By Stephen S. Kroll

Discussing the most up-tp-date and pioneering thoughts in breast reconstruction with no using implants, THE ARTISTRY OF BREAST RECONSTRUCTION WITH AUTOLOGOUS TISSE is the quantity each breast health professional has been watching for. Focusing not just on how you can reconstruct breasts following mastectomy but in addition on the best way to in attaining the top measure of aesthetic luck attainable, this quantity describes intimately Dr. Kroll's strategies in utilizing autologous tissue. Over 500 pictures and customized illustrations exhibit and examine the various recommendations utilized in breast reconstruction with autologous tissue reminiscent of traditional (pedicled) TRAM flaps, unfastened TRAM flaps, the prolonged latissimus dorsi myocutaneous flap, the Rubens fats pad loose flap, between others. additionally contain are chapters on quick and not on time reconstructions, shaping the breast mound, nipple and areolar reconstruction and selection of approach, follow-up and sufferer choice. Dr. Kroll's method of reconstructive breast surgical procedure both encompasses paintings and technology and either are absolutely represented during this quantity.

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To avoid disappointment, patients should be made aware of this prior to reconstruction. In a previously irradiated patient, scar tissue is likely to be more dense and difficult to release than in a nonirradiated patient, and a vertical releasing incision in the lower mastectomy flap (Figs 5-7 and 5-8; also see chapter 17) is more likely to be required. Dissection of recipient vessels in the axilla may also be more difficult. The surgeon should be prepared for these challenges. Obviously, one way to solve the problem of a difficult dissection in a heavily scarred axilla is to use the internal mammary vessels as recipients; they may well have been irradiated but will not have had previous surgery.

Using jeweler’s forceps with tips that do not meet correctly and will not hold sutures, for example, is frustrating and can lead to poor anastomoses and flap failure. Microsurgical instruments are delicate and can easily be damaged by operating room personnel during cleaning or storage. If the operating room staff is not used to working with microsurgical instruments, the surgeon needs to take a personal interest in the instruments and ensure that they are properly cared for. Instruments used for breast reconstruction should be long enough to reach easily into the axilla (Fig 3-7).

Note that a skin-sparing mastectomy had been done on the right, but not on the left. (B) The same patient after bilateral free TRAM flap breast reconstruction. A vertical releasing incision was required in the left inferior mastectomy flap. 50 C H A P T E R 5 D ELAYED B REAST R ECONSTRUCTION FIG. 5-9 A patient 4 years after bilateral free TRAM flap breast reconstruction. She had been treated previously with mastectomy and radiotherapy on the left side, but there is no apparent difference between the irradiated (left) and nonirradiated (right) sides.

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