New Surgical Technique offered at The St. John Health Breast Care Program
"Perforator flaps represent the state of the art in breast reconstruction. Replacing the skin and soft tissue removed at mastectomy with soft, warm, living tissue is accomplished by borrowing skin and fatty tissue from the abdomen.
A slim incision along the bikini line is made much like that used for a tummy tuck. The necessary skin, soft tissue, and tiny feeding blood vessels are removed. These tiny blood vessels are matched to supplying vessels at the mastectomy site and reattached under a microscope.
Unlike conventional TRAM flap reconstructions, use of our refined perforator flap techniques allow for collection of this tissue without sacrifice of underlying abdominal muscles. This tissue is then surgically transformed into a new breast mound. The abdomen is the most common donor site, since excess fat and skin are usually found in this area. In addition to reconstructing the breast the contour of the abdomen is often improved much like a tummy tuck.
Restoration of the nipple and areola follow. Scars fade substantially with time. For many women the reconstructed breast may be firmer and have a more youthful appearance than their natural breasts."
Contact Dr. Rebecca Studinger for More Information:
26850 Providence Parkway, Suite 125
Novi, MI 48374
248-305-8400
3270 West Big Beaver, Suite 415
Troy, MI 48084
248-305-8400
Frequently Asked Questions
1) “What is autogenous breast reconstruction?
Autogenous breast reconstruction is the use of your own body's tissue to reconstruct the breast. This includes the TRAM (transverse rectus abdominus myocutaneous flap), gluteal flap (gluteus maximus myocutaneous flap), latissimus dorsi flap, DIEP (deep inferior epigastric perforator flap), SIEA (superficial inferior epigastric artery flap) and GAP (gluteal artery perforator flap) techniques.
2) What are the benefits of autogenous reconstruction versus implant reconstruction?
Since autogenous reconstruction uses your own body's tissue to reconstruct the breast, the tissue is there for life. You cannot reject it. It will change in volume as your normal weight fluctuations occur through life and often tends to improve in shape over time. The breast is reconstructed with fat, which is similar in density to breast tissue, thus the “feel” is similar to that of a normal breast.
Implant reconstructions tend to require multiple operations prior to achieving the final result. These could include sequential expansion of breast skin, repositioning of the implant, correction of infra-mammary fold distortion, correction of shape deformity, correction of implant extrusion, correction of implant leakage, correction of capsular contracture, removal of implant because of infection, replacement of temporary implant or expander with permanent implant. If a patient has had radiation or is planning to have radiation, implant reconstruction is discouraged because of the unacceptably high complication rate. The implants often require replacement. Implant manufacturers do not consider them “lifetime devices”. Their life expectancy is <10 years per manufacturer documentation. The occurrence of capsular contracture is often a concern with implant reconstructions. It is the result of your body's recognition of the implant as a foreign material. A capsule of scar is layed down around the prosthesis to as a barrier to contact with the body. The capsules vary in thickness and can sometimes calcify and become hard. As a result implant reconstructions tend to be more firm than a normal breast, thus feeling more artificial and remaining somewhat immobile to normal activity.
3) Are there any benefits of implant reconstruction over autogenous?
Implant reconstructions are typically shorter operations (1-2 hours) and do not prolong hospitalization. Autogenous reconstruction, specifically perforator flap reconstruction, typically takes 4-5 hours for a single reconstruction and 5-7 hours for a bilateral breast reconstruction. The hospital stay is 3-4 days for perforator flap reconstruction and may be slightly longer with TRAM flap procedures. Implant reconstructions also do not require a donor site and recovery is therefore usually shorter.
4) What is a DIEP flap?
DIEP stands for Deep Inferior Epigastric Perforator. This is the named vessel for which the tissue to be transferred is based. “Flap” is a plastic surgery term referring to the tissue which is to be transferred.
The deep inferior epigastric vessels arise from the external iliac vessels (the external iliac vessels become the femoral vessels in the leg). The deep inferior epigastric vessels course beneath the rectus abdominus (the major abdominal “six pack” muscle) on each side. These vessels send off branches to the muscle as well as through the muscle into the overlying fat. These perforating branches are those which are identified, preserved and transferred with the overlying tummy fat to reconstruct the breast.
5) How do they differ from the TRAM and gluteal flaps?
The TRAM and gluteal flaps take the underlying muscles with the skin and fat for the breast reconstruction. This can lengthen recovery and and in the case of the TRAM flap may increase your risk for hernia or abdominal “bulge”. Taking the gluteal musculature may result in some weakness in the buttocks.
6) What determines if I am a candidate for a DIEP or GAP flap?
You are a candidate for a DIEP flap reconstruction if the amount of fat you have on your lower abdomen is sufficient to reconstruct one or both breasts to the desired volume. The tissue used is that which is often removed during tummy tucks. Prior abdominal operations (i.e. hysterectomy, c-section, appendectomy, bowel resection, liposuction) does not exclude the DIEP flap from use. A prior tummy-tuck does exclude the DIEP flap from being used. In those cases where abdominal fat is inadequate or prior surgery excludes the use of the DIEP flap the GAP flap is used.
7) Can I be reconstructed at the same time as my mastectomy?
Yes. This is referred to as “immediate reconstruction”. Some of the best aesthetic results are accomplished when the reconstructions are performed at the time of mastectomy in conjunction with a skin-sparing mastectomy. The total surgical time is unchanged because the breast surgeon and the reconstructive surgeons work together at the same time.
8) How long after chemotherapy or radiation therapy do I need to wait before reconstruction?
You should wait 3-6 months following chemotherapy. This allows your body time to recover from the chemotherapy before stressing it with an operation. You should wait 6 months or more following radiation therapy. This allows your chest skin to recover from the effects of radiation before your reconstruction.
9) Why don't more surgeons perform the DIEP and GAP flap procedures?
Most Plastic Surgeons do not perform perforator flap breast reconstruction due to its complexity. It is technically very difficult and time consuming. Best success rates and efficiency are afforded when performed by a team of microsurgeons. There are very few microsurgical breast reconstruction teams committed to such an endeavor.”
Derived from: diepflap.com
