Open Access Medical Books



Edited by Aldona J. Spiegel .

246 pages .
Open Access .
ISBN 978-953-51-1181-8 .

The Group for Advancement of Breast Reconstruction (GABRs) was organized as a way to advance the specialized field of Perforator Flap Reconstruction. It began as an outgrowth of a stimulating discussion between Dr. Robert Allen and colleagues at the 6th International Course on Perforator Flaps (2002) in Taipei, Taiwan. Since then, biannual meetings have been held around the world. The first meeting was hosted by Dr. Allen in Charleston, S.C. (2006), followed by a meeting at Chateau Villette in France (2007). The third meeting was hosted by Dr. Lan Mu in Beijing, China (2008), and most recent meeting was in Kenwood, California (2012).
Many of the chapters of this book are written by GABRs members, and some of the book’s content was presented at the last meeting. Some of the most interesting parts of this book can be found in the important ideas, tips, tricks and personal advice shared during these discussions. Authors have been given flexibility to include this interesting information in their individual chapters. Since there is very limited exposure to these ideas within scientific journals that require rigorous statistical data, this book will be an excellent source for additional information in this highly specialized field.
In breast reconstruction, flap based procedures and implant based procedures are the two major modalities that have emerged as surgical options for patients. These are both continuing to evolve as new, innovative techniques help to improve outcomes and patient satisfaction.
This book is divided into four sections. The first section includes overviews of mastectomy options and considerations in breast reconstruction procedure selection. The next section comprises non microsurgical reconstruction options which include implant based reconstruction refinements, the emerging role of fat grafting, as well as a novel technique of robotic latissimus flap harvesting. The third section is devoted to microsurgical reconstruction including flap refinements, tips and tricks, as well as advice on handling difficult situations. The final section includes the growing field of lymphedema surgery which is an important addition to breast reconstruction.
Surgeons specializing in breast reconstruction are challenged by the need for both artistic and technical skills. This very specialized field requires that the surgeon understands the patient’s emotional needs and guides her in choosing from among the many techniques available. True success is measured in the eyes of the patient.
The field is evolving as new technically challenging microsurgical procedures are being developed including smaller caliber vessels being transferred from new areas of the body and a more “free” style dictated by patient body habitus, while preserving the donor site aesthetics as much as possible. Implant-based reconstruction is also advancing, with development of new devices, the addition of acellular dermal matrix, and new fat grafting techniques.
New mastectomy techniques have recently allowed more patients to be candidates for nipple- sparing mastectomy, which has permitted some patients to choose prophylactic mastectomy more freely. While maintaining the life of the tissue, reconstructive breast surgery is also challenged with the need to maintain the individual aesthetics of each patient’s individual breasts. To maintain balance and symmetry, and to return the breast to a natural state of, hopefully, “better than the original” takes the hand of a well-trained, compassionate, thoughtful artist. In the reconstruction process, which involves much problem solving, there is room for constant innovation which keeps this emerging field challenging. Surgeons are forever making strides to enable patients burdened with breast cancer to regain their femininity and, as much as possible, leave their burden behind.

Aldona J. Spiegel
Director, Center for Breast Restoration, Institute for Reconstructive Surgery,
The Methodist Hospital, Houston, Texas
Associate Professor, Division of Plastic Surgery,
Weill Medical College, Cornell University


Section 1 Oncology and Breast Reconstruction .

 1 Oncoplastic Surgery 3 Rachel Wellner

 2 Selection of an Appropriate Method of Breast Reconstruction: Factors Involved in Customizing Breast Restoration 21 Zachary Menn and Aldona Spiegel

Section 2 Non Microsurgical Reconstruction .

 3 Implant-Based Dual-Plane Reconstruction of the Breast Following Sparing Mastectomy 35 Egidio Riggio and Maurizio B. Nava

 4 Prosthetic Breast Reconstruction with Acellular Dermal Matrix 67 Katie Weichman and Joseph Disa

 5 Fat Grafting in Breast Reconstruction with Expanders and Prostheses in Patients Who Have Received Radiotherapy 81 Jose Ma Serra-Renom, Jose Ma Serra-Mestre and Francesco D’Andrea

 6 Robotic Harvest of the Latissimus Dorsi Muscle for Breast Reconstruction 99 Jesse Selber

Section 3 Microsurgical Reconstruction .

 7 Mastering the Deep Inferior Epigastric Artery Perforator Flap (DIEP): Refining Techniques and Improving Efficiency 115 Joshua L. Levine, Julie V. Vasile, Hakan Usal, Heather A. Erhard and John J. Ho

 8 Double Venous System Drainage in Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction 127 Scott Reis, Jules Walters, Jason Hall and Sean Boutros

 9 Septocutaneous Gluteal Artery Perforator (Sc-GAP) Flap for Breast Reconstruction: How We Do It 135 Stefania Tuinder, Rene Van Der Hulst, Marc Lobbes, Bas Versluis and Arno Lataster

 10 Profunda Artery Perforator (PAP) Flap for Breast Reconstruction 161 Constance M. Chen, Maria LoTempio and Robert J. Allen

 11 The Use of Proximal and Distal Ends of Internal Mammary Arteries and Veins as the Recipient Vessels for Combined Breast and Chest Wall Reconstruction with Free Bipedicled TRAM or DIEP Flap 173 Lan Mu and Senkai Li

 12 Getting Out of a Tight Spot in Breast Reconstruction — Salvage and Saving Techniques for DIEP, SIEA, and Lymphatic Flaps 185 Rebecca Studinger

Section 4 Lymphedema .

 13 Treatment of Breast Cancer-Related Lymphedema Using Combined Autologous Breast Reconstruction and Autologous Lymph Node Transplantation 229 Corinne Becker .

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Published by: Unknown - Friday, August 23, 2013


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