Francois J Duminy

PLASTIC & RECONSTRUCTIVE SURGEON

BREAST RECONSTRUCTION BY TISSUE FLAPS

A breast can be reconstructed by means of soft tissue, mainly Fatty tissue obtained from elsewhere on the body. This tissue is moved into the breast area either as a:

  • pedicled flap (remaining attached by its blood vessels inside a long piece of muscle)e.g.
    • TRAM Flap
    • Latissimus Dorsi Flap
    • Lateral Thoracic Flap
       
  • or a free flap (in which the flap's blood vessels have to be microsurgically joined to donor vessels near the breast)
    • DIEP Flap

These flaps bring new tissue and new blood supply into the area and they are useful especially where there has been radiotherapy.

When the new breast has settled, it is sometimes necessary to make an adjustment to the other breast to obtain better symmetry.

Once the breasts are symmetrical in shape and size, a new Nipple and Areola are made to get the best possible symmetry and appearance.

 

Benefits experienced by most patients:

1. Limiting of the Physical impact of mastectomy

2. Limiting the Psychological impact of mastectomy

3. Restoring symmetry - making clothing easier to wear comfortably and confidently

4. Restoring Confidence

5. The final breast is completely natural, made of living tissue.

6. The patient loses fat in places where fat is undesirable e.g. the lower abdomen.

7. There is usually no need for future prosthesis changes or for further touch-up surgery occasioned by increasing asymmetry as the breasts age. This is because they are essentially made of the same tissues and therefore, aging is symmetrical.

8. Future complications of prostheses, such as Capsular Contractures, are completely avoided.

 

Negative Aspects:

1. These are big operations taking many hours and the risk of surgical complications is high.

2. There are additional areas of scarring at the donor sites.

3. Procedures such as TRAM flaps require the loss of one of the muscles of the abdominal wall, often leading to some form of abdominal wall weakness. The DIEP Flap helps to preserve the muscle, but it is a more complex operation requiring a longer operating time and a greater risk of surgical complications including flap loss.

4. Areas of Fat Necrosis are common.

5. When skin is included, it is usually not well matched to breast skin.

Despite the above, it must be said that lower abdominal flaps such as the TRAM Flap and the DIEP Flap have in the past 20 years become the Gold Standard of Breast Reconstruction