What is Breast Reconstruction by Flap Surgery?

Breast Reconstruction with Flap Surgery is the most complex Breast Reconstructive option. Mr Khan transfers a section of skin, muscle, fat and blood vessels from one part of your body to your chest to create a new breast mound. In some cases, the skin and tissue need to be augmented with a Breast Implant to achieve the desired breast size.

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Surgical Methods

Autologous tissue Breast Reconstruction uses one of two surgical methods:

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Pedicle Flap Surgery: Mr Khan cuts some of the blood vessels to the tissue to be transferred but keeps other blood vessels intact. Tunneling the tissue beneath your skin to your chest area, Mr Khan then creates the new breast mound or pocket for the implant.

 

Free Flap Surgery: Mr Khan disconnects the tissue completely from its blood supply and reattaches the tissue to new blood vessels near your chest. Because of reattaching blood vessels, Free Flap Surgery typically takes longer than does Pedicle Flap Surgery.

 

Types of Flap Surgery

The tissue for reconstructing your breast most often comes from your abdomen. Tissue from your back or — less commonly — your buttocks may also be used. Mr Khan determines which method is best for you based on your body type and your medical and surgical history.

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• Abdomen (TRAM flap). Mr Khan removes tissue — including muscle — from your abdomen in a procedure known as a transverse rectus abdominis muscle (TRAM) flap. The TRAM flap can be transferred as a free flap or a pedicle flap.

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• Abdomen (DIEP flap). A newer procedure, Deep Inferior Epigastric Perforator (DIEP) Flap, is similar to an msTRAM flap, but only skin and fat are removed. Most of the abdominal muscle is left in place and minimal muscle tissue is taken to form the new breast mound. Reattaching blood vessels requires expertise in surgery through a microscope (Microsurgery).

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An advantage to this type of Breast Reconstruction is that you'll retain more strength in your abdomen. If Mr Khan can't perform a DIEP Flap procedure for anatomical reasons, he might opt for the msTRAM procedure instead.

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• Abdomen (SIEA flap). A variation of the DIEP Flap, the Superficial Inferior Epigastric Artery (SIEA) Flap uses the same abdominal tissue but relies on blood vessels that aren't as deep within the abdomen. This provides a less invasive option, but not all women's SIEA blood vessels are adequate for this type of Flap Surgery.

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• Back (Latissimus Dorsi Flap). This surgical technique takes skin, fat and muscle from your upper back, tunneling it under your skin to your chest. Because the amount of skin and other tissue is generally less than in a TRAM Flap Surgery, this approach may be used for small and medium-sized breasts or for creating a pocket for a breast implant. Although uncommon, some women experience muscle weakness in the back, shoulder or arm after this surgery.

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• Buttocks (Gluteal Flap). A Gluteal Flap is a Free Flap procedure that takes tissue from your buttocks and transplants it to your chest area. A Gluteal Flap may be an option for women who prefer tissue reconstruction but who don't have enough extra tissue in their backs or abdomens.

 

• Inner Thigh (TUG). Another newer option, the Transverse Upper Gracilis (TUG) Flap, uses muscle and fatty tissue from the bottom of the buttocks to the inner thigh. TUG Flap Surgery, which isn't available everywhere, may be an option for women whose thighs touch and who have small to medium-sized breasts.

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Because adequate blood supply is critical to the survival of transplanted tissue in Flap surgery, Mr Khan may prefer not to perform a Pedicle Flap procedure if you're a smoker or if you have diabetes, vascular disease or a connective tissue disorder. If you smoke, you may be asked to quit for 4-6 weeks before your surgery. Also, obesity may preclude you from having a Pedicle TRAM flap.

In general, Flap Breast Reconstruction Surgery is more extensive than is Mastectomy or Implant Reconstruction. Flap procedures result in larger incisions that take longer to heal, so they require a longer recovery period and may require a longer hospital stay.

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In general, Flap Breast Reconstruction Surgery is more extensive than is Mastectomy or Implant Reconstruction. Flap procedures result in larger incisions that take longer to heal, so they require a longer recovery period and may require a longer hospital stay.

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Nipple Reconstruction

Breast Reconstruction may also entail reconstruction of your nipple, if you choose, including tattooing to define the dark area of skin surrounding your nipple (Areola).

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Recovery after the Breast Reconstruction Surgery

You’re likely to feel tired and sore for a week or 2 after Implant Surgery, and longer after Flap procedures (which will leave you with 2 surgical wounds). Mr Khan will give you medicines to help control pain and other discomfort.

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Depending on the type of surgery you have, you will most likely be able to go home from the hospital within a few days. You may be discharged with one or more drains in place. A drain is a small tube that’s put in the wound to remove extra fluid from the surgery site while it heals. In most cases, fluid drains into a little hollow ball that you’ll learn how to empty before you leave the hospital. You must follow Mr Khan's instructions on wound and drain care. Also be sure to ask what kind of support garments you should wear. If you have any concerns or questions, ask Mr Khan or nurse.

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You'll also have stitches (sutures) after your surgery. They'll probably be absorbable sutures, though, so you won't need to have them removed. Scarring is permanent, but the scars generally fade over time.

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Getting back to normal activities may take up to six weeks or more. Mr Khan will let you know of any restrictions to your activities, such as avoiding overhead lifting or strenuous physical activities. Don't be surprised if it seems to take a long time to bounce back from surgery — some women report that it takes as long as a year or two before feeling completely healed and back to normal.