Flap Reconstruction
Flap Reconstruction
What is Flap Reconstruction?
Breast reconstruction [Link to Breast Reconstruction] using flaps of the patient's own tissue is also known as autologous tissue reconstruction. It's a complex surgical procedure that rebuilds the breast or breasts of mastectomy patients using tissue from their own body. Flap reconstruction can often be done either during your mastectomy (immediate reconstruction) or as a separate surgery later (delayed reconstruction).
During a mastectomy, breast tissue is removed to treat breast cancer or reduce the risk of developing it. Reconstruction may be performed using implants, tissue expanders or autologous flaps. With flap reconstruction, the surgeon takes skin, fat, and sometimes muscle from another area of the body to create the breast mound. Typical places for this tissue to be taken from include the abdomen, back, or buttocks.
Your surgeon can sometimes create a nipple reconstruction at the same time, or this may be done at a later date.
What are the Benefits of Flap Reconstruction?
As flap reconstruction is created using the patient's own tissue, this type of procedure offers several benefits for women after mastectomy:
- Natural Look and Feel: Using your own tissue allows for a more natural-looking and feeling breast reconstruction compared to implants. The reconstructed breast can closely resemble the shape, size, and texture of the original breast.
- Long-Term Durability: Flap reconstruction tends to have better long-term outcomes compared to implant-based reconstruction. The reconstructed breast is less likely to develop complications such as capsular contracture or implant rupture over time.
- Improved Symmetry and Contour: In the case of a unilateral mastectomy [Link to Unilateral Mastectomy] requiring only one breast to be reconstructed, flap reconstruction enables more precise shaping and contouring of the breast mound. This can result in better symmetry between the reconstructed breast and the remaining natural breast.
- Reduced Risk of Infection and Rejection: Since the tissue used for reconstruction comes from the patient's own body, there is a lower risk of infection and rejection compared to using foreign materials such as implants.
- Potential for Simultaneous Mastectomy and Reconstruction: In some cases, flap reconstruction can be performed immediately following mastectomy in a single surgical procedure, eliminating the need for multiple surgeries and reducing overall treatment time.
- Preservation of Sensation: Flap reconstruction may preserve more sensation in the reconstructed breast compared to implant-based reconstruction, leading to improved quality of life for some patients.
- Ability to Address Complex Cases: Flap reconstruction may preserve more sensation in the reconstructed breast compared to implant-based reconstruction, leading to improved quality of life for some patients.
Overall, flap reconstruction offers a personalized approach to breast reconstruction. This procedure requires meticulous surgical skill and will result in more scarring due to having two surgical sites. Furthermore, it may involve longer recovery times compared to implant-based reconstruction. However, it can result in a more satisfying outcome for many patients, providing them with restored confidence, improved body image, and a sense of wholeness after mastectomy.
Who is a Good Candidate for Flap Reconstruction?
Because flap reconstruction takes skin and fat from elsewhere in the patient's body, most women will benefit from this type of reconstructive procedure. In recent research studies, it was found that all participants, regardless of their BMI or medical history, were more satisfied with flap reconstruction than implants.
Flap reconstruction is considered a safer alternative for breast reconstruction in obese patients with a BMI over 30, those with other, unrelated health problems such as diabetes and hypertension, and those who will need radiation therapy.
However, it should be noted that very thin women may not be suitable for this type of reconstruction due to a lack of body fat.
Types of Flap Reconstruction
Breast reconstruction using flaps involves transferring tissue from one part of the body to the chest to rebuild the breast mound after mastectomy. There are several types of flap reconstruction techniques, each utilizing different donor sites and tissue types.
DIEP Flap Reconstruction
DIEP flap reconstruction is a surgical procedure used after mastectomy to rebuild the breast using tissue from the lower abdomen. Unlike other flap techniques, such as TRAM flap, [Link to TRAM flap] it preserves the abdominal muscles, although they do need to be split to access the required tissue and blood vessels.
Fat Grafting Reconstruction
Also known as autologous fat transfer, fat grafting involves the removal of fat from one part of the body, typically the abdomen, thighs, or buttocks, through liposuction. The harvested fat is then processed and injected into the breast area to restore volume and shape.
Latissimus Dorsi Muscle Flap Reconstruction
In this procedure, the latissimus dorsi muscle, located in the back, is used along with its overlying skin and fat to create a flap. This flap is then tunneled under the skin to the chest area, where it is used to reconstruct the breast.
PAP Flap Reconstruction
A PAP flap (rofunda artery perforator flap) reconstruction involves using tissue from the inner thigh, including skin, fat, and blood vessels, to create a flap. The flap is then transferred to the chest area to reconstruct the breast.
SIEA Flap Reconstruction
In the SIEA flap (superficial inferior epigastric artery flap) procedure tissue from the lower abdomen, including skin, fat, and blood vessels, is used to create a flap. Unlike other similar flap techniques, such as the TRAM or DIEP flap, [Link to DIEP flap] the SIEA flap preserves the abdominal muscle, resulting in less muscle damage and reduced risk of abdominal wall weakness or hernia.
TRAM Flap Reconstruction
In this procedure, the skin, fat, and a portion of the rectus abdominis muscle from the lower abdomen are removed and transferred to the chest to create a new breast mound. There are two types of TRAM flaps:
- Pedicled TRAM flap: the tissue remains attached to its original blood supply
- Free TRAM flap: the tissue is completely detached and reattached to blood vessels in the chest.
The choice between the two depends on the patient's anatomy and the surgeon's preference.
A flap reconstruction offers several advantages over reconstruction using implants, including a more natural look and feel, improved long-term outcomes, and the potential for better symmetry and contouring.
Contact us [Link to Contact] for a confidential video call with one of our expert flap reconstruction surgeons today to discuss your options for breast reconstruction after mastectomy.