Lesson 1Perioperative management and complication surveillance: flap failure, seroma, infection, donor-site morbidity, and long-term surveillanceThis part handles around-surgery improvement, including clot prevention, pain control, and fluid handling, and details early and late problem watching for flap failure, seroma, infection, donor-site issues, and long-term rebuilding follow-up.
Enhanced recovery and analgesia pathwaysAntibiotic use and infection preventionRecognition and management of flap compromiseSeroma, hematoma, and wound dehiscenceDonor-site contour and functional issuesLong-term follow-up and imaging protocolsLesson 2Oncologic context and timing: immediate vs delayed reconstruction, impact of adjuvant therapy and recurrence surveillanceThis part explains how tumour growth, stage, and edges affect rebuilding timing, comparing immediate, delayed, and delayed-immediate ways, and looking at how chemo, radiation, and watching needs shape rebuilding plans.
Tumor stage and margin status considerationsImmediate vs delayed vs delayed-immediateCoordination with medical oncology teamEffects of chemotherapy on wound healingRadiation planning and field considerationsImpact on imaging and recurrence detectionLesson 3Implant-specific issues: capsular contracture, infection, implant rupture, and use of acellular dermal matrix and fat grafting adjunctsThis part focuses on implant problems, including capsule tightening, infection, breaking, wrong place, and rippling, and reviews roles of skin matrix, mesh, and fat grafting to better support and shape.
Risk factors for capsular contractureDiagnosis and management of implant infectionDetection and management of implant ruptureUse of acellular dermal matrix and meshFat grafting to improve contour and coveragePrevention and correction of implant malpositionLesson 4Comparative risks and benefits: surgical risk profiles, aesthetic outcomes, longevity, need for revisions, and sensory recoveryThis part compares implant and own-tissue rebuilding in terms of surgery risk, recovery, beauty lasting, balance, revision needs, effect on body function, and feeling recovery, aiding personal patient advice.
Short-term surgical risks by techniqueHospital stay, recovery, and return to workAesthetic durability and ptosis over timeRevision rates and common secondary proceduresImpact on core strength and shoulder functionSensory changes and potential reinnervationLesson 5Influence of prior treatments: radiation effects on tissues, timing modification, and strategies to mitigate complicationsThis part looks at how past lump removal, breast removal, and radiation change tissue quality, blood flow, and problem risk, and discusses timing changes, staged ways, and extra methods to ease radiation issues.
Assessment of irradiated skin and soft tissueImpact of prior lumpectomy and mastectomyTiming reconstruction around radiation therapyStaged approaches in high-risk patientsUse of fat grafting to improve radiated bedsWhen to favor autologous over implant optionsLesson 6Shared decision-making and expectation management: symmetry, revisions, scar patterns, and psychosocial support resourcesThis part details planned joint decision-making, including getting patient values, talking real balance and scar types, outlining revision chances, and adding mind support, survivor care, and body image advice resources.
Eliciting goals, lifestyle, and risk toleranceExplaining likely scars and breast symmetryDiscussing revision probability and timelinesUse of visual aids and before–after photosScreening for distress and body image issuesCoordinating psychosocial and peer supportLesson 7Implant-based reconstruction: direct-to-implant vs two-stage expander-implant — indications and surgical stepsThis part contrasts direct-to-implant and two-stage expander-implant rebuilding, detailing indications, patient choice, pocket making, device pick, surgery steps, and ways to best safety, balance, and long results.
Patient selection and contraindicationsPrepectoral vs subpectoral pocket choiceTwo-stage expander fill protocolsIntraoperative implant sizing and selectionManagement of mastectomy skin flapsStrategies to reduce implant loss riskLesson 8Microsurgical principles for free flap reconstruction: anastomosis technique, ischemia time, flap monitoring methodsThis part reviews main tiny-surgery rules for free flap breast rebuilding, including vessel choice, joining methods, cut blood time reduction, surgery fixes, and after-surgery flap watching with clinical and extra tools.
Recipient vessel selection and preparationEnd-to-end vs end-to-side anastomosisStrategies to minimize ischemia timeUse of couplers and microvascular suturesIntraoperative assessment of flap perfusionPostoperative flap monitoring protocolsLesson 9Autologous reconstruction: pedicled flaps (latissimus dorsi) and free flaps (DIEP, TRAM, SIEA) — flap selection principles and donor-site considerationsThis part outlines own-tissue rebuilding options, focusing on attached latissimus dorsi and free flaps like DIEP, TRAM, and SIEA, stressing flap choice, donor-site problems, blood flow, and matching flap size to breast goals.
Latissimus dorsi flap indications and limitsDIEP flap anatomy and perforator selectionTRAM flap variants and abdominal wall impactSIEA flap advantages and reliability issuesMatching flap volume to breast sizeManaging donor-site scars and contourLesson 10Preoperative evaluation for reconstruction: imaging, oncologic clearance, PET/CT/MRI role, vascular mapping (CTA) for perforator flapsThis part covers full before-surgery check, including history, exam, breast and donor-site imaging, cancer clearance, and roles of PET/CT, MRI, and CTA blood mapping in planning safe implant and perforator flap rebuilding.
History, comorbidities, and risk stratificationBreast imaging review and oncologic clearanceAssessing abdominal and alternative donor sitesRole of MRI in implant and flap planningPET/CT for staging and treatment sequencingCTA mapping for perforator flap selection
