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MR imaging of the reconstructed breast: What the radiologist needs to know.

Dialani V, Lai KC, Slanetz PJ - Insights Imaging (2012)

Bottom Line: Surgical management of breast cancer often entails lumpectomy or mastectomy.In this article, we will review the more commonly encountered types of breast reconstruction, which include implants, tranversus rectus abdomnis flap, latissimus dorsi flap, deep inferior epigastric perforator flap, and gluteal flaps.Radiologists will better understand the different types of breast reconstruction after mastectomy and their normal imaging appearance on MRI.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Beth Israel Deaconess Medical Center, C/o Dr. Vandana Dialani, 330 Brookline Avenue, Boston, MA, 02215, USA, vdialani@bidmc.harvard.edu.

ABSTRACT

Objective: The objective is to review the different types of breast reconstruction following cancer surgery and describe expected imaging appearances and complications seen in the reconstructed breast.

Methods: Surgical management of breast cancer often entails lumpectomy or mastectomy. When mastectomy is performed, patients often opt for breast reconstruction. Most facilities do not routinely image the reconstructed breast with mammography.

Results: However, many of these women are imaged with screening breast MRI for evaluation of the contralateral breast, or they may develop a clinical problem that warrants a diagnostic evaluation with MRI. In this article, we will review the more commonly encountered types of breast reconstruction, which include implants, tranversus rectus abdomnis flap, latissimus dorsi flap, deep inferior epigastric perforator flap, and gluteal flaps. Each of these types of reconstruction has different appearances on MR. We will also discuss potential complications that can be seen in the reconstructed breasts, including fat necrosis and recurrence.

Conclusion: Radiologists will better understand the different types of breast reconstruction after mastectomy and their normal imaging appearance on MRI. Radiologists will be more aware of how to recognize complications related to surgery as well as how to determine whether recurrence is present.

Main messages: • The different surgical techniques used in breast reconstruction are discussed. • Describes the normal magnetic resonance imaging appearance of the breast after reconstruction. • Identify MR imaging features of benign sequelae and recurrence following breast reconstruction.

No MeSH data available.


Related in: MedlinePlus

a Reconstruction with latissimus dorsi myocutaneous flap. Latissimus dorsi muscle, fat, and skin are rotated to reconstruct the breast. b Axial fat-saturated T1W image with post-contrast gadolinium injection, the flap consisting of the latissimus dorsi muscle and its overlying skin and fat flipped and tunneled from the back to the neobreast (white arrows), giving a tailed appearance to the muscle in the lateral breast. This can be used as a differentiator on imaging from TRAM flap reconstruction. c Sagittal nonfat-saturated T2W image show latissimus dorsi muscle flipped anteriorly for reconstruction, and the denuded dermal layer is seen parallel to the chest wall (white arrow heads)
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Fig2: a Reconstruction with latissimus dorsi myocutaneous flap. Latissimus dorsi muscle, fat, and skin are rotated to reconstruct the breast. b Axial fat-saturated T1W image with post-contrast gadolinium injection, the flap consisting of the latissimus dorsi muscle and its overlying skin and fat flipped and tunneled from the back to the neobreast (white arrows), giving a tailed appearance to the muscle in the lateral breast. This can be used as a differentiator on imaging from TRAM flap reconstruction. c Sagittal nonfat-saturated T2W image show latissimus dorsi muscle flipped anteriorly for reconstruction, and the denuded dermal layer is seen parallel to the chest wall (white arrow heads)

Mentions: The latissimus dorsi (LD) flap is a standard method for breast reconstruction that was first utilized in the 1970s. It is most commonly combined with a tissue expander or implant, or occasionally, for a thin patient with a small breast volume, can be used alone as the primary reconstruction without the need for an implant, restoring volumes of up to 1.5 l in large patients or with the use of modified techniques [2, 3], which is considered oncologically safe. It is often reserved for patients in whom TRAM reconstruction is contraindicated. It can also be used as a salvage procedure for patients who have had previous radiation and are not candidates for other autogeneous procedures. Reconstruction with the latissimus dorsi myocutaneous flap produces a breast with ptosis and projection while maintaining the natural consistency and feel of normal tissue (Fig. 2).Fig. 2


MR imaging of the reconstructed breast: What the radiologist needs to know.

Dialani V, Lai KC, Slanetz PJ - Insights Imaging (2012)

a Reconstruction with latissimus dorsi myocutaneous flap. Latissimus dorsi muscle, fat, and skin are rotated to reconstruct the breast. b Axial fat-saturated T1W image with post-contrast gadolinium injection, the flap consisting of the latissimus dorsi muscle and its overlying skin and fat flipped and tunneled from the back to the neobreast (white arrows), giving a tailed appearance to the muscle in the lateral breast. This can be used as a differentiator on imaging from TRAM flap reconstruction. c Sagittal nonfat-saturated T2W image show latissimus dorsi muscle flipped anteriorly for reconstruction, and the denuded dermal layer is seen parallel to the chest wall (white arrow heads)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3369124&req=5

Fig2: a Reconstruction with latissimus dorsi myocutaneous flap. Latissimus dorsi muscle, fat, and skin are rotated to reconstruct the breast. b Axial fat-saturated T1W image with post-contrast gadolinium injection, the flap consisting of the latissimus dorsi muscle and its overlying skin and fat flipped and tunneled from the back to the neobreast (white arrows), giving a tailed appearance to the muscle in the lateral breast. This can be used as a differentiator on imaging from TRAM flap reconstruction. c Sagittal nonfat-saturated T2W image show latissimus dorsi muscle flipped anteriorly for reconstruction, and the denuded dermal layer is seen parallel to the chest wall (white arrow heads)
Mentions: The latissimus dorsi (LD) flap is a standard method for breast reconstruction that was first utilized in the 1970s. It is most commonly combined with a tissue expander or implant, or occasionally, for a thin patient with a small breast volume, can be used alone as the primary reconstruction without the need for an implant, restoring volumes of up to 1.5 l in large patients or with the use of modified techniques [2, 3], which is considered oncologically safe. It is often reserved for patients in whom TRAM reconstruction is contraindicated. It can also be used as a salvage procedure for patients who have had previous radiation and are not candidates for other autogeneous procedures. Reconstruction with the latissimus dorsi myocutaneous flap produces a breast with ptosis and projection while maintaining the natural consistency and feel of normal tissue (Fig. 2).Fig. 2

Bottom Line: Surgical management of breast cancer often entails lumpectomy or mastectomy.In this article, we will review the more commonly encountered types of breast reconstruction, which include implants, tranversus rectus abdomnis flap, latissimus dorsi flap, deep inferior epigastric perforator flap, and gluteal flaps.Radiologists will better understand the different types of breast reconstruction after mastectomy and their normal imaging appearance on MRI.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Beth Israel Deaconess Medical Center, C/o Dr. Vandana Dialani, 330 Brookline Avenue, Boston, MA, 02215, USA, vdialani@bidmc.harvard.edu.

ABSTRACT

Objective: The objective is to review the different types of breast reconstruction following cancer surgery and describe expected imaging appearances and complications seen in the reconstructed breast.

Methods: Surgical management of breast cancer often entails lumpectomy or mastectomy. When mastectomy is performed, patients often opt for breast reconstruction. Most facilities do not routinely image the reconstructed breast with mammography.

Results: However, many of these women are imaged with screening breast MRI for evaluation of the contralateral breast, or they may develop a clinical problem that warrants a diagnostic evaluation with MRI. In this article, we will review the more commonly encountered types of breast reconstruction, which include implants, tranversus rectus abdomnis flap, latissimus dorsi flap, deep inferior epigastric perforator flap, and gluteal flaps. Each of these types of reconstruction has different appearances on MR. We will also discuss potential complications that can be seen in the reconstructed breasts, including fat necrosis and recurrence.

Conclusion: Radiologists will better understand the different types of breast reconstruction after mastectomy and their normal imaging appearance on MRI. Radiologists will be more aware of how to recognize complications related to surgery as well as how to determine whether recurrence is present.

Main messages: • The different surgical techniques used in breast reconstruction are discussed. • Describes the normal magnetic resonance imaging appearance of the breast after reconstruction. • Identify MR imaging features of benign sequelae and recurrence following breast reconstruction.

No MeSH data available.


Related in: MedlinePlus