Tissue Flap Breast Reconstruction Houston
Breast reconstruction using the patient’s own tissue is one of the best and most revolutionary procedures available today. The flat consists of muscle, skin, and fat and is used to simulate breast tissue. The three most common procedures for this type of reconstruction are TRAM Flaps (Traditional or FreeTRAM flap), DIEP Flaps, and LatissimusDorsi Flaps. Which procedure Dr. Hsu performs will depend on a number of factors, which he will discuss with you in detail for surgery.
*Trans Rectus Abdominal Muscle
Many women refer to this procedure as a reconstruction and tummy tuck in one. The flap is harvested from the Transverse Rectus Abdominus Muscle (TRAM) area that lies in the lower abdomen, between the pubic bone and the waist, resulting in a much smaller midsection. However, if you are already skinny and don’t have enough excess belly fat to facilitate the procedure, the flap will need to be harvested from a different area of the body, such as your back.
Breasts that are reconstructed from TRAM flaps look and feel more like a natural breast when touched, though actual sensation is minimal in the breast itself. It is important to know that there will be scarring on the abdomen from the removal of the flap, and there may be some loss of strength due to having some of the muscle in your lower belly removed. Eventually you should be able to regain your original level of strength.
Tissue can be taken from your abdomen only once. If you ever need a second breast reconstruction, the tissue used will come from elsewhere, such as your back.
Two Types of TRAM Flaps
- Traditional TRAM Flap(Pedicled TRAM Flap): As previously stated, this procedure uses a flap of skin harvested from the lower belly (the same tissue which is removed during a tummy tuck). The flap retains a connection with the upper part of the underlying Rectus Abdominis Muscle, which means blood flow is maintained. The rectus abdominis muscle has two blood supplies – one from above and one from below. One of the problems with the Pedicled TRAM Flap has been a variable and sometimes unreliable blood supply due to the distance from the upper portion of the muscle to the lower abdominal skin. In some cases, there has been a weakening and sometimes prolonged discomfort in the harvest area. Next, the flap is tunneled under the chest wall skin in order to recreate the breast at the site of the mastectomy wound. Although the flap has been tunneled under the skin and is now part of the new breast, this abdominal tissue has remained attached to its original site and to its original blood supply – the feeding artery and vein. (Think of an umbilical cord or a leash.)
- The Free TRAM Flap: It takes a physician who is skilled in microvascular techniques to perform this type of surgery. Dr. Hsu is extremely knowledgeable and experienced with Free TRAM Flap procedures. Starting with removing a small portion of the Rectus Abdominis Muscle while keeping the lower blood vessels attached, then will relocate the harvested tissue to the site of the mastectomy wound. Using an operating microscope the severed blood vessels from the rest of the muscle are reattached to blood vessels under the arm, ensuring proper blood flow. Though the risk of complications should be less than 1%, there is a slight chance that smaller blood vessels may clot and restrict blood, which will cause the total loss of the transplanted flap. Dr. Hsu employs the most advanced techniques in microsurgery to ensure the least amount of risk to the patient. The development of the TRAM has allowed improved options for patients whose choices may be limited by obesity, cigarette-smoking or previous upper abdominal surgery. Though this surgery is the most complex and involves a high level of skill, it is also considered one of the best and most advanced treatments available. Overall the procedure is less traumatic to the surrounding tissues and there are fewer chances for complications with the transplanted tissue.
DIEP Flap (Deep Interior Epigastric Perforator)
Similar to the Free TRAM Flap procedure, skin, fat and blood vessels are harvested from the lower abdomen. The only difference is no muscle is taken, leaving the RetusAbdominis Muscle completely intact. This procedure is used mostly for women who only need a small amount of tissue for the reconstruction or require bilateral reconstruction.
Though slightly more complicated than a standard Free TRAM Flap procedure, Dr. Hsu is competent to perform this type of reconstruction surgery.
Your time of recovery for this procedure will be similar to that of the Free TRAM Flap procedure, with a hospital stay of four to five days after a surgery taking four to six hours. Rapid recovery is expected over the next several months.
This procedure is used for women with small to moderate-sized breasts due to the lack of body fat in the back. A flap of tissue containing muscle, fat, and skin is removed from the latissimusdorsi area of the upper back. A short tunnel is made through the skin and the flap is slid around through the tunnel to be repositioned at the mastectomy wound. The flap is then shaped into a natural-looking breast and the blood vessels are reattached with microsurgery where necessary.
The procedure takes anywhere from two to three hours, and most surgeons like the relative simplicity of the procedure since the tunnel through the skin is short and it is easier to reposition the flap. However, women will fuller natural breasts will require an implant at the time of the procedure to ensure proper sizing, since so little fat can be removed from the back. Also, there may be some unevenness to the back after surgery. Results are excellent for most women despite these issues. Usually, though, back function and strength aren’t affected.
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