Surgery and Imaging of Breast Reconstruction

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Breast Sonography: 3.25
Procedures: 3.25
Pathology: 1.00
Breast Interventions: 2.25

Mammography: 3.25
Patient Care: 1.00
Patient Interactions and Management: 1.00
Procedures: 2.25
Anatomy, Physiology, and Pathology: 2.25

Magnetic Resonance Imaging: 2.25
Procedures: 2.25
Body: 2.25

Registered Radiologist Assistant: 3.25
Patient Care: 1.00
Patient Management: 1.00
Procedures: 2.25
Thoracic Section: 2.25

Sonography: 2.25
Procedures: 2.25
Superficial Structures and Other Sonographic Procedures: 2.25

Radiation Therapy: 3.25
Patient Care: 2.25
Patient and Medical Record Management: 2.25
Procedures: 1.00
Treatments: 1.00

Outline

1. Introduction
2. Breast Reconstruction Techniques
   1. Reconstruction with Prosthetic Implants
   2. Reconstruction with Autologous Tissue Flaps
      1. Latissimus Dorsi Mycutaneous Flap
      2. TRAM Flaps
         1. Pedicled TRAM Flap
         2. Free TRAM Flap
         3. Free Muscle-sparing TRAM Flap
      3. DIEP Flap
      4. SIEA Flap
3. Preoperative Imaging Studies
4. Breast Imaging Appearances after Autologous Reconstruction
   1. Normal Finding and Benign Changes
      1. Seromas and Hematomas
      2. Fat Necrosis
      3. Fibrosis
   2. Breast Cancer Recurrence
5. Analysis of Patient Records at Our Breast Imaging Center

Objectives

Upon completion of this course, students will:

1. discuss why breast reconstruction is performed following mastectomy
2. describe the solutions utilized for prosthetic breast implants
3. differentiate between silicon and saline breast implants
4. explain the advantage of prosthetic breast reconstruction
5. organize the grades of breast capsular contracture
6. specify the preferred tissue donor site for autologous tissue flaps
7. describe the advantage of the latissimus dorsi myocutaneous flap technique
8. know what pedicled means
9. describe how pedicled TRAM flaps are tunneled to the mastectomy site
10. communicate the disadvantages of the pedicled TRAM flap procedure
11. understand the advantages of the free TRAM flap technique
12. list success factors for free TRAM flap procedures
13. specify vessels used for free TRAM flap procedures
14. identify components of the free muscle-sparing TRAM flap procedure
15. describe components of the DIEP flap procedure
16. list advantages of the DIEP flap procedure
17. explain the use of the rectus abdominis muscle for SIEA flap procedures
18. describe the veins utilized for SIEA flap procedures
19. differentiate between pre-operative vascular mapping studies
20. describe the appearance of reconstructed breasts on mammography and breast MRI
21. list common benign changes in breasts reconstructed with autologous tissue flaps
22. specify the time frame following radiation therapy when skin and trabeculae thickening of the reconstructed breast may occur
23. explain the composition of seromas
24. be familiar with the appearance of tissues on T2-weighted MR images
25. describe factors causing seromas
26. explain the cause of fat necrosis
27. discuss the presentation of fat necrosis at physical examination
28. describe the appearance of fibrosis on mammograms
29. be familiar with the enhancement patterns of fibrosis and recurrent tumors following the injection of a gadolinimum-based MR contrast agent
30. understand by how much breast cancer is reduced following mastectomy
31. compare T1 and T2 tumor classifications
32. describe where recurrent breast cancer occurs post-reconstruction
33. list the factors influencing risk of local breast cancer recurrence
34. be familiar with the features of MR subtraction imaging
35. explain the relevance of additional imaging procedures when MR demonstrates abnormalities