Mismatch Repair

Dna polymerase copies both strand of DNA the top strand and bottom strand, sometimes these stands are called Watson and crick strand. But these strands are not perfect, Normally A opposite to T and G opposite to C.Sometimes these make mistakes in copies wrong nucleotide for example T is copied For G where C should be copied potential mutation fortunately cells have repair system that can erase the mutations and those repair protein are called PMS2, MLH1, MSH2, MSH6, these enzyme recruit another enzyme called EX01 (exonulcease), which choppes off the mutant strand and allows dna polymerase to synthesis the correct strand and there by fixing out DNA

Cell Division

A informative and informative video on cell division


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Cloning

Clones are organisms that have identical genetic material. In other words, the sequence of bases n their DNA is exactly same. Long before the birth of Dolly the sheep, clones had bee observed in both nature and in the laboratory.When a couple has an identical twin or identical triplets, the children are clones of one another.A plant cutting can also be used to generate a clone.
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Prior to 199, it was thought that cloning an entire animal could only be done with embryonic cells-cells present in the early stages of an organism’s development. In the 1950's, scientists generated entire frogs from embryonic frog cells.
After a small number of cell divisions, embryonic cells start to change into the different types of cells that form muscle, blood, liver, etc. This process is called differntiation. Although each of these cells has the same genetic material, each cell can only access the genes needed for its particular function.


Before the experiment at the roslin institute, it was thought that once cells differentiated, they could not be used to generate an entire organism, for instance, in sheep udder cells could generate other udder cells, but not an entire sheep.

The scientist of roslin institute solved this problem by growing sheep udder cells under starvation conditions, this put the cells in a state similar to embryonic cells. This is called the G0 state.

An egg cell was taken from another sheep. The nucleus (which contains the genetic material) was removed from the egg cell using fine needle. They then used electric shock to fuse one starved udder cell with one nucleus free egg cell. They made 277 of these fused cells.

Although the egg cell came from a black-faced sheep, notice that the nucleus with the genetic material came from the white-faced sheep.


The fused egg cell was then inserted into several different sheep. These surrogate mothers also black-faced.

Of the 277 fused cells, only one progressed to form a developed lamb. Dolly was born on July 5, 1996.Scientist found that dolly had same DNA as the udder cells she came from. She is a clone of these udder cells.Dolly has given birth to a lamb named Bonnie, produced the natural way.Other lambs have been born at the roslin institute through their cloning process, some carry genes that will produce usable human drugs.

A laboratory in Hawaii run by Dr.Ryuzo Yanagimachi was the second group to successfully clone an animal from an adult cell. They cloned mice using cumulus cells, a cell type found in the ovaries.

The cloning method used by the lab in Hawaii was different in two ways from the method used to clone Dolly. First, the cells used to clone the mice were not grown in culture, but instead were used immediately.

Second the nucleus was removed from the cumulus cell and then directly injected into the egg cell. This egg cell's nucleus had already been removed.

The yabagimachi lab used coat color to track genetic heritage. The cumulus cell comes from an agouti (brown) mouse, and the cell comes from a black mouse.

The egg cell now had the same genetic information as the nucleus donor mouse. The egg cell was then activated and implanted into a white host mother. On October 3, 1997 the host mouse gave birth to cumulina, named after the cumulus cells she was cloned from.


Cumulina is the same color as the mouse that donated the nucleus. The DNA fingerprinting confirmed that cumulina had the same DNA as the nucleus donor.

The scientist has taken cells from cumulina to make more clones. They have successfully made several generations of clones and all mice seem normal.Dolly the sheep died at the age of 6. Since the world said hello to Dolly, Several other animals have also been cloned.

Both Dolly and cumulina were cloned from cells in the female reproductive system; cows have also been cloned using ovary and cumulus cells with the same method that was used to clone Dolly.Pigs have been added to the cloned animal menagerie. Scientist hopes to use cloned pigs to grow organs that can be transplanted into humans.

Mucociliary Apparatus

Mucociliary apparatus is the key feature of the upper and lower respiratory tracks and it includes mucous producing glands of the nasal epithelium as well as ciliated cells, one of its primary function is to shield the airways with hazardous substances, it does so by creating a layer of mucous that catches unwanted material and move them into posterior pharynx where they can be removed by sneezing splitting, swallowing or blowing

Inflammation of small intestine Animation

Inflammation of small intestine is can be revealed by use of radiology enhanced by barium compound or other contrast agents. If small bowel disease is suspected a follow through barium study or small bowel follow through SBFT is performed, the test is performed through x-rays which are taken after every 30 minutes after the patient ingests barium, once the barium reaches large intestine fluoroscopy is used to monitor small intestine in real time and snap shots taken for reporting

Electrophoresis Animation

Gel electrophoresis is a technique used for the separation of DNA, RNA, or protein molecules using electric current applied to gel matrix.It is used has as a preparative technique prior to use of other methods such as mass spectrometry, RFLP, PCR, cloning, DNA sequencing, or Southern blotting
Gel electrophoresis is performed in silica gel which inert porus medium. In electrophoresis macromolecules like DNA, RNA and protein migrate when electric current is passed through the medium. Separation of molecules depends upon two forces namely mass and charge, When the macromolecules are mixed with a buffer and applied to a gel, the electric current from one eletrode refuses the molecule while the other one attracts the molecule, this frictional force separates the molecule by size, During the process of electrophoresis molecules are forced to move through the pores when a electrical current is applied, the molecules speed depends on the strength of the field, their shape, size and strength and temperature of the buffer,separeted molecules can be seen in bands


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After the electrophoresis is complete, the molecules in the gel can be stained to make them visible. Ethidium bromide, silver, or coomassie blue dye may be used for this process. Other methods may also be used to visualize the separation of the mixture's components on the gel. If the analyte molecules fluoresce under ultraviolet light, a photograph can be taken of the gel under ultraviolet lighting conditions. If the molecules to be separated contain radioactivity added for visibility, an autoradiogram can be recorded of the gel.

If several mixtures have initially been injected next to each other, they will run parallel in individual lanes. Depending on the number of different molecules, each lane shows separation of the components from the original mixture as one or more distinct bands, one band per component. Incomplete separation of the components can lead to overlapping bands, or to indistinguishable smears representing multiple unresolved components.
Bands in different lanes that end up at the same distance from the top contain molecules that passed through the gel with the same speed, which usually means they are approximately the same size. There are molecular weight size markers available that contain a mixture of molecules of known sizes. If such a marker was run on one lane in the gel parallel to the unknown samples, the bands observed can be compared to those of the unknown in order to determine their size. The distance a band travels is approximately inversely proportional to the logarithm of the size of the molecule.
Text ref:http://en.wikipedia.org/wiki/Gel_electrophoresis

Pleura of the lungs

Pleural cavity is the body cavity that contains the lungs. The lungs are surrounded by two serous membranes, the pleurae. The outer pleura (parietal pleura) covers and is attached to the chest wall. The inner pleura (visceral pleura) covers and is attached to the lung and other structures, i.e. blood vessels, bronchi and nerves. The thin space between the two pleura is known as the pleural space; it normally contains a small amount of pleural fluid.Pleural fluid serves several functions. It lubricates the pleural surfaces, thus allowing the pleural layers to slide easily against each other during ventilation. The surface tension resulting from the presence of the pleural fluid keeps the lung surfaces in close apposition to the chest wall. This allows for optimal inflation of the alveoli during respiration. It also directly transmits pressures from the chest wall to the visceral pleural surface (and hence, the lung). In this manner, movements of the chest wall, particularly during heavy breathing, are coupled to movements of the lungs.


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The thoracic cavity is enclosed by the thoracic cage or ribs and the diaphram, the two lungs occupy the majority of the cavity, Most of work of breathing is accomplished by diaphragm, which separates the thoracic and abdominal cavities it is wide and dump shaped muscle that works with Intercostal muscles which is located between the ribs to expand and contract the chest the are both internal and external Intercostal muscles with the internal muscle positioned near the lungs surrounded by the external muscles

The Neuroscience of Nothing lecture

Richard O. Brown, Staff Neuroscientist at The Exploratorium, talks about the interaction between mind and matter and visual perception. He talks about and illustrates with fascinating visuals three concepts: 1. There is nothing out there and we perceive nothing which he feels comes closest to blackness. 2. There is something out there and we can't perceive it, which comes closest to invisibility. 3. There is nothing out there and we're still experiencing or perceiving something.



Surgical Treatment of Crohn's Disease

What is Crohn's Disease
Crohn's disease is a disease of the digestive system. It may affect any part of the gastrointestinal tract from mouth to anus. As a result, the symptoms of Crohn's disease vary among afflicted individuals. The main gastrointestinal symptoms are abdominal pain, diarrhea (which may be visibly bloody), vomiting, or weight loss. Crohn's disease can also cause complications outside of the gastrointestinal tract such as skin rashes, arthritis, and inflammation of the eye.

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The precise cause of Crohn's disease is not known. The disease occurs when the immune system attacks the gastrointestinal tract; for this reason, Crohn's disease is considered an autoimmune disease. This autoimmune activity produces inflammation in the gastrointestinal tract. For this reason, Crohn's disease is classified as an inflammatory bowel disease.

Development of Immunity

B cells are lymphocytes that play a large role in the humoral immune response (as opposed to the cell-mediated immune response, which is governed by T cells). The principal functions of B cells are to make antibodies against antigens, perform the role of Antigen Presenting Cells (APCs) and eventually develop into memory B cells after activation by antigen interaction. B cells are an essential component of the adaptive immune system.

Development of Immunity Mode of Action
When antigen enters the body it stimulates B-lymphocytes in blood to produce antibodies specific to antigen which attack and destroy it, after the initial attack number of specific antibodies in the blood falls slowly over several weeks, but the body remembers the structure and can produce in short notice subsequent invasion of same antigen is therefore rapidly halted and specific immunity is acquired, when second antigen is encounter the lymphocytes must produce new antibody since the first antibody is specific only to first antigen ,second antibody continuously circulate on the blood stream and immunity to second antigen is acquired.

Glucocorticosteroid Mechansim of Action

Defintion
A class of steroid hormones produced by the adrenal cortex that enable the body to cope with stressors by increasing concentrations in the blood of glucose, fatty acids and amino acids, and by raising blood pressure. Excessively high levels of glucocorticosteroids depress the immune system and inflammation response.(ref:Answers.com)


Mechanism Of Action:
Glucocorticosteroids directly act on nasal passage epithelial cells and on the T-lymphocytes mast cells and esoniphils of the immune system, these target cells have cell membranes composed of Glucocorticosteroid dissolving lipids, the Glucocorticosteroid routinely crosses into cell membrane and cell cytoplasm. Glucocorticosteroids bind to Glucocorticoid receptor to form Glucocorticosteroid receptor complex after entering the cytoplasm, these receptors are particularly common in nasal epithelial and blood vessels and though the are present in nearly all the cells. Glucocorticosteroid receptor complex formation has two effects to fight the effects of cytokines the new complex first binds to activated protein 1 (AP-1) this inhibits cell response to the chemical messages like inflammatory cytokines reducing inflammation, Glucocorticosteroid receptor formation also causes the complex to move to cell nucleus where it binds Glucocortiod response elements of GRE's which control protein production, this binding decreases the pro-inflammatory cytokine production and increases anti-inflammatory protein production.

Gene Probe

Hybridization probe is a fragment of DNA or RNA of variable length (usually 100-1000 bases long), which is used to detect in DNA or RNA samples the presence of nucleotide sequences (the DNA target) that are complementary to the sequence in the probe. The probe thereby hybridizes to single-stranded nucleic acid (DNA or RNA) whose base sequence allows probe-target base pairing due to complementarity between the probe and target. The labeled probe is first denatured (by heating or under alkaline conditions) into single DNA strands and then hybridized to the target DNA (Southern blotting) or RNA (northern blotting) immobilized on a membrane or in situ.

To detect hybridization of the probe to its target sequence, the probe is tagged (or labelled) with a molecular marker; commonly used markers are 32P (a radioactive isotope of phosphorus incorporated into the phosphodiester bond in the probe DNA) or Digoxigenin, which is non-radioactive antibody-based marker. DNA sequences or RNA transcripts that have moderate to high sequence similarity to the probe are then detected by visualizing the hybridized probe via autoradiography or other imaging techniques. Detection of sequences with moderate or high similarity depends on how stringent the hybridization conditions were applied — high stringency, such as high hybridization temperature and low salt in hybridization buffers, permits only hybridization between nucleic acid sequences that are highly similar, whereas low stringency, such as lower temperature and high salt, allows hybridization when the sequences that are less similar. Hybridization probes used in DNA microarrays refer to DNA covalently attached to an inert surface, such as coated glass slides or gene chips, and to which a mobile cDNA target is hybridized.
Depending on the method the probe may be synthesised via phosphoramidite technology or generated and labeled by PCR amplification or cloning (older methods). In order to increase the in vivo stability of the probe RNA is not used, instead RNA analogues may be used, in particular morpholino.

Development of Nervous system

Definition
The nervous system is a network of specialized cells that communicate information about an animals surroundings and its self, it processes this information and causes reactions in other parts of the body. It is composed of neurons and other specialized cells called glia, that aid in the function of the neurons. The nervous system is divided broadly into two categories; the peripheral nervous system and the central nervous system. Neurons generate and conduct impulses between and within the two systems. The peripheral nervous system is composed of sensory neurons and the neurons that connect them to the nerve cord, spinal cord and brain, which make up the central nervous system. In response to stimuli, sensory neurons generate and propagate signals to the central nervous system which then process and conduct back signals to the muscles and glands. The neurons of the nervous systems of animals are interconnected in complex arrangements and use electrochemical signals and neurotransmitters to transmit impulses from one neuron to the next. The interaction of the different neurons form neural circuits that regulate an organisms perception of the world and what is going on with its body, thus regulating its behavior. Nervous systems are found in many multicellular animals but differ greatly in complexity between species.[1]



About the Speaker
This Lecture is conducted by Professor Marian Diamond who is first women science faculty Berkely,her current research is on environmental effects on the structure and function of the brain
Professor Diamond's discovery that the brain continues to develop at any age with proper stimulation has revolutionized thinking about aging. An equally significant finding of Daimond's is that female and male brains are structured differently. Her studies conclusively show that positive, nurturing environments that encourage interaction and response are the prime conditions for developing the more complex neural networks that appear to be the "hardware" of intelligence. Her work also indicates the ongoing influence of environment, experience, learning, and emotions on neural equipment throughout life- for better or for worse.

What is Gene Splicing

Gene splicing is process of cutting a gene from one organism and pasting it into the DNA of another so that a characteristic can be transferred from one plant or animal to another
Restriction enzymes can be used to cut the DNA at different places making the DNA sticky ends so that it can be pasted into DNA from another organism
Splicing a gene into a plasmid
In this activity, you can cut out a gene from a chromosome of one organism and paste it into a plasmid.
To do this successfully: Be careful not to cut up the gene you are working with Cuts the DNa with jagged ends, not blunt ones, so that it can be pasted into the plasmid, Make sure that cut ends of the plasmid match the cut ends of the DNA

The Splicing starts with identifying the correct Restriction enzyme for the Gene, if u choose wrong restriction enzyme it may cut Gene into half rather than isolating the whole gene, So care should be taken in identifying the restriction enzyme which isolates the whole gene (in this case HindIII),
After isolating gene we should cut Plasmid with corresponding restriction enzyme (HindIII) so that gene of interest can be inserted into the plasmid.
After inserting the gene we need to seal the plasmid with Ligase enzyme to achieve a recombinant DNA.

Ovulation

This is the first ever video footage of ovulation captured with an  endoscope inserted through cut in women’s vaginal wall, the patient monitored for   temperature and hormones to predict when she is about ovulate and when to begin filming, here you can see the ovary end of fallopian tubule covered by finger like projection called fimbria, A mucous plug containing the egg breaks away from the ovary, the fingers move in time with the women’s heart beat and become more distinct when the reach for the egg, eventually they sweep egg into the fallopian tube where pass into the uterus The process of ovulation is controlled by the hypothalamus of the brain and through the release of hormones secreted in the anterior lobe of the pituitary gland, (Luteinizing hormone (LH) and Follicle-stimulating hormone (FSH)). In the follicular (pre-ovulatory) phase of the menstrual cycle, the ovarian follicle will undergo a series of transformations called cumulus expansion, this is stimulated by the secretion of FSH. After this is done, a hole called the stigma will form in the follicle, and the ovum will leave the follicle through this hole. Ovulation is triggered by a spike in the amount of FSH and LH released from the pituitary gland. During the luteal (post-ovulatory) phase, the ovum will travel through the fallopian tubes toward the uterus. If fertilized by a sperm, it may perform implantation there 6-12 days later
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Ovulation is the process in the menstrual cycle by which a mature ovarian follicle ruptures and discharges an ovum (also known as an oocyte, female gamete, or casually, an egg) that participates in reproduction. Ovulation also occurs in the estrous cycle of other animals, which differs in many fundamental ways from the menstrual cycle.

In humans, the few days near ovulation constitute the fertile phase. The average time of ovulation is the fourteenth day of an average length (twenty-eight day) menstrual cycle. It is normal for the day of ovulation to vary from the average, with ovulation anywhere between the tenth and nineteenth day being common. Cycle length alone is not a reliable indicator of the day of ovulation. While in general an earlier ovulation will result in a shorter menstrual cycle, and vice versa, the luteal (post-ovulatory) phase of the menstrual cycle may vary by up to a week between women.

Breast Reconstruction Surgery Animation

Breast reconstruction is a surgical procedure to restore the appearance of a breast for women who have had a breast removed to treat breast cancer. The surgery rebuilds the size and shape of the breast and, if you desire, the nipple and areola (the darker area surrounding the nipple). Most women who have had a mastectomy can have reconstruction. Women who have had a lumpectomy usually do not need reconstruction. Breast reconstruction is done by a plastic surgeon.

Breast Reconstruction by mosesp6

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This information is designed to give you the facts you need to make an informed decision about breast reconstruction. The decision to have breast reconstruction is a matter of personal choice. No single source of information can provide every fact or give you all the answers. You and those close to you should discuss any questions and concerns about reconstructive surgery with your doctor.


New Choices in Breast Reconstruction

Each year more than 200,000 American women face the reality of breast cancer. Today, the emotional and physical results are very different from what they were in the past. Great strides have been made in our understanding of the disease and its treatment. New approaches in treatment, as well as advances in reconstructive surgery mean that women who have breast cancer today have new choices.

More and more women with breast cancer are choosing surgery that removes less breast tissue than a mastectomy (removal of the entire breast). This is called breast conservation surgery (lumpectomy or segmental mastectomy). However, some women choose (or need) a mastectomy. Some of those who have a mastectomy also choose to have reconstructive surgery to restore the breast's appearance.

If you are thinking about having reconstructive surgery, it is a good idea to discuss it with your surgeon and a plastic surgeon experienced in breast reconstruction before your mastectomy. This allows the surgical teams to plan the treatment that is best for you, even if you decide to wait and have reconstructive surgery later.



Goals of Reconstruction

Women choose breast reconstruction for different reasons. The goals of reconstruction are:

  • to make your breasts look balanced when you are wearing a bra
  • to permanently regain your breast contour
  • to give the convenience of not needing an external prosthesis

The difference between the reconstructed breast and the remaining breast can be seen when you are nude. When the breasts are in a bra though, they should be close enough to one another in size and shape that you will feel comfortable about how you look in most types of clothing.

Your body image and self-esteem may improve after your reconstruction surgery, but this is not always the case. Breast reconstruction does not fix things you were unhappy about before your surgery. Also, you may be disappointed with how your breast looks after surgery. You and those close to you must be realistic about what to expect from reconstruction.

You should decide to have breast reconstruction only after you are fully informed about the procedure. There are often many options to think about as you and your doctors discuss what is best for you. The reconstruction process may require one or more operations. You should discuss the benefits and risks of reconstruction with your doctors before the date of surgery to give yourself plenty of time to make the best decision for you.



Special Considerations in Breast Reconstruction

Several types of operations can be done to reconstruct your breast. You can have a newly shaped breast with the use of a breast implant, your own tissue flap, or a combination of the two. A tissue flap is a section of skin, fat, and muscle which is moved from your tummy, back, or other area of your body to the chest area.

Immediate or Delayed Reconstruction with Breast Cancer

Immediate reconstruction is reconstructive surgery that is done at the same time as the mastectomy, when the entire breast is removed. A plus with immediate reconstruction is that the chest tissues are undamaged by radiation therapy or scarring. Also, immediate reconstruction means one less surgery. Delayed reconstruction is surgery that is done at a later time. For some women, this may be advised if radiation is to follow mastectomy. This is because radiation therapy that follows breast reconstruction can increase complications after surgery.

Decisions about reconstructive surgery depend on many personal factors such as:

  • your overall health
  • the stage of your breast cancer
  • the size of your natural breast
  • the amount of tissue available (for example, very thin women may not have the excess body tissue to make flap grafts possible)
  • your desire to match the appearance of the opposite breast
  • your desire for bilateral reconstructive surgery and your insurance coverage for the unaffected breast and related costs
  • the type of procedure
  • the size of implant or reconstructed breast

Other important factors to consider:

You may choose to wait until after your initial breast surgery to decide about reconstruction if you do not want to think about this issue while you are coping with a diagnosis of cancer.

  • You may simply not want to have any more surgery than is needed.
  • Scarring is a natural outcome of surgery, but skin necrosis (cell death) may occur if your ability to heal is impaired.
  • Not all surgery is completely successful, and you may not be pleased with your cosmetic result.
  • You may be concerned if you have bleeding or scarring tendencies.
  • Your ability to heal may be hindered by previous surgery, chemotherapy, radiation, smoking, alcohol, diabetes, various medications, and other factors.

  • Is it your preference to have chemotherapy or radiation therapy after reconstruction or wait and have surgery after all treatment is completed?

Breast reconstruction restores the shape of the breasts but cannot restore your normal breast sensation. With time, the skin on the reconstructed breast can become more sensitive, but it will not give you the same kind of pleasure as before a mastectomy.

Surgeons may suggest you wait for one reason or another. This may happen if you smoke or have other health conditions. Many surgeons require you to quit smoking at least 2 months prior to reconstructive surgery to allow for better healing. You may not be a candidate for reconstruction at all if you are obese, too thin, or have circulatory problems.

The surgeon may recommend surgery to reshape the remaining breast to match the reconstructed breast. This could include reducing or enlarging the size of the breast or lifting the breast.

Knowing your reconstruction options before surgery can help you prepare for a mastectomy with a more realistic outlook for the future.



Types of Breast Reconstruction

Implant Procedures

The most common implant is a saline-filled implant that has an external silicone shell and is filled with sterile saline (salt water). Silicone gel-filled implants are another option for breast reconstruction, but they are not used as often as they were in the past because of concerns that silicone leakage might cause debilitating immune system diseases. However, the vast majority of recent studies indicate that implants do not increase the risk of immune system problems. Also, alternative breast implants that have different shells and are filled with different materials are being studied, but these are available only in a clinical trial.

One-stage immediate breast reconstruction may be done at the same time as your mastectomy. After the general surgeon removes the breast tissue, a plastic surgeon places a breast implant where the breast tissue was removed to form the breast contour.

Two-stage immediate or two-stage delayed reconstruction is performed if your skin and chest wall tissues are tight and flat. An implanted tissue expander, like a balloon, is placed beneath the skin and chest muscle. Through a tiny valve mechanism beneath the skin, the surgeon injects a salt-water solution at regular intervals to fill the expander over time. After the skin over the breast area has stretched enough, the expander is usually removed in a second operation, and a permanent saline implant is put in its place. Some expanders are left in place as the final implant.

There are some important factors for you to think about when deciding to have implants:

Your implants may not last a lifetime, so you may need additional surgeries to replace them.

You can have local complications with breast implants such as rupture, pain, capsular contracture (scar tissue forms around the implant), infection, and an unpleasing cosmetic result. This means that implants may become less attractive over time.

Tissue Flap Procedures

Tissue flap procedures use tissue from your tummy, back, thighs, or buttocks to reconstruct the breast. The 2 most common types of tissue flap surgeries are the TRAM flap (transverse rectus abdominis muscle flap), which uses tissue from the tummy area, and the latissimus dorsi flap, which uses tissue from the upper back. These operations leave 2 surgical sites and scars, both from where the tissue was taken and on the reconstructed breast. The scars fade over time, but they will never go away completely. There can also be complications at the donor sites, such as abdominal hernias, muscle damage or weakness, and differences in the size and shape of the 2 breasts. Because blood vessels are involved, these procedures usually cannot be offered to women with diabetes, connective tissue or vascular disease, or to smokers.


TRAM (transverse rectus abdominis muscle) flap: The TRAM flap procedure uses tissue and muscle from the lower abdominal wall (tummy tissue). The tissue from this area alone is often enough to create a breast shape, and an implant may not be needed. The skin, fat, blood vessels, and at least 1 of the abdominal muscles are moved from the abdomen to the chest area. This procedure also results in a tightening of the lower abdomen, or a "tummy tuck." There are 2 types of TRAM flaps:


Pedicle flap involves leaving the flap attached to its original blood supply and tunneling it under the skin to the breast area.

Free flap means that the surgeon cuts the flap of skin, fat, blood vessels, and muscle free from its original location and then attaches the flap to blood vessels in the chest area. This requires the use of a microscope (microsurgery) to connect the tiny vessels and takes longer to finish than a pedicle flap. The free flap is not done as often as the pedicle flap but some doctors think that it can result in a more natural shape.



Latissimus dorsi flap: The latissimus dorsi procedure moves muscle and skin from your upper back when extra tissue is needed. The flap is made up of skin, fat, muscle, and blood vessels. It is tunneled under the skin to the front of the chest. This creates a pocket for an implant, which can be used for added fullness to the reconstructed breast. Though it is not common, some women may have weakness in their back, shoulder, or arm after this surgery.



DIEP (deep inferior epigastric artery perforator) flap: A newer type of flap procedure, the DIEP flap, uses fat and skin from the same area as in the TRAM flap but does not use the muscle to form the breast mound. This procedure results in a tightening of the lower abdomen, or a "tummy tuck." The procedure is done as a "free" flap meaning that the tissue is completely detached from the tummy and then moved to the chest area. This requires the use of a microscope (microsurgery) to connect the tiny vessels. The procedure takes longer than the TRAM pedicle flap discussed above.


Donor Site DIEP Flap


Gluteal free flap: This is another newer type of surgery that uses tissue, including the gluteal muscle, from the buttocks to create the breast shape. It is an option for women who cannot use the tummy sites due to thinness, incisions, failed tummy flap, or patient preference. The procedure is similar to the free TRAM flap mentioned above. The skin, fat, blood vessels, and muscle are detached from the buttock and then moved to the chest area. This requires the use of a microscope (microsurgery) to connect the tiny vessels.



Nipple and Areola Reconstruction

The decision to have your nipple and areola (the dark area around the nipple) reconstructed is up to you. Nipple and areola reconstructions are optional and considered the final phase of breast reconstruction. This separate surgery is done to make the reconstructed breast more closely resemble the original breast. It can be done as an outpatient under local anesthesia. It is usually done after the new breast has had time to heal (3-4 months after surgery).

The ideal nipple and areola reconstruction requires symmetry in position, size, shape, texture, pigmentation, and projection. Tissue used to rebuild the nipple and areola is taken from your own body, such as from the newly created breast, opposite nipple, ear, eyelid, groin, upper inner thigh, or buttocks. Tattooing may be done to match the color of the nipple of the other breast and to create the areola.

Though it is done, saving and using the nipple from the breast with cancer that has been removed (called nipple saving or nipple banking) is not a good idea. Cancer cells may still be hidden in the nipple and the tissue is often injured by the cryopreservation process necessary for storage. Further research is needed in this area.



Your Plastic Surgeon

Once you decide to have breast reconstruction, you will need to find a board-certified plastic surgeon experienced in breast reconstruction. Your breast surgeon can suggest doctors for you.

To find out if a surgeon is board certified, contact the American Society of Plastic Surgeons (ASPS). This organization has a Plastic Surgery Information Service that provides a list of ASPS members in a caller's area who are certified by the American Board of Plastic Surgery.

Questions to Ask

It is very important that you ask as many questions of your surgeon as you need to before having breast reconstruction. If you don't understand something, ask your surgeon about it. Here is a list of questions to get you started. Write down other questions as you think of them. You may want to record your conversations with your surgeons. It is also helpful to bring a friend or family member with you to the doctor to help you remember what was said. The answers to these questions may help you make your decisions.


Am I a candidate for breast reconstruction?
When can I have reconstruction done?
What types of reconstruction are possible in my specific case?
What is the average cost of each type? Does my insurance cover them?
What type of reconstruction is best for me? Why?
How much experience do you (plastic surgeon) have with this procedure?
What results are realistic for me?
Will the reconstructed breast match my remaining breast in size?
How will my reconstructed breast feel to the touch?
Will I have any feeling in my reconstructed breast?
What possible complications should I know about?
How much discomfort or pain will I feel?
How long will I be in the hospital?
Will I need blood transfusions? If so, can I donate my own blood?
How long is the recovery time?
What type of wound care will I need to do at home?
How much help will I need at home to take care of my drain and wound?
When can I start my exercises?
How much activity can I do at home?
What do I do if I get swelling in my arm (lymphedema)?
When will I be able to return to normal activity such as driving and working?
Can I talk with other women who have had the same surgery?
Will reconstruction interfere with chemotherapy?
Will reconstruction interfere with radiation therapy?
How long will the implant last?
What kinds of changes to the breast can I expect over time?
How will aging affect the reconstructed breast?
What happens if I gain or lose weight?
Are there any new reconstruction options that I should know about?

It is common to get a second opinion before having any surgery. Breast reconstruction and even mastectomy are not emergencies. It is more important for you to make the right decisions based on the correct information than to act quickly before you know all your options.



Before Surgery

Planning Your Surgery

You can begin talking about reconstruction as soon as you know you have breast cancer. You will want your breast surgeon and your plastic surgeon to work together to come up with the best possible plan for reconstruction.

After reviewing your medical history and overall health, your surgeon will explain which reconstructive options are best for your age, health, body type, lifestyle, and goals. Openly discuss your expectations. Your surgeon should be frank with you when talking about your risks and benefits for each option.

Breast reconstruction after a mastectomy can improve your appearance and renew your self-confidence. However, keep in mind that the desired result is improvement, not perfection.

If you would like to talk with someone who has had your type of surgery, our Reach to Recovery volunteers are trained to support people facing breast cancer, as well as those who have surgery, chemotherapy, radiation therapy, and who are thinking about breast reconstruction. Ask your doctor or nurse to refer you to a Reach to Recovery volunteer in your area, or call us at 1-800-ACS-2345.

Your surgeon should also explain the details of your surgery, including

the anesthesia he or she will use
where the surgery will take place
what to expect after surgery
the plan for follow up
costs

Health insurance policies often cover most or all of the cost of reconstruction after a mastectomy. Check your policy to make sure you are covered. Also, see if there are any limits on what types of reconstruction are covered.

Sometimes your insurance company will deny breast reconstruction costs if you have already submitted claims for a breast prosthesis.

Preparing for Your Surgery

Your breast surgeon and your plastic surgeon will give you specific instructions on how to prepare for surgery. These will likely include

guidelines on eating and drinking
tips to quit smoking
instructions to take or avoid certain vitamins and medications for a period of time before your surgery

You should arrange for someone to drive you home after your surgery and to help you out for a few days.

Where Your Surgery Will Be Performed

Breast reconstruction often involves more than 1 operation. The first stage involves creation of the breast mound. Whether this is done at the same time as the mastectomy or later on, it is usually done in a hospital.

Follow-up procedures, such as creating the nipple and areola, may also be done in the hospital or in an outpatient facility. This decision depends on the extent of surgery needed and what your surgeon prefers.

Types of Anesthesia

The first stage of reconstruction is almost always done using general anesthesia, so you'll be asleep during the surgery.

Follow-up procedures may only require a local anesthesia with a sedative to make you drowsy. You'll be awake, but relaxed and you may feel some discomfort.

Possible Risks

Almost any woman who must have her breast removed because of cancer can have reconstructive surgery. Certain risks go along with any surgery, and reconstruction may have certain unique problems associated with it.

Some risks of reconstruction surgery are:

bleeding
fluid collection with swelling and pain
excessive scar tissue
infection
tissue necrosis (death) of all or part of the flap
problems at the donor site (immediate and long-term)
changes in nipple and breast sensation
fatigue
the need for additional surgeries to correct problems
changes in the affected arm
problems with anesthesia

Risks of smoking: The use of tobacco causes constriction of the blood vessels and reduces the supply of nutrients and oxygen to tissues. As with any surgery, smoking can delay healing. This can result in scars that are more noticeable and a longer recovery time. Sometimes these complications are severe enough to require a second operation.

Risks of infection: Infection can develop with any surgery. This usually happens within the first 2 weeks after surgery. If an implant has been used, it may need to be removed until the infection clears. A new implant can later be inserted. If you have a tissue flap, surgical cleaning of the wound is usually done.

Risks of capsular contracture: The most common problem with breast implants is capsular contracture. This can occur if the scar or capsule around the implant begins to tighten and squeezes down on the soft implant. This can make the breast feel hard. Capsular contracture can be treated in several ways. Sometimes more surgery is needed to remove the scar tissue. The implant might also need to be removed or replaced.



After Breast Reconstruction Surgery

What to Expect

You are likely to feel tired and sore for a week or 2 after implant reconstruction and longer after flap procedures. Your doctor can give you medicines to control most of your discomfort.

Depending on the type of surgery, you should go home from the hospital in 1 to 6 days. You may be discharged with a surgical drain in place to remove excess fluids from the site. Follow your doctor’s exact instructions on wound and drain care. If you have any concerns or questions, call your doctor.

Getting Back to Normal

You should be up and around in 6 to 8 weeks. If implants are used without flaps, your recovery time may be less. Some things to remember:

Reconstruction does not restore normal sensation to your breast, but some feeling may return.

It may take as long as 1 to 2 years for tissues to completely heal and for scars to fade, but the scars never go away entirely.

Follow your surgeon's advice on when to begin stretching exercises and normal activities. As a rule, you'll want to avoid any overhead lifting, strenuous sports, and sexual activity for 4 to 6 weeks following reconstruction.

Women who have reconstruction months or years after a mastectomy may go through a period of emotional readjustment once they have their breast reconstructed. Just as it takes time to get used to the loss of a breast, you may feel anxious and confused as you begin to think of the reconstructed breast as your own. Talking with other women who have had reconstruction might be useful. Talking with a mental health professional may also help with these feelings.

Silicone gel implants may open up inside the body without causing symptoms. Women with this type of implant should have MRI scans of the breast starting 3 years after surgery and every 2 years after that to detect this problem. If the silicone device ruptures, another surgery will be required to replace it.

For more information on coping after cancer, see "After Diagnosis: A Guide for Patients and Families" and "Sexuality For Women and Their Partners."



Breast Reconstruction and Cancer Recurrence

Studies to date have shown that reconstruction has no known effect on the recurrence of breast cancer. It should not cause problems with chemotherapy or radiation treatment if cancer does recur.

If you are considering a breast reconstruction procedure, either an implant or flap, you need to know that reconstruction rarely, if ever, hides or obscures a return of breast cancer. You should not consider this a significant risk when deciding to have breast reconstruction after mastectomy.

It is important to have regularly scheduled mammograms on the opposite breast at a facility with technologists experienced in taking and reading mammograms.

All doctors may not recommend mammograms for a breast reconstructed with an implant. Mammogram pictures can be impaired by implants; more so by silicone than saline filled. If your reconstruction involves an implant, be sure to get your mammograms done at an accredited facility with technologists trained in manipulating the implant to get the best possible images of the rest of the breast.

While studies have supported mammograms of tissue flap breast reconstructions, no standard recommendation is in place. It is recognized that reconstructed breasts can have a fatty appearance, surgical clips, and surgical scars visible on the mammogram, but abnormalities can also be seen. Cancer can recur in the skin or any remaining breast tissue at areas of breast reconstruction. If you have a tissue flap reconstruction, you may need to continue mammograms on both breasts. Discuss this with your plastic surgeon and oncologist.