breast reconstruction

• 乳房再建、乳房再建術、乳房再建手術、乳房形成術、乳房形成手術

関

breast implant、mammaplasty、mammoplasty

WordNet

1. meet at breast level; "The runner breasted the tape"
2. the part of an animals body that corresponds to a persons chest
3. either of two soft fleshy milk-secreting glandular organs on the chest of a woman (同)bosom, knocker, boob, tit, titty
4. the front of the trunk from the neck to the abdomen; "he beat his breast in anger" (同)chest
5. meat carved from the breast of a fowl (同)white_meat
6. the activity of constructing something again
7. recall that is hypothesized to work by storing abstract features which are then used to construct the memory during recall (同)reconstructive memory
8. an interpretation formed by piecing together bits of evidence
9. the period after the American Civil War when the southern states were reorganized and reintegrated into the Union; 1865-1877 (同)Reconstruction Period
10. having a breast or breasts; or breasts as specified; used chiefly in compounds; "small-breasted"; "red-breasted sandpiper"

PrepTutorEJDIC

1. 『胸』,『胸部』;(服の)胸部 / 『乳房』,乳 / 《文》胸中,心紳 / …'を'胸に受ける,胸に受けて進む / …‘に'雄々しく立ち向かう
2. 〈U〉再建,改造,復興,復元 / 〈C〉再建(改造,復元)された物 / 《the R-》《米》南部諸州の再統合期,再建時代(南北戦争後,法律・諸制度を改正した1865年から1877年までの期間)

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/09/24 13:29:03」(JST)

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[Wiki en表示]

Result of breast reconstruction after mastectomy. Nipple missing, and cicatrix (scar) is prominent.

Breast reconstruction is the rebuilding of a breast, usually in women. It involves using autologous tissue or prosthetic material to construct a natural-looking breast. Often this includes the reformation of a natural-looking areola and nipple. This procedure involves the use of implants or relocated flaps of the patient's own tissue.

The primary part of the procedure can often be carried out immediately following the mastectomy. As with many other surgeries, patients with significant medical comorbidities (high blood pressure, obesity, diabetes) and smokers are higher-risk candidates. Surgeons may choose to perform delayed reconstruction to decrease this risk. There is little evidence available from randomised studies to favour immediate or delayed reconstruction. The infection rate may be higher with primary reconstruction (done at the same time as mastectomy), but there are psychologic and financial benefits to having a single primary reconstruction. Patients expected to receive radiation therapy as part of their adjuvant treatment are also commonly considered for delayed autologous reconstruction due to significantly higher complication rates with tissue expander-implant techniques in those patients. Waiting for six months to a year following may decrease the risk of complications, but this risk will always be higher in patients who have received radiation therapy.

Delayed breast reconstruction is considered more challenging than immediate reconstruction. Frequently not just breast volume, but also skin surface area needs to be restored. Many patients undergoing delayed breast reconstruction have been previously treated with radiation or have had a reconstruction failure with immediate breast reconstruction. In nearly all cases of delayed breast reconstruction tissue must be borrowed from another part of the body to make the new breast.

Breast reconstruction is a large undertaking that usually takes multiple operations. Sometimes these follow-up surgeries are spread out over weeks or months. If an implant is used, the individual runs the same risks and complications as those who use them for breast augmentation but has higher rates of capsular contracture (tightening or hardening of the scar tissue around the implant) and revisional surgeries.

Outcomes based research on quality of life improvements and psychosocial benefits associated with breast reconstruction served as the stimulus in the United States for the 1998 Women's Health and Cancer Rights Act, which mandated health care payer coverage for breast and nipple reconstruction, contralateral procedures to achieve symmetry, and treatment for the sequelae of mastectomy. This was followed in 2001 by additional legislation imposing penalties on noncompliant insurers. Similar provisions for coverage exist in most countries worldwide through national health care programs.

Techniques

There are many methods for breast reconstruction. The two most common are:

Breast Reconstruction using a Tissue Expander.

• Tissue Expander - Breast implants This is the most common technique used worldwide. The surgeon inserts a tissue expander, a temporary silastic implant, beneath a pocket under the pectoralis major muscle of the chest wall. The pectoral muscles may be released along its inferior edge to allow a larger, more supple pocket for the expander at the expense of thinner lower pole soft tissue coverage. The use of acellular human or animal dermal grafts have been described as an onlay patch to increase coverage of the implant when the pectoral muscle is released, which purports to improve both functional and aesthtic outcomes of implant-expander breast reconstruction.
  • In a process that can take weeks to months, saline solution is injected to progressively expand the overlaying tissue. Once the expander has reached an acceptable size, it may be removed and replaced with a more permanent implant. Reconstruction of the areola and nipple are usually performed in a separate operation after the skin has stretched to its final size.
• Flap reconstruction The second most common procedure uses tissue from other parts of the patient's body, such as the back, buttocks, thigh or abdomen. This procedure may be performed by leaving the donor tissue connected to the original site to retain its blood supply (the vessels are tunnelled beneath the skin surface to the new site) or it may be cut off and new blood supply may be connected.
  • The latissimus dorsi muscle flap is the donor tissue available on the back. It is a large flat muscle which can be employed without significant loss of function. It can be moved into the breast defect while still attached to its blood supply under the arm pit (axilla). A latissimus flap is usually used to recruit soft-tissue coverage over an underlying implant. Enough volume can be recruited occasionally to reconstruct small breasts without an implant.

Transverse Rectus Abdominis Myocutaneous flap (TRAM).

Post-operative state after Transverse Rectus Abdominis Myocutaneous flap(TRAM).

• • Abdominal flaps The abdominal flap for breast reconstruction is the TRAM flap (Transverse Rectus Abdominis Myocutaneous flap) or its technically distinct variants of microvascular "perforator flaps" like the DIEP/SIEP flaps. In a TRAM procedure, a portion of the abdomen tissue group, including skin, adipose tissues, minor muscles and connective tissues, is taken from the patient's abdomen and transplanted onto the breast site. Both TRAM and DIEP/SIEP use the abdominal tissue between the umbilicus and the pubis. The DIEP flap and free-TRAM flap require advanced microsurgical technique and are less common as a result. Both can provide enough tissue to reconstruct large breasts. These procedures are preferred by some breast cancer patients because they result in an abdominoplasty (tummy tuck), and allow the breast to be reconstructed with one's own tissues instead of a foreign implant. TRAM flap procedures may weaken the abdominal wall and torso strength, but are tolerated well in most patients. To prevent muscle weakness and incisional hernias, the portion of abdominal wall exposed by reflection of the rectus abdominis muscle may be strengthened by a piece of surgical mesh placed over the defect and sutured in place. Perforator techniques such as the DIEP (deep inferior epigastric perforator) flap and SIEA (superficial inferior epigastric artery) flap require precise dissection of small perforating vessels through the rectus muscle, and purport the advantage of less weakening of the abdominal wall, though rectus abdominus muscle function may still be compromised. Other total autologous tissue breast reconstruction donor sites include the buttocks (superior or inferior gluteal artery perforator flaps (SGAP or IGAP)). The purpose of perforator flaps (DIEP, SIEA, SGAP, IGAP) is to provide sufficient skin and fat for an aesthetic reconstruction while minimizing morbidity from harvesting the underlying muscles. See free flap breast reconstruction for more information.
  • Mold-assisted reconstruction Made using laser scanning and 3D printing, a patient-specific silicone mold can be used as an aid during surgery. It is used as a guide for orienting and shaping the flap to improve accuracy and symmetry.

Other considerations

Breast Reconstruction using a Prosthesis

To restore the appearance of the breast with surgical reconstruction, there are a few options regarding the nipple and areola.

• A nipple prosthesis can be used to restore the appearance of the reconstructed breast. Impressions can be made and photographs can be used to accurately replace the nipple lost with some types of mastectomies. This can be instrumental in restoring the psychological well-being of the breast cancer survivor. The same process can be used to replicate the remaining nipple in cases of a single mastectomy. Ideally, a prosthesis is made around the time of the mastectomy and it can be used just weeks after the surgery.
• Nipple reconstruction is usually delayed until after the breast mound reconstruction is completed so that the positioning can be planned precisely. There are several methods of reconstructing the nipple-areolar complex, including:

• Nipple-Areolar Composite Graft (Sharing) - if the contralateral breast has not been reconstructed and the nipple and areolar are sufficiently large, tissue may be harvested and used to recreate the nipple-areolar complex on the reconstructed side.
• Local Tissue Flaps - a nipple may be created by raising a small flap in the target area and producing a raised mound of skin. To create an areola, a circular incision may be made around the new nipple and sutured back again. The nipple and areolar region may then be tattooed to produce a realistic colour match with the contralateral breast.
• Local Tissue Flaps With Use of AlloDerm - as above, a nipple may be created by raising a small flap in the target area and producing a raised mound of skin. AlloDerm (cadaveric dermis) can then be inserted into the core of the new nipple acting like a "strut" which may help maintain the projection of the nipple for a longer period of time. The nipple and areolar region may then be tattooed later. There are however some important issues in relation to NAC Tattooing that should be considered prior to opting for tattooing, such as the choice of pigments and equipment used for the procedure.

See also

• Breast implant
• Breast lift
• Breast reduction plasty
• Free flap breast reconstruction
• Nipple prosthesis
• Titoo

References

External links

• Breast Reconstruction Following Breast Removal from the American Society of Plastic Surgeons
• National Cancer Institute breast cancer page
• US Dept. of Labor - Women's Health & Cancer Rights Act of 1998
• Plastic Surgery Stirs a Debate

UpToDate Contents

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• 1. 乳房再建：術前評価 breast reconstruction preoperative assessment
• 2. 乳房再建：乳房プロテーゼ breast reconstruction prosthetic devices
• 3. 乳房再建：自家組織 breast reconstruction autologous tissue
• 4. 乳房切除：適応、種類、および切除時の腋窩リンパ節マネージメント mastectomy indications types and concurrent axillary lymph node management
• 5. 乳房温存手術におけるオンコプラスティックテクニック oncoplastic techniques in breast conserving surgery

English Journal

• Alleviation of capsular formations on silicone implants in rats using biomembrane-mimicking coatings.

• Park JU1, Ham J2, Kim S3, Seo JH4, Kim SH5, Lee S2, Min HJ6, Choi S2, Choi RM6, Kim H2, Oh S7, Hur JA8, Choi TH9, Lee Y10.
• Acta biomaterialia.Acta Biomater.2014 Oct;10(10):4217-25. doi: 10.1016/j.actbio.2014.07.007. Epub 2014 Jul 12.
• Despite their popular use in breast augmentation and reconstruction surgeries, the limited biocompatibility of silicone implants can induce severe side effects, including capsular contracture - an excessive foreign body reaction that forms a tight and hard fibrous capsule around the implant. This st
• PMID 25020265

• Use of prophylactic postoperative antibiotics during surgical drain presence following mastectomy.

• Edwards BL1, Stukenborg GJ, Brenin DR, Schroen AT.
• Annals of surgical oncology.Ann Surg Oncol.2014 Oct;21(10):3249-55. doi: 10.1245/s10434-014-3960-7. Epub 2014 Aug 20.
• BACKGROUND: National guidelines recommend one dose of perioperative antibiotics for breast surgery and discourage postoperative continuation. However, reported skin and soft tissue infection (SSI) rates after mastectomy range from 1-26 %, higher than expected for clean cases. Utility of routine or
• PMID 25138078

• Randomized trial of drain antisepsis after mastectomy and immediate prosthetic breast reconstruction.

• Degnim AC1, Hoskin TL, Brahmbhatt RD, Warren-Peled A, Loprinzi M, Pavey ES, Boughey JC, Hieken TJ, Jacobson S, Lemaine V, Jakub JW, Irwin C, Foster RD, Sbitany H, Saint-Cyr M, Duralde E, Ramaker S, Chin R, Sieg M, Wildeman M, Scow JS, Patel R, Ballman K, Baddour LM, Esserman LJ.
• Annals of surgical oncology.Ann Surg Oncol.2014 Oct;21(10):3240-8. doi: 10.1245/s10434-014-3918-9. Epub 2014 Aug 6.
• BACKGROUND: In this 2-site randomized trial, we investigated the effect of antiseptic drain care on bacterial colonization of surgical drains and infection after immediate prosthetic breast reconstruction.METHODS: With IRB approval, we randomized patients undergoing bilateral mastectomy and reconstr
• PMID 25096386

Japanese Journal

• 中国における乳癌患者の身体経験

• 社会学論考 (36), 49-74, 2015-12
• NAID 120005708932

• 患者まで届いている再生医療 脂肪組織由来幹細胞を用いた乳房再建術

• 再生医療 : 日本再生医療学会雑誌 14(4), 370-376, 2015-11
• NAID 40020660788

• DIEP flapとエキスパンダーを用いた二次乳房再建 (AYUMI マイクロサージャリーに関する最近の話題)

• 医学のあゆみ 255(4), 271-275, 2015-10-24
• NAID 40020624545

Related Links

• Breast Reconstruction.org

Women who have undergone breast reconstruction share their stories and photos. New additions are added regularly to help connect our users with women who have had all types of breast reconstruction surgery.

• Breast Reconstruction: Mastectomy, Reconstructive ...

Breast reconstruction is an option for a woman who has lost a breast due to cancer or other condition. Learn more, view before and after photos from ASPS. ... Breast Reconstruction Helping You Become Whole Again Breast ...

Related Pictures

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★リンクテーブル★

リンク元	「乳房形成術」「乳房再建術」「乳房再建」「乳房再建手術」「乳房形成手術」
関連記事	「reconstruction」「breast」

「乳房形成術」

　　[★]

英

mammoplasty、breast reconstruction、mammaplasty

関

乳房再建、乳房再建術、乳房再建手術、乳房形成手術、乳房形成

「乳房再建術」

　　[★]

英

breast reconstruction、breast implant

関

乳房形成術、乳房再建、乳房再建手術、乳房形成手術、豊胸術

「乳房再建」

　　[★]

英

breast reconstruction

関

乳房形成術、乳房再建術、乳房再建手術、乳房形成手術

「乳房再建手術」

　　[★]

英

breast reconstruction

関

乳房形成術、乳房再建、乳房再建術、乳房形成手術

「乳房形成手術」

　　[★]

英

breast reconstruction

関

乳房形成術、乳房再建、乳房再建術、乳房再建手術

「reconstruction」

　　[★]

• n.

• 再構築、再建

関

reassembly、reconstruct、reestablish、reestablishment、remodel、remodeling、remodelling、reorganization、restoration、restore、restructure

　 　 　 　

「breast」

　　[★]

• n.

• 胸、胸部
• 乳房