Question

from Surgical Technology for the Surgical Technologist: A Positive Care Approach, 5th ed.

A 52-year-old female patient had a modified radical mastectomy a year ago after being diagnosed with breast cancer. She completed additional treatments such as chemotherapy and the wound has healed. She is now discussing a breast reconstruction with a plastic surgeon.

1. Discuss the different reconstructive options that the surgeon might perform and whether each uses an implant or muscle.
2. 
   
3. For each option, list the differences in surgical instruments that the surgeon will require.

Answer 1

In Breast reconstruction surgeons use two main techniques ;They are flap reconstruction surgery and implant reconstruction surgery.

1.Flap reconstruction: In this procedure surgeon use tissue ,fat or muscle from another part of the patient's body to form a breast shape.Flap is usually taken from back,belly or buttocks to reconstruct the breast.Most of the times surgeon use pedicled flap(In this flap tissue is attached to original blood vessels and moved under patient skin to patient chest.Flaps reconstruction surgery is time consuming and takes longer period to recover.This type of surgery last lifetime.

Flap reconstruction using tissues from belly:

1.DIEP(deep inferior epigastric perforator Flap:)Here no muscle is used to reconstruct the breast.In this procedure skin, fat and blood vessels are cut from lower belly and placed in the chest to reconstruct the breast.

2.SIEA Flap:It is a muscle sparing type of flap.Here different sections of blood vessels in the belly are moved with skin and fat and placed under the chest to reconstruct the breast.Recovery time is quick.

3.TRAM Flap:It is the most common type of flap reconstruction surgery.Transverse rectus abdominis is a muscle in lower belly and this is used for reconstruction of the breast.

Flap reconstruction using tissues from buttocks:

1.SGAP flap:In this procedure gluteal artery perforator blood vessel is used to reconstruct the breast.This is a muscle sparing type of flap.

2.IGAP flap:Here inferior gluteal artery perforator with skin and fat is used to reconstruct the breast.

Flap reconstruction using tissues from thighs:

1.PAP flap:Profunda artery perforator blood vessel in the thigh along with the fat and skin is used for reconstruction of the breast.

2.TUG flap:In this procedure gracilis muscle in the thigh along with skin,fat and blood vessels is used for reconstruction of breast.

Instruments used for flap reconstruction of the breast are;

1.Scissors

2.scalpels

3.curved,dilator,fine tipped forceps.

4.Tissue retractors

5.needle holder

6.microvascular anastomotic coupler

7.microvascular occluding clamp

8.microvascular hemo clip

9.Fiber optic retractor

2.Implant reconstruction ; Here a implant filled with silicone gel or saline water is used for reconstruction.Implant reconstruction surgery is less time consuming and patient's recover fast.Most of the times implant reconstruction surgery develop issues like wearing out of implants ,scars around the implants.It needs additional surgery to fix the problems.

The implant is placed under pectoral chest muscle.Implants are round or teardrop shape.In saline implants the shell of implant is silicone and filled with saline water. Silicone gel implants are filled with firm silicone gel.This silicone gel implants are softer than saline implants.Gummy implant is a type of silicone implant which is firmer and provides more natural shape the breast.

One of main drawback of implants is the risk of rupturing.In the case of rupturing surgery is needed to replace the implant.

In implant reconstruction surgery surgeon use mastectomy incision for the procedure.

Surgical instruments used in implant breast reconstruction surgery are:

1.Richardson retractor

2.forceps

3.Scissors

4.tenotomy scissors

5.scalpels

6.different types of implants

7.Tissue expander

8.needle holder

9.Fiber optic retractor