECT-TO-IMPLANT PREPECTORAL RECONSTRUCTION WITH ROUND IMPLANTS

INTRODUCTION

PREOPERATIVE PLANNING

SURGICAL MANAGEMENT

TECHNIQUE: PREPECTORAL DIRECT-TO-IMPLANT RECONSTRUCTION WITH ROUND IMPLANTS

SUMMARY

CHAPTER 14 PREPECTORAL IMMEDIATE DIRECT-TO-IMPLANT BREAST RECONSTRUCTION WITH ANTERIOR ALLODERM COVERAGE

INTRODUCTION

PROBLEMS WITH THE SUBPECTORAL PLANE

SURGICAL TECHNIQUE

DECISION MAKING WITH PERFUSION ASSESSMENT

ANTERIOR TENTING TECHNIQUE OF ACELLULAR DERMAL MATRIX FIXATION

CLINICAL STUDY DATA ON PREPECTORAL DTI RECONSTRUCTION

RESULTS

DISCUSSION

Why Anterior Acellular Dermal Matrix Coverage?

SUMMARY

CHAPTER 15 ANTERIOR/POSTERIOR ACELLULAR DERMAL MATRIX COVERAGE IN PREPECTORAL PROSTHETIC BREAST RECONSTRUCTION

INTRODUCTION

RATIONALE FOR PREPECTORAL PLACEMENT

Prepectoral Device Placement

Lower Pole Gutter with Anterior Reinforcement (On Label)

Prefabricated ADM–Device Construct (Off Label)

Ravioli Technique (Off Label)

DISADVANTAGES OF OFF-LABEL TECHNIQUES

SUMMARY

BIBLIOGRAPHY

CHAPTER 16 PREPECTORAL CONVERSION

INTRODUCTION

PREOPERATIVE PLANNING

SURGICAL MANAGEMENT OF ANIMATION DEFORMITY

Patient Positioning and Anesthesia

Surgical Technique—Skin-Sparing Mastectomy, Apical Incision

Surgical Technique—Nipple-Sparing Mastectomy, Inframammary Incision

Surgical Technique—Implant Selection

Surgical Technique—Acellular xDermal Matrix

Surgical Technique—Implant Insertion

OUTCOMES

CHAPTER 17 DELAYED PREPECTORAL BREAST RECONSTRUCTION

INTRODUCTION

INDICATIONS FOR DELAYED PREPECTORAL RECONSTRUCTION

SURGICAL TECHNIQUE

Preoperative Considerations

Expander Reconstruction

Implant Reconstruction

Postoperative Care

Additional Procedures

Latissimus-Based Prepectoral Reconstruction

SUMMARY

CHAPTER 18 PREPECTORAL RECONSTRUCTION AND RADIATION THERAPY PLASTIC SURGEON’S PERSPECTIVE

INTRODUCTION

Failed BCT With Patient Desiring Immediate Reconstruction

Patient Desiring Immediate Reconstruction With Planned PMRT

Patient Desiring Reconstruction Following Mastectomy and Chest Wall Radiotherapy

Patient With Prior Implant-Based Dual-Plane Reconstruction and Either Premastectomy or PMRT

Surgical Technique

DISCUSSION

SUMMARY

CHAPTER 19 CANCER SURVEILLANCE FOLLOWING PREPECTORAL RECONSTRUCTION

INTRODUCTION

SUMMARY

CHAPTER 20 COMPLICATIONS ASSOCIATED WITH PREPECTORAL RECONSTRUCTION

INTRODUCTION

SUBCUTANEOUS PROSTHETIC BREAST RECONSTRUCTION: 1970S TO 1980S

SUBPECTORAL PROSTHETIC BREAST RECONSTRUCTION: 1980S TO THE PRESENT

PREPECTORAL PROSTHETIC BREAST RECONSTRUCTION: 2010 TO THE PRESENT

SUMMARY

CHAPTER 21 POSTOPERATIVE CONSIDERATIONS FOLLOWING PREPECTORAL RECONSTRUCTION

INTRODUCTION

THE IMMEDIATE POSTOPERATIVE PERIOD

The Surgical Dressing

Drain Management

Expansion

THE LATE POSTOPERATIVE PERIOD

Thin Mastectomy Flap, No Radiation

Thick Mastectomy Flap, No Radiation

Radiation, Rapid Implant Exchange

Radiation, No Rapid Implant Exchange

SUMMARY

CHAPTER 22 BUILDING AN ECONOMIC MODEL FOR PREPECTORAL BREAST RECONSTRUCTION

INTRODUCTION

PAIN

LESS NARCOTIC USE

DECREASED LENGTH OF STAY/INCREASED AMBULATORY SURGERY

SHORTER OPERATIVE TIME/EASIER TECHNIQUE

LESS POSTOPERATIVE EXPANSIONS

QUICKER RETURN TO WORK

IMPROVED AESTHETICS

EARLIER RANGE OF MOTION/ENHANCED RANGE OF MOTION/LESS PHYSICAL THERAPY

ENHANCED PATIENT SATISFACTION

DECREASED INCIDENCE OF CAPSULAR CONTRACTURE

LESS REVISIONAL SURGERY

SUMMARY

DISCLOSURES

INDEX