Tissue Reconstruction
An alternative to implant reconstruction is the use of a muscle flap to recreate the breast.
To learn more about Autologous tissue reconstruction visit our colleagues web site at The University of Pennsylvania.
Latissinus Flap-The Latissimus muscle from the back can be used in conjunction with a small implant. The surgery is longer then implant alone but is an excellent choice to reconstruct a previously radiated breast or chest wall.
TRAM- Trans rectus abdominis myocutaneous flap, uses the lower abdominal skin, muscle and fat to recreate the breast. The skin, fat and muscle are disconnected from the lower portion of the abdomen and then a tunnel is made under the upper abdomen and is attached to the chest where the breast previously resided. The flap remains attached to its original blood supply. This procedure adds 4 to 5 hours to the surgery and adds significant postoperative recovery time for the patient. Patients who smoke, have midline lower abdominal incisions, are morbidly obese or have other health issues may not be candidates for this reconstruction.
Free Flap Reconstruction-A free flap means that the tissue is dissected from where it was attached and the blood vessels are then reattached to the vessels in the axilla (armpit). The flaps can come from the Latissimus muscle, the rectus muscle and also the gluteal muscle. Free flap reconstruction has an increased risk of the flap dying or becoming compromised due to the microscopic vascular connection and the surgey time will be longer then in implant reconstruction.
DIEP Flap-Subsequently, the deep inferior epigastric perforator flap, or DIEP, was described. The DIEP flap uses the same skin island as the TRAM flap, but preserves all of the rectus muscle and anterior rectus fascia, potentially reducing the risk for abdominal wall weakness and subsequent hernia formation or lower abdominal bulge. The skin island in the DIEP flap is based on one or more perforating branches off the deep inferior epigastric artery and vein.
SIEA-More recently, the superficial inferior epigastric artery flap (SIEA) was described as the true abdominoplasty flap for breast reconstruction. It is based on the superficial inferior epigastric vessels which arise from the common femoral vessels and course through the subcutaneous tissues. The harvest of this flap does not violate the anterior abdominal wall fascia or musculature and as a result, patients experience less post-operative pain, quicker recovery and no chance of hernia formation. Unfortunately, clinical experience has shown that the superficial inferior epigastric vessels are either absent or too small to adequately perfuse a free flap transfer of abdominal tissue in the majority of patients. These vessels are only adequate for use in approximately 20-30% of patients and are smaller than the deep inferior epigastric vessel system with less blood volume flow as a result.
Nipple areolar reconstruction is completed at a later stage regardless of the type of reconstruction that is chosen. The areolar nipple complex surgery is outpatient procedure and the final touch is tattooing of the areolar complex.
