PDF herunterladen
Semin Plast Surg 2004; 18(2): 157-173
DOI: 10.1055/s-2004-829050
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001 USA.

Breast Reconstruction in Private Practice

Steven M. Pisano1 , Peter R. Ledoux1 , Chet L. Nastala1
  • 1Plastic, Reconstructive, and Microsurgical Associates of South Texas, P.A., San Antonio, TX
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
14. Juni 2004 (online)

    Lizenzen und Reprints

Comprehensive breast reconstruction can be performed in private practice. Our practice philosophy is that autogenous tissue provides the best substrate for breast reconstruction; the deep inferior epigastric perforator flap is our primary method of breast reconstruction. Microsurgical training and a group practice model permit routine use of all autogenous tissue techniques. Office, operating room, and hospital teams must be assembled; these teams follow clinical pathways, which make the execution of reconstructive procedures consistent and efficient. The practice must implement a plan for physician and patient education. The practice must review clinical outcomes, making adjustments in operative techniques and pre- and postoperative clinical pathways so that the best results can be achieved with a low complication rate. Breast reconstruction is a core service of our practice. We have accrued an economy of scale including these features: intraoperative and clinical efficiency, low practice overhead costs, and a high patient satisfaction rate.

KEYWORDS

Autogenous tissue - clinical pathways - efficiency

REFERENCES

  • 1 Kroll S S. Why autologous tissue?.  Clin Plast Surg. 1998;  25 135-143
    PubMedGoogle Scholar
  • 2 Miller M J. Immediate breast reconstruction.  Clin Plast Surg. 1998;  25 145-156
    PubMedGoogle Scholar
  • 3 Craigie J E, Allen R J, DellaCroce F J, Sullivan S K. Autogenous breast reconstruction with the deep inferior epigastric perforator flap.  Clin Plast Surg. 2003;  30 359-369
    CrossrefPubMedGoogle Scholar
  • 4 Asko-Seljavaara S. Delayed breast reconstruction.  Clin Plast Surg. 1998;  25 157-166
    PubMedGoogle Scholar
  • 5 Schusterman M A. The free TRAM flap.  Clin Plast Surg. 1998;  25 191-195
    PubMedGoogle Scholar
  • 6 Evans G RD, Kroll S S. Choice of technique for reconstruction.  Clin Plast Surg. 1998;  25 311-316
    PubMedGoogle Scholar
  • 7 Wanzel K R, Brown M H, Anastakis D J, Regehr G. Reconstructive breast surgery: referring physician knowledge and learning needs.  Plast Reconstr Surg. 2002;  110 1441-1450
    PubMedGoogle Scholar
  • 8 Reaby L. Reasons why women who have mastectomy decide to have or not to have breast reconstruction.  Plast Reconstr Surg. 1998;  101 1810-1818
    CrossrefPubMedGoogle Scholar
  • 9 Alderman A K, Wilkins E G, Lowery J C et al.. Determinants of patient satisfaction in postmastectomy breast reconstruction.  Plast Reconstr Surg. 2000;  106 769-776
    CrossrefPubMedGoogle Scholar
  • 10 Reece G P, Kroll S S. Abdominal wall complications: prevention and treatment.  Clin Plast Surg. 1998;  25 235-249
    PubMedGoogle Scholar
  • 11 Nahabedian M Y, Momen B, Galdino G, Manson P N. Breast reconstruction with the free TRAM or DIEP flap: patient selection, choice of flap, and outcome.  Plast Reconstr Surg. 2002;  110 466-477
    CrossrefPubMedGoogle Scholar
  • 12 Kroll S S. Bilateral breast reconstruction.  Clin Plast Surg. 1998;  25 251-259
    PubMedGoogle Scholar
  • 13 Blondeel P N. One hundred free DIEP flap breast reconstructions: a personal experience.  Br J Plast Surg. 1999;  52 104-111
    CrossrefPubMedGoogle Scholar
  • 14 Wei F C, Suominen M D, Cheng M H et al.. Anterolateral thigh flap for postmastectomy breast reconstruction.  Plastic and Reconstructive Surgery. 2002;  110 82-88
    CrossrefPubMedGoogle Scholar
  • 15 Karanas Y L, Santoro T D, Da Lio A L, Shaw W W. Free TRAM flap breast reconstruction after abdominal liposuction.  Plast Reconstr Surg. 2003;  112 1851-1855
    CrossrefPubMedGoogle Scholar
  • 16 Schusterman M A. Bilateral breast reconstruction in very thin patients with extended free TRAM flaps.  British Journal of Plastic Surgery. 1998;  51 191-195
    CrossrefPubMedGoogle Scholar
  • 17 Schusterman M A, Kroll S S, Weldon M E. Immediate breast reconstruction: why the free TRAM over the conventional TRAM flap?.  Plast Reconstr Surg. 1992;  90 255-261
    PubMedGoogle Scholar
  • 18 Langstein H N, Cheng M H, Singletary E et al.. Breast cancer recurrence after immediate reconstruction: patterns and significance.  Plast Reconstr Surg. 2003;  111 712-720
    CrossrefPubMedGoogle Scholar
  • 19 Polednak A. Geographic variation in postmastectomy breast reconstruction rates.  Plast Reconstr Surg. 2000;  106 298-301
    PubMedGoogle Scholar
  • 20 Alderman A K, McMahon Jr L, Wilkins E G. The national utilization of immediate and early delayed breast reconstruction and the effect of sociodemographic factors.  Plast Reconstr Surg. 2003;  111 695-703
    CrossrefPubMedGoogle Scholar
  • 21 Collins E D. Discussion, reconstructive breast surgery: referring physician knowledge and learning needs.  Plast Reconstr Surg. 2002;  110 1451-1454
    PubMedGoogle Scholar
  • 22 Chang D W, Wang B, Robb G L et al.. Effect of obesity on flap and donor-site complications in free transverse rectus abdominus myocutaneous flap breast reconstruction.  Plast Reconstr Surg. 2002;  109 1199-1200
    PubMedGoogle Scholar
  • 23 Chang D W, Reece G P, Wang B G et al.. Effect of smoking complications in patients undergoing free TRAM flap breast reconstruction.  Plast Reconstr Surg. 2002;  110 2374-2380
    PubMedGoogle Scholar
  • 24 Spear S L, Majidian A. Immediate breast reconstruction in two stages using textured, integrated-valve tissue expanders and breast implants: a retrospective review of 171 consecutive breast reconstructions from 1989 to 1996.  Plast Reconstr Surg. 1998;  101 53-63
    PubMedGoogle Scholar
  • 25 Allen R J, Treece P. Deep inferior epigastric perforator flap for breast reconstruction.  Ann Plast Surg. 1994;  32 32-38
    Google Scholar
  • 26 Hamdi M, Weiler-Mithoff E M, Webster M H. Deep inferior epigastric perforator flap in breast reconstruction: experience with the first 50 flaps.  Plast Reconstr Surg. 1999;  103 86-95
    CrossrefPubMedGoogle Scholar
  • 27 Blondeel P N, Boeckx W D. Refinements in free flap breast reconstruction: the free bilateral deep inferior epigastric perforator flap anastomosed to the internal mammary artery.  Br J Plast Surg. 1994;  47 495-501
    Google Scholar
  • 28 Blondeel P N, De Muynck M, Mete D et al.. Sensate nerve repair in perforator flaps for autologous breast reconstruction: sensational or senseless?.  Br J Plast Surg. 1999;  52 37-44
    CrossrefPubMedGoogle Scholar
  • 29 Nahabedian M Y, Tsangaris T, Momen B, Manson P N. Infectious complications following breast reconstruction with expanders and implants.  Plast Reconstr Surg. 2003;  112 467-476
    CrossrefPubMedGoogle Scholar
  • 30 Kroll S S, Evans G RD, Reece G P et al.. Comparison of resource costs between implant-based and TRAM flap breast reconstruction.  Plast Reconstr Surg. 1996;  97 364-372
    CrossrefPubMedGoogle Scholar
  • 31 Miller S H. Comparison of costs between implant-based and TRAM flap breast reconstruction.  Plast Reconstr Surg. 1996;  98 916-917
    PubMedGoogle Scholar
  • 32 Spear S L, Mardini S, Ganz J C. Resource cost comparison of implant-based breast reconstruction versus TRAM flap breast reconstruction.  Plast Reconstr Surg. 2003;  112 101-105
    CrossrefPubMedGoogle Scholar
  • 33 Blondeel P N, Vanderstraeten G G, Monstrey S J et al.. The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction.  Br J Plast Surg. 1997;  50 322-330
    Google Scholar
  • 34 Nahabedian M Y, Manson P N. Contour abnormalities of the abdomen after transverse rectus abdominis muscle flap breast reconstruction: a multifactorial analysis.  Plast Reconstr Surg. 2002;  109 81-87
    CrossrefPubMedGoogle Scholar
  • 35 Blondeel P N. Discussion: contour abnormalities of the abdomen after transverse rectus abdominis muscle flap breast reconstruction: a multifactorial analysis.  Plast Reconstr Surg. 2002;  109 88-90
    PubMedGoogle Scholar
  • 36 Nahabedian M D, Dooley W, Singh N, Manson P N. Contour abnormalities of the abdomen after breast reconstruction with abdominal flaps: the role of muscle preservation.  Plast Reconstr Surg. 2002;  109 91-101
    CrossrefPubMedGoogle Scholar
  • 37 Kroll S S, Schusterman M A, Reece G P et al.. Abdominal wall strength, bulging, and hernia formation after TRAM flap breast reconstruction.  Plast Reconstr Surg. 1995;  96 616-619
    CrossrefPubMedGoogle Scholar
  • 38 Ninkovic M M, Schwabegger A H, Anderl H. Internal mammary vessels as a recipient site.  Clin Plast Surg. 1998;  25 213-221
    PubMedGoogle Scholar
  • 39 Clark III C P, Rohrich R J, Copit S et al.. An anatomic study of the internal mammary veins: clinical implications for free-tissue-transfer breast reconstruction.  Plast Reconstr Surg. 1997;  99 400-404
    CrossrefPubMedGoogle Scholar
  • 40 Feng L J. Recipient vessels in free-flap breast reconstruction: a study of the internal mammary and thoracodorsal vessels.  Plast Reconstr Surg. 1997;  99 405-416
    CrossrefPubMedGoogle Scholar
  • 41 Mehrara B J, Santoro T, Smith A et al.. Alternative venous outflow vessels in microvascular breast reconstruction.  Plast Reconstr Surg. 2003;  112 448-455
    CrossrefPubMedGoogle Scholar
  • 42 Robb G L. Thoracodorsal vessels as a recipient site.  Clin Plast Surg. 1998;  25 207-211
    PubMedGoogle Scholar
  • 43 Hallock G G. Doppler sonography and color duplex imaging for planning a perforator flap.  Clin Plast Surg. 2003;  30 347-357
    Google Scholar
  • 44 Vandevoort M, Vranckx J J, Fabre G. Perforator topography of the deep inferior epigastric perforator flap in 100 cases of breast reconstruction.  Plast Reconstr Surg. 2002;  109 1912-1918
    CrossrefPubMedGoogle Scholar
  • 45 El-Mrakby H H, Milner R H. The vascular anatomy of the lower anterior abdominal wall: a microdissection study on the deep inferior epigastric vessels and the perforator branches.  Plast Reconstr Surg. 2002;  109 539-543
    CrossrefPubMedGoogle Scholar
  • 46 Blondeel P N, Van Landuyt K, Monstrey S JM et al.. The “Gent” consensus on perforator flap terminology: preliminary definitions.  Plast Reconstr Surg. 2003;  112 1378-1382
    CrossrefPubMedGoogle Scholar
  • 47 Blondeel P N, Arnstein M, Verstraete K et al.. Venous congestion and blood flow in free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps.  Plast Reconstr Surg. 2000;  106 1295-1299
    CrossrefPubMedGoogle Scholar
  • 48 Kroll S S. Fat necrosis in free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps.  Plast Reconstr Surg. 2000;  106 576-583
    CrossrefPubMedGoogle Scholar
  • 49 Allen R J. The superior gluteal artery perforator flap.  Clin Plast Surg. 1998;  25 293-302
    PubMedGoogle Scholar
  • 50 Blondeel P N, Van Landuyt K, Hamdi M, Monstrey S J. Soft tissue reconstruction with the superior gluteal artery perforator flap.  Clin Plast Surg. 2003;  30 371-382
    CrossrefPubMedGoogle Scholar
  • 51 Papp C, McCraw J B. Autogenous latissimus breast reconstruction.  Clin Plast Surg. 1998;  25 261-266
    CrossrefPubMedGoogle Scholar
  • 52 Delay E, Gounot N, Bouillot A et al.. Autologous latissimus breast reconstruction: a 3-year clinical experience with 100 patients.  Plast Reconstr Surg. 1998;  102 1461-1478
    CrossrefPubMedGoogle Scholar
  • 53 Kroll S S, Schusterman M A, Mistry D. The internal oblique repair of abdominal bulges secondary to TRAM flap breast reconstruction.  Plast Reconstr Surg. 1995;  96 100-104
    PubMedGoogle Scholar
  • 54 Tebbetts J B. Achieving a predictable 24-hour return to normal activities after breast augmentation: part I. Refining practices by using motion and time study principles.  Plast Reconstr Surg. 2002;  109 273-290
    PubMedGoogle Scholar
  • 55 Tebbetts J B. Achieving a predictable 24-hour return to normal activities after breast augmentation: part II. Patient preparation, refined surgical techniques, and instrumentation.  Plast Reconstr Surg. 2002;  109 293-305
    PubMedGoogle Scholar
  • 56 Rogers N, Allen R J. Radiation effects on breast reconstruction with the deep inferior epigastric perforator flap.  Plast Reconstr Surg. 2002;  109 1919-1924
    CrossrefPubMedGoogle Scholar
  • 57 Heinz T R, Cowper P A, Levin L S. Microsurgery costs and outcome.  Plast Reconstr Surg. 1999;  104 89-96
    CrossrefPubMedGoogle Scholar

Steven M PisanoM.D. 

Plastic, Reconstructive, and Microsurgical Associates of South Texas

P.A., 4499 Medical Drive, Suite 311

San Antonio, TX 78229

      >