Lesson 1Perioperative management and complication surveillance: flap failure, seroma, infection, donor-site morbidity, and long-term surveillanceThis section addresses perioperative optimisation, including thromboprophylaxis, pain control, and fluid management, and details early and late complication surveillance for flap failure, seroma, infection, donor-site morbidity, and long-term reconstructive follow-up.
Enhanced recovery and analgesia pathwaysAntibiotic use and infection preventionRecognition and management of flap compromiseSeroma, haematoma, 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 section explains how tumour biology, stage, and margins influence reconstruction timing, comparing immediate, delayed, and delayed-immediate approaches, and examining how chemotherapy, radiation, and surveillance needs shape reconstructive planning.
Tumour 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 section focuses on implant-specific complications, including capsular contracture, infection, rupture, malposition, and rippling, and reviews the roles of acellular dermal matrix, mesh, and fat grafting as adjuncts to improve support and contour.
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 section compares implant-based and autologous reconstruction in terms of operative risk, recovery, aesthetic durability, symmetry, need for revisions, impact on physical function, and sensory recovery, supporting individualised patient counselling.
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 section examines how prior lumpectomy, mastectomy, and radiation alter tissue quality, vascularity, and complication risk, and discusses timing modifications, staged approaches, and adjunctive techniques to mitigate radiation-related problems.
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 favour autologous over implant optionsLesson 6Shared decision-making and expectation management: symmetry, revisions, scar patterns, and psychosocial support resourcesThis section details structured shared decision-making, including eliciting patient values, discussing realistic symmetry and scar patterns, outlining revision likelihood, and integrating psychosocial support, survivorship care, and body image counselling 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 section contrasts direct-to-implant and two-stage expander-implant reconstruction, detailing indications, patient selection, pocket creation, device choice, intraoperative sequencing, and strategies to optimise safety, symmetry, and long-term outcomes.
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, ischaemia time, flap monitoring methodsThis section reviews core microsurgical principles for free flap breast reconstruction, including vessel selection, anastomosis techniques, ischaemia time reduction, intraoperative troubleshooting, and postoperative flap monitoring using clinical and adjunctive technologies.
Recipient vessel selection and preparationEnd-to-end vs end-to-side anastomosisStrategies to minimise ischaemia 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 section outlines autologous reconstruction options, focusing on pedicled latissimus dorsi and free flaps such as DIEP, TRAM, and SIEA, with emphasis on flap selection, donor-site morbidity, perfusion, and matching flap volume 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 section covers comprehensive preoperative assessment, including history, physical exam, breast and donor-site imaging, oncologic clearance, and the roles of PET/CT, MRI, and CTA vascular mapping in planning safe implant and perforator flap reconstruction.
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
