Breast reconstruction - Revision history

Sglier1: typo fixes

2025-07-22T22:27:37Z

typo fixes

← Older revision		Revision as of 15:27, 22 July 2025
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	===Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. -->===		===Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. -->===
	===Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. -->===		===Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. -->===
	~~The most established regional~~ techniques ~~are~~ thoracic paravertebral block (PVB), pectoral nerve blocks (PECS I and II), serratus anterior plane (SAP) block, and erector spinae plane (ESP) block.		Regional techniques include thoracic paravertebral block (PVB), pectoral nerve blocks (PECS I and II), serratus anterior plane (SAP) block, and erector spinae plane (ESP) block.

	* Thoracic paravertebral block (PVB) has overwhelming evidence in both prosthetic and autologous breast reconstruction with a low complication rate: it provides significant reductions in postoperative pain, opioid consumption, nausea, and length of stay. PVB is ~~particularly~~ effective for mastectomy with or without ~~reconstruction~~, and is often preferred when lymph node dissection or flap-based reconstruction is planned. However, it is technically more challenging and carries a higher perceived risk compared to other blocks.<ref>{{Cite journal\|last=Calì Cassi\|first=L.\|last2=Biffoli\|first2=F.\|last3=Francesconi\|first3=D.\|last4=Petrella\|first4=G.\|last5=Buonomo\|first5=O.\|date=2017-03\|title=Anesthesia and analgesia in breast surgery: the benefits of peripheral nerve block\|url=https://pubmed.ncbi.nlm.nih.gov/28387892\|journal=European Review for Medical and Pharmacological Sciences\|volume=21\|issue=6\|pages=1341–1345\|issn=2284-0729\|pmid=28387892}}</ref><ref>{{Cite journal\|last=FitzGerald\|first=Simon\|last2=Odor\|first2=Peter M.\|last3=Barron\|first3=Ann\|last4=Pawa\|first4=Amit\|date=2019-03\|title=Breast surgery and regional anaesthesia\|url=https://pubmed.ncbi.nlm.nih.gov/31272657\|journal=Best Practice & Research. Clinical Anaesthesiology\|volume=33\|issue=1\|pages=95–110\|doi=10.1016/j.bpa.2019.03.003\|issn=1878-1608\|pmid=31272657}}</ref>		* Thoracic paravertebral block (PVB) has overwhelming evidence in both prosthetic and autologous breast reconstruction with a low complication rate: it provides significant reductions in postoperative pain, opioid consumption, nausea, and length of stay. PVB is effective for mastectomy with or without recon, and is often preferred when lymph node dissection or flap-based reconstruction is planned. However, it is technically more challenging and carries a higher perceived risk compared to other blocks.<ref>{{Cite journal\|last=Calì Cassi\|first=L.\|last2=Biffoli\|first2=F.\|last3=Francesconi\|first3=D.\|last4=Petrella\|first4=G.\|last5=Buonomo\|first5=O.\|date=2017-03\|title=Anesthesia and analgesia in breast surgery: the benefits of peripheral nerve block\|url=https://pubmed.ncbi.nlm.nih.gov/28387892\|journal=European Review for Medical and Pharmacological Sciences\|volume=21\|issue=6\|pages=1341–1345\|issn=2284-0729\|pmid=28387892}}</ref><ref>{{Cite journal\|last=FitzGerald\|first=Simon\|last2=Odor\|first2=Peter M.\|last3=Barron\|first3=Ann\|last4=Pawa\|first4=Amit\|date=2019-03\|title=Breast surgery and regional anaesthesia\|url=https://pubmed.ncbi.nlm.nih.gov/31272657\|journal=Best Practice & Research. Clinical Anaesthesiology\|volume=33\|issue=1\|pages=95–110\|doi=10.1016/j.bpa.2019.03.003\|issn=1878-1608\|pmid=31272657}}</ref>
	* Pectoral nerve blocks (PECS I and II) and serratus anterior plane blocks are easier to perform and demonstrate efficacy in reducing pain and opioid requirements, especially in implant-based and flap-based reconstructions. These blocks are ~~increasingly~~ favored for their safety profile ~~and versatility,~~ and can be combined with PVB for extensive procedures.<ref>{{Cite journal\|last=Abi-Rafeh\|first=Jad\|last2=Safran\|first2=Tyler\|last3=Abi-Jaoude\|first3=Joanne\|last4=Kazan\|first4=Roy\|last5=Alabdulkarim\|first5=Abdulaziz\|last6=Davison\|first6=Peter G.\|date=2022-07-01\|title=Nerve Blocks in Breast Plastic Surgery: Outcomes, Complications, and Comparative Efficacy\|url=https://pubmed.ncbi.nlm.nih.gov/35499513\|journal=Plastic and Reconstructive Surgery\|volume=150\|issue=1\|pages=1e–12e\|doi=10.1097/PRS.0000000000009253\|issn=1529-4242\|pmid=35499513}}</ref><ref>{{Cite journal\|last=Matsumoto\|first=Marcio\|last2=Flores\|first2=Eva M.\|last3=Kimachi\|first3=Pedro P.\|last4=Gouveia\|first4=Flavia V.\|last5=Kuroki\|first5=Mayra A.\|last6=Barros\|first6=Alfredo C. S. D.\|last7=Sampaio\|first7=Marcelo M. C.\|last8=Andrade\|first8=Felipe E. M.\|last9=Valverde\|first9=João\|last10=Abrantes\|first10=Eduardo F.\|last11=Simões\|first11=Claudia M.\|date=2018-05-18\|title=Benefits in radical mastectomy protocol: a randomized trial evaluating the use of regional anesthesia\|url=https://pubmed.ncbi.nlm.nih.gov/29777144\|journal=Scientific Reports\|volume=8\|issue=1\|pages=7815\|doi=10.1038/s41598-018-26273-z\|issn=2045-2322\|pmc=5959858\|pmid=29777144}}</ref>		* Pectoral nerve blocks (PECS I and II) and serratus anterior plane blocks are easier to perform and demonstrate efficacy in reducing pain and opioid requirements, especially in implant-based and flap-based reconstructions. These blocks are favored for their safety profile and can be combined with PVB for extensive procedures.<ref>{{Cite journal\|last=Abi-Rafeh\|first=Jad\|last2=Safran\|first2=Tyler\|last3=Abi-Jaoude\|first3=Joanne\|last4=Kazan\|first4=Roy\|last5=Alabdulkarim\|first5=Abdulaziz\|last6=Davison\|first6=Peter G.\|date=2022-07-01\|title=Nerve Blocks in Breast Plastic Surgery: Outcomes, Complications, and Comparative Efficacy\|url=https://pubmed.ncbi.nlm.nih.gov/35499513\|journal=Plastic and Reconstructive Surgery\|volume=150\|issue=1\|pages=1e–12e\|doi=10.1097/PRS.0000000000009253\|issn=1529-4242\|pmid=35499513}}</ref><ref>{{Cite journal\|last=Matsumoto\|first=Marcio\|last2=Flores\|first2=Eva M.\|last3=Kimachi\|first3=Pedro P.\|last4=Gouveia\|first4=Flavia V.\|last5=Kuroki\|first5=Mayra A.\|last6=Barros\|first6=Alfredo C. S. D.\|last7=Sampaio\|first7=Marcelo M. C.\|last8=Andrade\|first8=Felipe E. M.\|last9=Valverde\|first9=João\|last10=Abrantes\|first10=Eduardo F.\|last11=Simões\|first11=Claudia M.\|date=2018-05-18\|title=Benefits in radical mastectomy protocol: a randomized trial evaluating the use of regional anesthesia\|url=https://pubmed.ncbi.nlm.nih.gov/29777144\|journal=Scientific Reports\|volume=8\|issue=1\|pages=7815\|doi=10.1038/s41598-018-26273-z\|issn=2045-2322\|pmc=5959858\|pmid=29777144}}</ref>
	* Erector spinae plane block is an emerging technique with promising results, but less extensive data compared to PVB and PECS blocks.<ref>{{Cite journal\|last=Wong\|first=Heung-Yan\|last2=Pilling\|first2=Rob\|last3=Young\|first3=Bruce W. M.\|last4=Owolabi\|first4=Adetokunbo A.\|last5=Onwochei\|first5=Desire N.\|last6=Desai\|first6=Neel\|date=2021-09\|title=Comparison of local and regional anesthesia modalities in breast surgery: A systematic review and network meta-analysis\|url=https://pubmed.ncbi.nlm.nih.gov/33873002\|journal=Journal of Clinical Anesthesia\|volume=72\|pages=110274\|doi=10.1016/j.jclinane.2021.110274\|issn=1873-4529\|pmid=33873002}}</ref>
	* Regional anesthesia techniques do not adversely affect flap perfusion or hemodynamics.
			Regional anesthesia techniques do not adversely affect flap perfusion or hemodynamics.

	==Intraoperative management==		==Intraoperative management==

Sglier1 at 22:23, 22 July 2025

2025-07-22T22:23:56Z

← Older revision		Revision as of 15:23, 22 July 2025
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	===Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. -->===		===Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. -->===
	For both implant-based and autologous ~~reconstructions~~, the patient is typically placed in the supine position with both arms abducted to less than 90 degrees (access and minimize brachial plexus injury risk).		For both implant-based and autologous recons, the patient is typically placed in the supine position with both arms abducted to less than 90 degrees (access and minimize brachial plexus injury risk).

	For autologous flap procedures (e.g., DIEP, TRAM, or latissimus dorsi flaps), may need to potentially prone patient (will flip from prone to supine during graft harvest) or may need access to abdominal wall depending on planned flap type.		For autologous flap procedures (e.g., DIEP, TRAM, or latissimus dorsi flaps), may need to potentially prone patient (will flip from prone to supine during graft harvest) or may need access to abdominal wall depending on planned flap type.

			After placement of implant or flap, surgeon will typically ask for HOB up 90 degrees to assess symmetry.

	===Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. -->===		===Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. -->===

Sglier1: added more info in regional section, complications, positioning

2025-07-22T22:19:42Z

added more info in regional section, complications, positioning

← Older revision		Revision as of 15:19, 22 July 2025
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	\| considerations_postoperative =		\| considerations_postoperative =
	}}The purpose of breast reconstruction is to restore the shape, symmetry, and appearance of the breast following mastectomy or breast-conserving surgery, with the primary goals of improving quality of life, psychosocial well-being, and body image. Breast reconstruction addresses the physical disfigurement and sense of loss that often follow mastectomy, and is associated with improved psychological, physical, and sexual well-being.<ref>{{Cite journal\|last=Bellini\|first=Elisa\|last2=Pesce\|first2=Marianna\|last3=Santi\|first3=PierLuigi\|last4=Raposio\|first4=Edoardo\|date=2017\|title=Two-Stage Tissue-Expander Breast Reconstruction: A Focus on the Surgical Technique\|url=https://pubmed.ncbi.nlm.nih.gov/29376067\|journal=BioMed Research International\|volume=2017\|pages=1791546\|doi=10.1155/2017/1791546\|issn=2314-6141\|pmc=5742435\|pmid=29376067}}</ref>		}}The purpose of breast reconstruction is to restore the shape, symmetry, and appearance of the breast following mastectomy or breast-conserving surgery, with the primary goals of improving quality of life, psychosocial well-being, and body image. Breast reconstruction addresses the physical disfigurement and sense of loss that often follow mastectomy, and is associated with improved psychological, physical, and sexual well-being.<ref>{{Cite journal\|last=Bellini\|first=Elisa\|last2=Pesce\|first2=Marianna\|last3=Santi\|first3=PierLuigi\|last4=Raposio\|first4=Edoardo\|date=2017\|title=Two-Stage Tissue-Expander Breast Reconstruction: A Focus on the Surgical Technique\|url=https://pubmed.ncbi.nlm.nih.gov/29376067\|journal=BioMed Research International\|volume=2017\|pages=1791546\|doi=10.1155/2017/1791546\|issn=2314-6141\|pmc=5742435\|pmid=29376067}}</ref>

			Reconstruction can be performed using implant-based or autologous tissue techniques, and the choice is individualized based on patient characteristics, cancer treatment plan, and preferences.<ref>{{Cite journal\|last=Gerber\|first=Bernd\|last2=Marx\|first2=Mario\|last3=Untch\|first3=Michael\|last4=Faridi\|first4=Andree\|date=2015-08-31\|title=Breast Reconstruction Following Cancer Treatment\|url=https://pubmed.ncbi.nlm.nih.gov/26377531\|journal=Deutsches Arzteblatt International\|volume=112\|issue=35-36\|pages=593–600\|doi=10.3238/arztebl.2015.0593\|issn=1866-0452\|pmc=4577667\|pmid=26377531}}</ref>

	==Overview==		==Overview==
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	\|-		\|-
	\|Pulmonary		\|Pulmonary
	\|		\|respiratory compromise can be present if pt had XRT to thorax
	\|-		\|-
	\|Gastrointestinal		\|Gastrointestinal
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	===Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. -->===		===Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. -->===
	===Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. -->===		===Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. -->===
			The most established regional techniques are thoracic paravertebral block (PVB), pectoral nerve blocks (PECS I and II), serratus anterior plane (SAP) block, and erector spinae plane (ESP) block.

			* Thoracic paravertebral block (PVB) has overwhelming evidence in both prosthetic and autologous breast reconstruction with a low complication rate: it provides significant reductions in postoperative pain, opioid consumption, nausea, and length of stay. PVB is particularly effective for mastectomy with or without reconstruction, and is often preferred when lymph node dissection or flap-based reconstruction is planned. However, it is technically more challenging and carries a higher perceived risk compared to other blocks.<ref>{{Cite journal\|last=Calì Cassi\|first=L.\|last2=Biffoli\|first2=F.\|last3=Francesconi\|first3=D.\|last4=Petrella\|first4=G.\|last5=Buonomo\|first5=O.\|date=2017-03\|title=Anesthesia and analgesia in breast surgery: the benefits of peripheral nerve block\|url=https://pubmed.ncbi.nlm.nih.gov/28387892\|journal=European Review for Medical and Pharmacological Sciences\|volume=21\|issue=6\|pages=1341–1345\|issn=2284-0729\|pmid=28387892}}</ref><ref>{{Cite journal\|last=FitzGerald\|first=Simon\|last2=Odor\|first2=Peter M.\|last3=Barron\|first3=Ann\|last4=Pawa\|first4=Amit\|date=2019-03\|title=Breast surgery and regional anaesthesia\|url=https://pubmed.ncbi.nlm.nih.gov/31272657\|journal=Best Practice & Research. Clinical Anaesthesiology\|volume=33\|issue=1\|pages=95–110\|doi=10.1016/j.bpa.2019.03.003\|issn=1878-1608\|pmid=31272657}}</ref>
			* Pectoral nerve blocks (PECS I and II) and serratus anterior plane blocks are easier to perform and demonstrate efficacy in reducing pain and opioid requirements, especially in implant-based and flap-based reconstructions. These blocks are increasingly favored for their safety profile and versatility, and can be combined with PVB for extensive procedures.<ref>{{Cite journal\|last=Abi-Rafeh\|first=Jad\|last2=Safran\|first2=Tyler\|last3=Abi-Jaoude\|first3=Joanne\|last4=Kazan\|first4=Roy\|last5=Alabdulkarim\|first5=Abdulaziz\|last6=Davison\|first6=Peter G.\|date=2022-07-01\|title=Nerve Blocks in Breast Plastic Surgery: Outcomes, Complications, and Comparative Efficacy\|url=https://pubmed.ncbi.nlm.nih.gov/35499513\|journal=Plastic and Reconstructive Surgery\|volume=150\|issue=1\|pages=1e–12e\|doi=10.1097/PRS.0000000000009253\|issn=1529-4242\|pmid=35499513}}</ref><ref>{{Cite journal\|last=Matsumoto\|first=Marcio\|last2=Flores\|first2=Eva M.\|last3=Kimachi\|first3=Pedro P.\|last4=Gouveia\|first4=Flavia V.\|last5=Kuroki\|first5=Mayra A.\|last6=Barros\|first6=Alfredo C. S. D.\|last7=Sampaio\|first7=Marcelo M. C.\|last8=Andrade\|first8=Felipe E. M.\|last9=Valverde\|first9=João\|last10=Abrantes\|first10=Eduardo F.\|last11=Simões\|first11=Claudia M.\|date=2018-05-18\|title=Benefits in radical mastectomy protocol: a randomized trial evaluating the use of regional anesthesia\|url=https://pubmed.ncbi.nlm.nih.gov/29777144\|journal=Scientific Reports\|volume=8\|issue=1\|pages=7815\|doi=10.1038/s41598-018-26273-z\|issn=2045-2322\|pmc=5959858\|pmid=29777144}}</ref>
			* Erector spinae plane block is an emerging technique with promising results, but less extensive data compared to PVB and PECS blocks.<ref>{{Cite journal\|last=Wong\|first=Heung-Yan\|last2=Pilling\|first2=Rob\|last3=Young\|first3=Bruce W. M.\|last4=Owolabi\|first4=Adetokunbo A.\|last5=Onwochei\|first5=Desire N.\|last6=Desai\|first6=Neel\|date=2021-09\|title=Comparison of local and regional anesthesia modalities in breast surgery: A systematic review and network meta-analysis\|url=https://pubmed.ncbi.nlm.nih.gov/33873002\|journal=Journal of Clinical Anesthesia\|volume=72\|pages=110274\|doi=10.1016/j.jclinane.2021.110274\|issn=1873-4529\|pmid=33873002}}</ref>
			* Regional anesthesia techniques do not adversely affect flap perfusion or hemodynamics.

	==Intraoperative management==		==Intraoperative management==
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	===Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. -->===		===Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. -->===
			For both implant-based and autologous reconstructions, the patient is typically placed in the supine position with both arms abducted to less than 90 degrees (access and minimize brachial plexus injury risk).

			For autologous flap procedures (e.g., DIEP, TRAM, or latissimus dorsi flaps), may need to potentially prone patient (will flip from prone to supine during graft harvest) or may need access to abdominal wall depending on planned flap type.

	===Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. -->===		===Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. -->===
			For implant-based reconstruction, the operative plane (prepectoral vs. subpectoral) affects anesthetic requirements, with prepectoral placement associated with lower perioperative opioid and antiemetic needs.

	===Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. -->===		===Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. -->===
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	===Potential complications<!-- List and/or describe any potential postoperative complications for this case. -->===		===Potential complications<!-- List and/or describe any potential postoperative complications for this case. -->===
			Major complications—those requiring rehospitalization or reoperation—are more frequent with autologous techniques, especially in the setting of higher BMI, comorbidities, or radiotherapy. Radiation therapy increases the risk of infection, implant loss, and fat necrosis, particularly in the late postoperative period.<ref>{{Cite journal\|last=Bennett\|first=Katelyn G.\|last2=Qi\|first2=Ji\|last3=Kim\|first3=Hyungjin M.\|last4=Hamill\|first4=Jennifer B.\|last5=Pusic\|first5=Andrea L.\|last6=Wilkins\|first6=Edwin G.\|date=2018-10-01\|title=Comparison of 2-Year Complication Rates Among Common Techniques for Postmastectomy Breast Reconstruction\|url=https://doi.org/10.1001/jamasurg.2018.1687\|journal=JAMA Surgery\|volume=153\|issue=10\|pages=901–908\|doi=10.1001/jamasurg.2018.1687\|issn=2168-6254}}</ref>

			* Seroma
			* Hematoma
			* Implant reconstruction:
			** Capsular contracture
			** Implant malposition / rupture / leakage
			* Autologous reconstruction:
			** Flap thrombosis can lead to necrosis
			*** monitoring for flap perfusion is critical in autologous reconstruction
			** Fat necrosis
			** Hernia

	==Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). -->==		==Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). -->==

Sglier1: started a page for breast recon, not completed

2025-07-22T20:03:08Z

started a page for breast recon, not completed

New page

{{Infobox surgical procedure
| anesthesia_type =
| airway =
| lines_access =
| monitors =
| considerations_preoperative =
| considerations_intraoperative =
| considerations_postoperative =
}}The purpose of breast reconstruction is to restore the shape, symmetry, and appearance of the breast following mastectomy or breast-conserving surgery, with the primary goals of improving quality of life, psychosocial well-being, and body image. Breast reconstruction addresses the physical disfigurement and sense of loss that often follow mastectomy, and is associated with improved psychological, physical, and sexual well-being.<ref>{{Cite journal|last=Bellini|first=Elisa|last2=Pesce|first2=Marianna|last3=Santi|first3=PierLuigi|last4=Raposio|first4=Edoardo|date=2017|title=Two-Stage Tissue-Expander Breast Reconstruction: A Focus on the Surgical Technique|url=https://pubmed.ncbi.nlm.nih.gov/29376067|journal=BioMed Research International|volume=2017|pages=1791546|doi=10.1155/2017/1791546|issn=2314-6141|pmc=5742435|pmid=29376067}}</ref>

==Overview==
===Indications===
===Surgical procedure===

==Preoperative management==
===Patient evaluation===
{| class="wikitable"
|+
!System
!Considerations
|-
|Airway
|
|-
|Neurologic
|
|-
|Cardiovascular
|
|-
|Pulmonary
|
|-
|Gastrointestinal
|
|-
|Hematologic
|
|-
|Renal
|
|-
|Endocrine
|
|-
|Other
|
|}
===Labs and studies===
===Operating room setup===
===Patient preparation and premedication===
===Regional and neuraxial techniques===

==Intraoperative management==
===Monitoring and access===

===Induction and airway management===

===Positioning===

===Maintenance and surgical considerations===

===Emergence===

==Postoperative management==
===Disposition===

===Pain management===

===Potential complications===

==Procedure variants==

{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Variant 1
!Variant 2
|-
|Unique considerations
|
|
|-
|Indications
|
|
|-
|Position
|
|
|-
|Surgical time
|
|
|-
|EBL
|
|
|-
|Postoperative disposition
|
|
|-
|Pain management
|
|
|-
|Potential complications
|
|
|}

==References==

[[Category:Surgical procedures]]