Breast reconstruction is a cosmetic surgery procedure commonly performed after a single or double mastectomy — surgical excision of the breast or breasts to either treat or prevent breast cancer. During flap surgery, or autologous breast reconstruction, a portion of tissue is removed from one part of the body and relocated to create a new breast mound.
This form of reconstruction may require a two-stage procedure in which the tissue expander is placed at the initial stage and tissue reconstruction is completed at the second stage. Flap surgery is performed by our plastic surgeons in Gainesville, FL, either in conjunction with or prior to nipple reconstruction to complete the breast reconstruction process.
Types Of Tissue Flap Surgery
The two main methods used for flap surgery are pedicled flap surgery and free flap surgery. Pedicle flap surgery involves transferring tissue from a patient’s back or abdomen without cutting the all of the blood vessels. Instead, our Gainesville plastic surgeon pulls the tissue underneath the skin until it reaches the chest and then secures it at the new site. During a free flap surgery, the surgeon cuts all of the blood vessels and then sews the flap to blood vessels in the chest. There are multiple types of breast flap techniques, each of which is named for the body location from which the tissue is removed.
TRAM (transverse rectus abdominis muscle) flap is one of the most common types of flap surgery. During TRAM flap reconstruction, muscle and tissue are transferred from the lower abdomen to the chest. The TRAM flap can be performed either using the pedicle flap method or the free flap method.
TUG (transverse upper gracilis) flap is performed with the free flap method. During this procedure, Gainesville plastic surgeons remove tissue from and hide the incision within the inner, upper thigh region. The TUG flap is preferable for patients who have small-size breasts and minimal abdominal tissue.
Latissimus Dorsi Flap
The latissimus dorsi flap uses the pedicle flap method to excise fat and tissue from the upper back. The contents are then tunneled under the skin and placed in the chest. Our surgeons can disguise the scar from the procedure by positioning the incision along the bra line.
DIEP (deep inferior epigastric artery perforator) flap surgery uses the free flap method to remove skin and fat from the abdomen. The DIEP flap surgery does not require excision of parts of the muscle — as with other types of flap surgery — which helps patients avoid abdominal weakness during DIEP flap recovery.
SIEA (superficial inferior epigastric artery) flap is a type of free flap procedure. The SIEA flap is a variation of the DIEP flap, because it requires the removal of fat and tissue from the abdomen but it uses arteries that are not as deeply embedded in the muscle resulting in a much less invasive type of flap surgery.
The gluteal flap transfers tissue found in the upper buttocks in order to create new breasts. This free flap procedure is typically chosen in cases in which patients have little tissue in their abdomen or when the patient has previously undergone abdominal surgery.
Benefits Of Flap Reconstruction
There are numerous benefits to undergoing breast reconstruction after mastectomy with the breast flap procedure. Fat transfer breast augmentation results in breasts that both appear and feel natural, making this procedure an ideal option for patients that seek large-size breasts that are soft to the touch. With flaps, newly reconstructed breasts also tend to age in harmony with the rest of the body. In addition, flap surgery does not require that patients undergo additional procedures to adjust their reconstructed breasts, as with saline or silicone implants. To determine the best type of breast reconstruction for you, schedule a consultation.
Flap Surgery Vs. Breast Implants
Typically performed as a standalone procedure, breast flap surgery may also be used with other types of breast plastic surgery, such as breast implants, to help patients meet their goals for breast reconstruction. While flap surgery produces natural-feeling breasts that age in harmony with the body, the procedure requires a greater amount of time to perform than breast implant surgery. In addition, patients that do not have an adequate amount of body tissue and fat may not be eligible for flap surgery. Breast implant surgery is a relatively simple procedure that requires less time to perform than flap surgery. However, breaks implants have a lifespan of approximately 10 years, after which additional surgery may be required to replace, modify, or repair the implants. Additionally, when assessing long-term patient-reported outcomes in post-mastectomy breast reconstruction, patients reported higher personal satisfaction with flap procedures over implants. Our plastic surgeons can help you decide the best option for breast reconstruction with regard to your medical needs and aesthetic preferences.
Breast Flap Procedure
During breast flap mastectomy reconstruction surgery, patients will be put under general anesthesia and can expect the procedure to last several hours. The exact duration of the procedure is dependent upon the chosen type of breast flap surgery. For more information about the individualized flap procedures, or to schedule a consultation for breast reconstruction, contact our plastic surgery center today.
Risks Of Flap Surgery
Following tissue flap breast reconstruction, patients report redness and swelling surrounding the surgical sites, which may last several weeks. Patients may also experience minor pain for which they may be prescribed pain medication. In order to decrease the likelihood of postoperative complications, the ideal candidate for tissue flap reconstruction should not suffer from diabetes, high blood pressure, obesity or use tobacco products.
Flap Procedure Recovery
Typically, it takes women about 6-8 weeks to recover, during which patients may have difficulty sitting down, standing up or lying down. Patients must also avoid any type of strenuous physical or sexual activity for a month or more following breast reconstruction surgery.
During mastectomy recovery, patients may be required to wear a post-surgical bra to keep in place the surgical bandages and collect excess fluid from any drains inserted near the surgical site. Our plastic surgeons will provide instruction to patients regarding exercises to ensure that any movement of the body does not pose a risk of harm to the incision sites.
For an optimal outcome and recovery, it is crucial that patients follow the provided instructions. Failure to adhere to the provided instructions for post-surgical care may exacerbate swelling, pain and less-than-ideal results to the procedure.