Tissue flaps are one of the most common forms of breast restoration, as they supply additional muscle tissue and skin to camouflage implants and help them look more natural, or recreate the breast mound with no need for implants or other foreign materials. These procedures involve taking skin, fat and/or muscle, usually from the abdomen or back, and placing them in the breast area after a mastectomy. The flap may remain attached to its original blood supply, or can be reattached to another part of the body.
Because of the natural tissue used, tissue based restoration produces warm, soft breasts that lasts for many years.
There are several different types of flaps that can be used during breast restoration, depending on the condition of the breast after mastectomy, as well as the personal preference of the patient. Your doctor will discuss these options with you prior to your restoration procedure to ensure that you receive the most appropriate treatment for your individual needs.
The results of breast restoration vary depending on the patient's individual case and the type of flap used. While we strive to achieve the most natural-looking results for each patient's reconstructive procedure, reconstructed breasts will not have the same sensation and feel of a real breast. It is important for patients to remember this and have realistic expectations for their restoration procedure.
The different types of breast restoration procedures we perform are listed below:
In general, tissue based breast restoration is recommended for patients who do not have enough skin or tissue in the breast area after mastectomy and require additional coverage for a breast mound or to cover an implant.
Although breast restoration of any kind is considered a beneficial procedure for many women, it is not for everybody. In order to achieve successful results from these procedures, women should be in good general health and able to handle the stress of a surgical procedure. Certain factors may increase a patient's risk of complications with breast restoration surgery, so you should speak to your doctor about whether or not tissue-based reconstruction is right for you.
A deep inferior epigastric perforator (DIEP) flap uses skin and tissue from the abdominal area to recreate the breast mound after a mastectomy procedure. In most cases, there is enough excess fat and skin in the tummy area to create a new breast mound and restore the patient's appearance.
During the DIEP flap restoration procedure, an incision is made across the stomach, just below the navel, and layers of skin and fat are lifted up, similar to the technique used in a tummy tuck procedure. Along with the deep inferior epigastric perforator artery and vein, which are preserved to supply blood to the new breast tissue, the tissue flap is then moved to the breast area. The blood vessels are reattached using microsurgery and the transported skin and fat are reshaped to create a breast mound before they are sutured into place.
After the DIEP procedure, patients will likely need to stay in the hospital for three to four days so that the healing process may be monitored by your doctor and nurses. Drains can usually be removed a week after surgery, and you will likely be able to return to work after four to six weeks of rest. It is important for patients to see their doctor for regular follow-up appointments to monitor the healing of incisions and the health and appearance of the breast.
Unlike other abdominal flaps, a DIEP flap does not involve moving any muscle, and results in less pain and shorter recovery times. Patients can also benefit from a flatter and more toned abdomen after skin and fat are removed. This procedure takes longer to perform than other flap procedures, but its benefits often outweigh the extra procedure time.
Many women undergoing breast restoration choose to use tissue expanders for natural-looking breasts that do not require any flaps or grafts. Through a series of appointments, the remaining breast tissue will be gradually expanded to accommodate an implant. The tissue expanders are placed during the initial procedure, which may be performed immediately after the mastectomy, or several months later, depending on the preference of the patient. They are placed under general anesthesia in a one to two hour procedure, and usually remain in place for four to six months.
Many women who undergo a mastectomy opt to have a breast reconstruction procedure performed as well. One of the latest advances in breast reconstruction techniques involves the use of AlloDerm, an acellular dermal matrix. Manufactured by LifeCell, AlloDerm can replace some of the lost breast tissue and provide support for implants. AlloDerm is created from donor tissue that goes through a cell removal process to reduce the likelihood of rejection, yet leaves the basic tissue structure intact. Since AlloDerm is produced from natural human tissue, it is not only well tolerated by most patients, but it actually integrates into the patient’s existing cells and becomes part of the body.
AlloDerm is attached to the lower portion of the breast between the pectoralis muscle and chest wall. This helps to reinforce the breast structures and leaves other muscles undisturbed. The pectoralis major muscle resides in the top portion of the breast pocket while the AlloDerm will support the bottom portion. It is positioned to provide the correct shape and foundation for the implants that will be inserted. AlloDerm offers a cosmetically pleasing appearance and natural looking options. In addition, it carries less of a risk of developing capsular contracture, a condition involving a hardening of scar tissue around the implant, than other methods involving implants.
In providing the supplemental tissue necessary for breast reconstruction, AlloDerm helps patients avoid a tissue expansion process. This benefits patients because expansion delays the reconstruction surgery and makes it a multi-step procedure. Depending on the type of reconstruction being performed, AlloDerm can allow for a single, one-time surgery.
As with any form of surgery, use of AlloDerm in breast reconstruction does come with a risk of some complications. These are rare, but include rejection of the AlloDerm by the body, allergic reaction and a tissue matrix failure.
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