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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 Pedicled TRAM flap-rectus abdominis muscle rotated up to the chest for breast reconstruction. b Sagittal fat-saturated T1W image with post-contrast gadolinium injection shows replacement of the normal glandular tissue of the breast with lower abdominal fat and the presence of atrophied rectus abdominis muscle along the anterior chest wall (black arrow). c Axial fat-saturated T1W images with dynamic gadolinium injection showing the atrophied rectus abdominis muscle along the anterior chest wall (arrow) and the bulk of the muscle in the center as opposed to the eccentric location in the latissimus flap. The lower abdominal fat constitutes the right reconstructed breast. Normal left breast for comparison
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Fig3: a Pedicled TRAM flap-rectus abdominis muscle rotated up to the chest for breast reconstruction. b Sagittal fat-saturated T1W image with post-contrast gadolinium injection shows replacement of the normal glandular tissue of the breast with lower abdominal fat and the presence of atrophied rectus abdominis muscle along the anterior chest wall (black arrow). c Axial fat-saturated T1W images with dynamic gadolinium injection showing the atrophied rectus abdominis muscle along the anterior chest wall (arrow) and the bulk of the muscle in the center as opposed to the eccentric location in the latissimus flap. The lower abdominal fat constitutes the right reconstructed breast. Normal left breast for comparison

Mentions: Transplantation of a TRAM flap is a commonly used surgical procedure for breast reconstruction following mastectomy. Since the description of this procedure by Hartrampf et al. [4] in 1982, numerous refinements of the basic technique have been developed, which include the pedicled, free, and delayed flap reconstruction. In the TRAM flap technique, the rectus abdominis muscle must be harvested along with the subcutaneous soft tissue to ensure the preservation of the perforating vessels that supply the abdominal skin and subcutaneous fat. The rectus abdominis muscle has a dual blood supply, which includes the superior and inferior epigastric vessels. The two major technical variants of the TRAM flap procedure include the pedicled flap (Fig. 3) and microsurgical free flap reconstructions.Fig. 3


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

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

a Pedicled TRAM flap-rectus abdominis muscle rotated up to the chest for breast reconstruction. b Sagittal fat-saturated T1W image with post-contrast gadolinium injection shows replacement of the normal glandular tissue of the breast with lower abdominal fat and the presence of atrophied rectus abdominis muscle along the anterior chest wall (black arrow). c Axial fat-saturated T1W images with dynamic gadolinium injection showing the atrophied rectus abdominis muscle along the anterior chest wall (arrow) and the bulk of the muscle in the center as opposed to the eccentric location in the latissimus flap. The lower abdominal fat constitutes the right reconstructed breast. Normal left breast for comparison
© Copyright Policy
Related In: Results  -  Collection

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

Fig3: a Pedicled TRAM flap-rectus abdominis muscle rotated up to the chest for breast reconstruction. b Sagittal fat-saturated T1W image with post-contrast gadolinium injection shows replacement of the normal glandular tissue of the breast with lower abdominal fat and the presence of atrophied rectus abdominis muscle along the anterior chest wall (black arrow). c Axial fat-saturated T1W images with dynamic gadolinium injection showing the atrophied rectus abdominis muscle along the anterior chest wall (arrow) and the bulk of the muscle in the center as opposed to the eccentric location in the latissimus flap. The lower abdominal fat constitutes the right reconstructed breast. Normal left breast for comparison
Mentions: Transplantation of a TRAM flap is a commonly used surgical procedure for breast reconstruction following mastectomy. Since the description of this procedure by Hartrampf et al. [4] in 1982, numerous refinements of the basic technique have been developed, which include the pedicled, free, and delayed flap reconstruction. In the TRAM flap technique, the rectus abdominis muscle must be harvested along with the subcutaneous soft tissue to ensure the preservation of the perforating vessels that supply the abdominal skin and subcutaneous fat. The rectus abdominis muscle has a dual blood supply, which includes the superior and inferior epigastric vessels. The two major technical variants of the TRAM flap procedure include the pedicled flap (Fig. 3) and microsurgical free flap reconstructions.Fig. 3

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