Download PDF
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
Further Information

Publication History

Publication Date:
14 June 2004 (online)

Also available at
    Permissions and 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
    PubMedSearch in Google Scholar
  • 2 Miller M J. Immediate breast reconstruction.  Clin Plast Surg. 1998;  25 145-156
    PubMedSearch in Google 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
    CrossrefPubMedSearch in Google Scholar
  • 4 Asko-Seljavaara S. Delayed breast reconstruction.  Clin Plast Surg. 1998;  25 157-166
    PubMedSearch in Google Scholar
  • 5 Schusterman M A. The free TRAM flap.  Clin Plast Surg. 1998;  25 191-195
    PubMedSearch in Google Scholar
  • 6 Evans G RD, Kroll S S. Choice of technique for reconstruction.  Clin Plast Surg. 1998;  25 311-316
    PubMedSearch in Google 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
    PubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google Scholar
  • 10 Reece G P, Kroll S S. Abdominal wall complications: prevention and treatment.  Clin Plast Surg. 1998;  25 235-249
    PubMedSearch in Google 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
    CrossrefPubMedSearch in Google Scholar
  • 12 Kroll S S. Bilateral breast reconstruction.  Clin Plast Surg. 1998;  25 251-259
    PubMedSearch in Google Scholar
  • 13 Blondeel P N. One hundred free DIEP flap breast reconstructions: a personal experience.  Br J Plast Surg. 1999;  52 104-111
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    PubMedSearch in Google 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
    CrossrefPubMedSearch in Google Scholar
  • 19 Polednak A. Geographic variation in postmastectomy breast reconstruction rates.  Plast Reconstr Surg. 2000;  106 298-301
    PubMedSearch in Google 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
    CrossrefPubMedSearch in Google Scholar
  • 21 Collins E D. Discussion, reconstructive breast surgery: referring physician knowledge and learning needs.  Plast Reconstr Surg. 2002;  110 1451-1454
    PubMedSearch in Google 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
    PubMedSearch in Google 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
    PubMedSearch in Google 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
    PubMedSearch in Google Scholar
  • 25 Allen R J, Treece P. Deep inferior epigastric perforator flap for breast reconstruction.  Ann Plast Surg. 1994;  32 32-38
    Search in 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
    CrossrefPubMedSearch in Google 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
    Search in 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google Scholar
  • 31 Miller S H. Comparison of costs between implant-based and TRAM flap breast reconstruction.  Plast Reconstr Surg. 1996;  98 916-917
    PubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    Search in 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
    CrossrefPubMedSearch in Google 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
    PubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google Scholar
  • 38 Ninkovic M M, Schwabegger A H, Anderl H. Internal mammary vessels as a recipient site.  Clin Plast Surg. 1998;  25 213-221
    PubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google Scholar
  • 42 Robb G L. Thoracodorsal vessels as a recipient site.  Clin Plast Surg. 1998;  25 207-211
    PubMedSearch in Google Scholar
  • 43 Hallock G G. Doppler sonography and color duplex imaging for planning a perforator flap.  Clin Plast Surg. 2003;  30 347-357
    Search in 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google Scholar
  • 49 Allen R J. The superior gluteal artery perforator flap.  Clin Plast Surg. 1998;  25 293-302
    PubMedSearch in Google 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
    CrossrefPubMedSearch in Google Scholar
  • 51 Papp C, McCraw J B. Autogenous latissimus breast reconstruction.  Clin Plast Surg. 1998;  25 261-266
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    PubMedSearch in Google 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
    PubMedSearch in Google 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
    PubMedSearch in Google 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
    CrossrefPubMedSearch in Google Scholar
  • 57 Heinz T R, Cowper P A, Levin L S. Microsurgery costs and outcome.  Plast Reconstr Surg. 1999;  104 89-96
    CrossrefPubMedSearch in Google Scholar

Steven M PisanoM.D. 

Plastic, Reconstructive, and Microsurgical Associates of South Texas

P.A., 4499 Medical Drive, Suite 311

San Antonio, TX 78229