Mastectomy & Reconstruction: Part 3

The second category of breast reconstruction is tissue flaps. Your own tissue is taken from donor sites on your body and used to form new breasts. There are different areas on your body that tissue can be taken from, therefore, resulting in a name for each donor site.

Who wants a tummy tuck? TRAM flap reconstruction takes tissue that would be removed in a traditional tummy tuck and uses it to form a new breast. TRAM (Transverse Rectus Abdominus Muscle) can be executed one of two ways. Pidicled TRAM flap involves a football shaped area of skin, fat tissue, and muscle located in the lower portion of the abdominal muscles. Imagine placing a two-dimensional drawing of a football centered over your belly-button. The two points of the football would be touching your hip bones on each side. This gives you an idea of where the tissue for your new breast would come from. In this process the tissue is removed from its original location with blood supply intact and tunneled under the abdominal skin to its new location on the chest. In this method, there are risks for hernia and blood clots.

Free TRAM flap reconstruction has become more popular and is beginning to replace the pedicled flap. In this method the above mentioned football is completely severed from its original position. The flap is then transferred to its new position on the chest. Microsurgery is required to reconnect a blood supply to the flap. By connecting a new blood supply to the flap in its new position there is better blood flow to the tissue. There is still a risk of hernia due to the loss of abdominal muscle.

DIEP flap breast reconstruction is similar to the above methods in the sense that it takes tissue from the same area. The tissue taken is limited to the skin, fat, and teased blood vessels. Meaning that there is no muscle tissue removed, only blood vessels from the muscle. Being able to remove only blood vessels significantly reduces the risk of hernia and also reduces healing time. Microsurgery is once again required to reconnect a blood supply to the transplanted tissue.

SIEA flap has improved further on the DIEP method. It is essentially the same with the exception of completely avoiding the use of any tissue linked to the muscle. Meaning that the blood vessels used are within the skin and fat tissue transferred. The superficial inferior epigastric vessels to be exact. There are very few patients who will be a candidate for this type of procedure.

Well we have completed our tummy tuck, but in some cases only one breast has been produced. So what are our other options for tissue transplant? We have two other options. Latissimus Dorsi flap uses tissue located to the rear of our natural breasts. Take your right hand and reach under your left arm to your back. The tissue under your hand will be partially detached and moved under your skin to the front of your chest. Like in the pedicled TRAM flap the blood supply is not cut. This method does not result in a large breast, so it is commonly paired with implant or expander type construction. You will have scarring on your back, and muscle weakness for a period of time following surgery.

The last area utilized for flap reconstruction is the booty. The GAP (gluteal artery perforator) flap uses skin located in the upper portion of the buttock. This results in a flatter bottom, but a very nice feeling breast. The tissue taken from your buttocks is completely severed and transplanted, therefore, microsurgery is necessary with this method to connect a blood supply to the new breast.

Flap reconstruction uses fat tissue from your own body, so the overall size of your breast will fluctuate with weight gain and loss. You will most likely experience sagging at some point in time because of the stretching of the skin with weight fluctuation. Flap methods are commonly used in women who have had a unilateral (one breast) removed to achieve an asymmetrical look with their remaining breast. It is also popular with patients who do not want the everlasting look and feel of implants. If you would like additional information I would suggest the following sites.

http://www.breastreconstruction.org
http://www.breastflap.com
http://www.alwaysyouthful.com