Download Breast Reconstruction

Breast Reconstruction
Jeffrey R. Scott, Ph.D.
Definition
Breast
Two milk-secreting, glandular organs on
the chest of a woman; the human
mammary gland.
Breast – Primary Function
Breast Feeding a Newborn
Anatomy / Function – Breast Facts
The Average Breast:
• Consists of 15-20 sections, called lobes, arranged in a petal
shape
• Each lobe consists of many smaller lobules, which end in tiny
bulbs that can produce milk.
• Lobes, lobules, and bulbs are linked by thin tubes (ducts)
• Ducts lead to the centralized nipple (in center of the areola)
• Adipose tissue fills the space between lobules and ducts
Anatomy – Breast (front view)
Anatomy – Breast (side view)
Definition
Breast Reconstruction
The rebuilding of a breast, which involves using
autologous tissue or prosthetic materials to
reconstruct a natural-looking breast. Often this
includes the reformation of a natural-looking
areola and nipple. The overall procedure
involves the use of implants and/or relocated
flaps of the patient's own tissue.
Definition
Breast Augmentation
Breast implant and/or fat-grafting
mammoplasty procedures for correcting
defects and/or enhancing the size, form, and
feel of a woman’s breasts.
Definition
Breast Cancer
Cancer that forms in tissues of the breast,
usually the ducts (tubes that carry milk to the
nipple) and lobules (glands that make milk).
What is the scope of the problem?
Scope
• Breast Cancer is the second leading cause of women, exceeded
only by Lung Cancer.
• 1 in 8 women will be afflicted within their lifetime (12.5%).
• 1.3 Million New Cases are Diagnosed Annually Worldwide.
• Greater than 200,000 New Cases Diagnosed Annually in US .
• Responsible for 40,000 Deaths Annually in US Alone.
Types of Breast Cancer (severity)?
1. Non-invasive (in situ)
- in which abnormal cancer cells remain within their
place of origin, and have not spread to breast tissue
around the duct or lobule. (i.e. DCIS – Ductal
Carcinoma in situ (precancerous lesion), LCIS –
lobular carcinoma in situ.
Types of Breast Cancer (severity)?
2. Invasive (metastatic)
- in which abnormal cancer cells spread outside the
membrane that lines a duct or lobule, invading the
surrounding tissues.
- cancer cells can then travel to other parts of the
body, such as lymph nodes.
- Typically graded as stage I, II, III or IV based on
severity of invasive spread form origin.
Types of Breast Cancer (location)?
1. Ductal Carcinoma (most common)
- in which abnormal cancer cells originate in the
lining of the milk ducts.
2. Lobular Carcinoma
- in which abnormal cancer cells originate in the
lobules connected to the milk ducts.
3. Sarcoma (rare) (i.e. angiosarcoma)
- in which abnormal cancer cells originate within the
connective tissue (blood vessels, muscle, adipose)
Breast Cancer Staging:
Size, Location, Spread
Tumor Size
Breast Cancer Staging:
Size, Location, Spread
Stage I
- The tumor is no more than 2 cm in diameter.
- The cancer has not spread to the lymph nodes.
- The cancer has not spread outside the breast.
Breast Cancer Staging:
Size, Location, Spread
Stage II (if one of the following is true)
- The tumor is 2-5 cm in diameter and the cancer may or
may not have spread to the axillary lymph nodes.
- The tumor is 5 cm in diameter, but the cancer has not
spread to the axillary lymph nodes. (A)
- The tumor is <2 cm in diameter, but the cancer has
spread to no more than 3 axillary lymph nodes. (B)
- No tumor is found in breast, but cancer cells are
detected in no more than 3 axillary lymph nodes.
Breast Cancer Staging:
Size, Location, Spread
Stage III (if one of the following is true)
- The tumor is >5 cm in diameter, with cancer cells that
have spread to axillary lymph nodes, which are not
attached to each other. (A)
- The tumor is <5 cm in diameter, but the cancer has
spread to nearby lymph nodes, which are growing into
each other or the surrounding tissues. (stroma)
- The tumor is <5 cm in diameter, but the cancer has
spread to lymph nodes above the collarbone. (B)
Breast Cancer Staging:
Size, Location, Spread
Stage IV
- is the most advanced form of Breast Cancer.
- cancer cells have spread to other areas of the body,
i.e. bones, brain, liver and/or lungs.
- called Metastasis
What early symptoms are associated
with Breast Cancer?
Symptoms
• A breast lump or thickening that feels different than
surrounding tissue.
• Bloody discharge from the nipple.
• Changes to the breast surface (i.e. dimpling, pitting)
• Inversion of the nipple.
• Peeling, Scaling, Flaking of the nipple of breast skin.
How does Breast Cancer develop?
Cancer begins as a cluster of normal cells (hyperplasia). Over time, the cells can
develop abnormalities (atypical hyperplasia) that make them different from normal
cells, but not yet cancerous. The abnormal cells may continue to change in
appearance and multiply, evolving into noninvasive (in situ) cancer or, eventually,
invasive cancer. Invasive cancer can spread to other areas of the body through the
bloodstream or the lymphatic system.
How is Breast Cancer diagnosed?
Diagnostic Tests for an Atypical Hyperplasia
• Physical Examination (Breast Exam)
• Blood Tests (to identify risk factor genes, i.e. BRCA 1/2)
• Mammogram
• Biopsy (pathological assessment) – in situ vs. invasive
• Lumpectomy (pathological assessment)
How is Breast Cancer diagnosed?
How is Breast Cancer diagnosed?
Needle Biopsy
Lumpectomy
How is Breast Cancer diagnosed?
Needle Biopsy
Lumpectomy
Treatment Options?
Radiation Therapy
Chemotherapy
Mastectomy
Mastectomy - Video
1998 Mandate?
Federal Breast Reconstruction Law
Mandates that a health insurer which provides medical and
surgical benefits with respect to a full or partial mastectomy,
shall also be required to provide coverage for reconstructive and
associated restorative procedures.
Overview of Breast Reconstructive
Procedures - Video
Latissimus Dorsi Flap
Breast Reconstruction
Latissimus Dorsi Flap
Breast Reconstruction
TRAM / DIEP – Fixed or Free Flap
Breast Reconstruction
TRAM – Free Flap
Breast Reconstruction
TRAM – Fixed Flap
Breast Reconstruction
Breast Reconstruction – with
Acellular Dermal Matrix /
Silicone Expander
Breast Expander or Implant Biomaterials
Biomaterials
• Tissue Expanders: High-Molecular Weight Silicone Elastomer
Shell (to be filled with Saline solution), self sealing silicone port
and Titanium (or Stainless Steel) needle guard.
• Permanent Implants: High-Molecular Weight Silicone
Elastomer Shell (filled with Saline or Silicone)
Breast Implant - Biomaterials


1st generation implants-Thick,
smooth-surfaced shells
2nd generation implantsThinner shells, for a more
natural feel


Higher rupture rates
Other innovations- Textured
surface to prevent excessive
fibrous tissue growth and to
help fixation of implant within
the breast
Breast Implant – Biomaterials (fillers)
Silicone Gel Filled
Saline Filled
Breast Reconstruction – with
Acellular Dermal Matrix /
Silicone Expander
Pectoralis
Expander
Pectoralis
Expander
ADM
Breast Reconstruction – with
Acellular Dermal Matrix /
Silicone Expander
Pectoralis Muscle
Allograft
Breast Reconstruction – with
Acellular Dermal Matrix /
Silicone Expander - Video
Silicone Expander Filling - Video
Breast Reconstruction –
Silicone Expander Removal /
Final Silicone Implant Insertion - Video
Novel Animal Models of
Breast Reconstruction – Rat Model
1
2
3
4
5
Novel Animal Models of
Breast Reconstruction – Pig Model
Breast Reconstruction –
Fat Grafting - Video
Breast Reconstruction
Jeffrey R. Scott, Ph.D.