Realm of Breast Reconstructive Surgery

• Breast reconstruction is a type of surgery for women who have had all or part of a breast removed
• The surgery rebuilds the breast mound to match the size and shape of the other breast
• The nipple and areola can also be added
• Most women who have had a breast removed (mastectomy) are able to have breast reconstruction
• Lumpectomy or breast conserving surgery may also require reconstruction
• Breast reconstruction is done by a Plastic Surgeon 

Advantages of Breast reconstruction

• Make the chest look balanced
• Permanently regain breast shape
• Do not use form or prosthesis that fits inside the bra
• To be happy with their bodies

Types of breast reconstruction

• Breast implants (using silicon and saline inserts)
• Tissue flap procedures (using own body tissues)
• Combination of an implant and flap procedure
• Multiple sessions of fat grafting

Advantages of Immediate Breast Reconstruction

• Psychological benefits 
• Cosmetic benefits
• Reduced morbidity
• Reduced cost (insurance cover for same stage surgery)
• Better reconstruction

Actionable Takeaways: Breast reconstruction

• Breast reconstruction should be offered to all patients undergoing mastectomy 
• Immediate breast reconstruction is most suited for our patients
• Autologous breast reconstruction is the best operation to achieve soft naturally ptotic breast
•  Lower abdomen flap procedure (DIEP/SIEP) is the flap of choice for autologous breast reconstruction 
• Personalized care with Shared Decision Making
• Careful Pre-op assessment, Planning and documentation with digital photography 
• Choose appropriate procedures (upscale patient outcomes)
• Multiple procedures to limit repeated OT visits
• Comprehensive counselling (identify patient concerns) and hand holding
• Manage patient expectations (under promise and over deliver)

Advances and future directions

• Spy camera – flap vascularity
• Sensory restoration of the autologous flaps
• Virtual and augmented reality technologies for preoperative planning
• AI – for surgical simulations to refine techniques and outcome
• Tissue engineering and regenerative medicine (off the shelf breast)
• CTA of the breast (improved immunosuppression) 
• Immunotherapy – eradication of all kinds of cancer