BREAST RECONSTRUCTION GOALS

The goal of reconstructive breast surgery is to restore absent breast tissue with an alternate that resembles as closely as possible the anatomic form and characteristics of a normal breast.  Autologous (your own) tissue reconstruction has been recognized as an excellent and reliable method to reconstruct the breast after mastectomy.  Tissue from other parts of your body that can be spared, like extra abdominal fat or thigh fat, can be used to reconstruct breasts.

Microsurgical DIEP, SIEA and TUG flap reconstruction can improve the aesthetics of the reconstructed breast reduce complications such as fat necrosis and flap loss.   Although microvascular autologous reconstruction can be surgically more complex and requires an increased operating time, the long term results have solidly established it as a superb method of reconstruction.  

Tissue from the abdomen provides a large amount of skin and subcutaneous fat with an excellent blood supply.  The most common technique for autologous reconstruction is the TRAM flap.  The TRAM provides the advantages of abdominal tissue, but requires removal of part or all of the rectus muscles from the abdomen and some of the fascia of the abdominal wall. The DIEP (deep inferior epigastric perforator) flap provides the abdominal skin and subcutaneous tissue the TRAM flap does while sparing the rectus muscles and fascia.  Patients have decreased post-operative pain, less post-surgical abdominal wall weakness and a decreased chance of abdominal wall hernia formation.  The SIEA flap provides the abdominal skin the DIEP flap does, but it relies on a different blood supply and requires less surgical dissection than the DIEP flap.  Hernia formation is exceedingly rare.  The TUG flap flap relies on tissue from the inner upper thigh - tissue that is commonly removed in the cosmetic medial thigh lift procedure - as well as a portion of the gracilis muscle.  Unlike the rectus muscle, loss of the small gracilis muscle does not lead to hernia formation or loss of strength.

PROCEDURE SELECTION

The unique history, circumstances and goals of each specific patient help to define the choice of a reconstruction method.  No single technique is applicable to everyone.  Some patients may be better candidates for for implants, expander or latissimus reconstruction. Or, for one reason or another, they choose to have one of these reconstructions. But to know if you are a candidate for autologous reconstruction with microsurgery, consultation with an experienced microsurgeon is required. You can't be fully informed about the benefits of this procedure and comparisons with older more conventional reconstruction unless you consult a surgeon that does microsurgery on a regular basis. Then you can determine if reconstruction with a DIEP, SIEA or Inner Thigh flap is right for you.  Although technically more complex, the potential benefits these flaps can be significant.