Flap reconstruction offers an autologous (your own tissue) reconstruction, and gives many of the benefits described in earlier posts, such as a soft and “natural” breast mound. Such flaps also are much better for those with a history of radiation, or those who will ultimately require postoperative radiation therapy following mastectomy. Autologous tissue flaps for breast reconstruction offer the best options for these purposes, until the possibility of reconstruction with stem cells becomes a reality. The conventional autologous flap reconstruction requires sacrificing a muscle to reconstruct the breast, either the latissimus dorsi or rectus abdominis muscle. Although popular and reliable procedures to accomplish the goal of breast reconstruction, some of the expected outcomes that coincide are increased pain and seroma formation, along with functional deficits, weakness, and increased rates of hernias/bulges in the areas where the muscle was taken.
Perforator flaps have come to the forefront of plastic & reconstructive surgery due to their decreased morbidity, decreased recuperation time, and increased aesthetic results. This is due in part since they are muscle-sparing procedures, which subsequently maintain muscle function and do not have any morbidity associated with sacrificing of muscles, such as those described previously. Since these types of flaps are technically challenging and more complex, microsurgical expertise is required and as such, very few plastic surgeons in the United States are skilled enough to perform these perforator flaps successfully. In addition to the elaborate dissection of these flaps, albeit tedious, the flap must be reanastomosed under a microscope to blood vessels in the nearby recipient site.
Although a poplar procedure elsewhere in the world, patients in the U.S. often must travel far to find a surgeon capable of performing these perforator flaps, such as the DIEP, SIEA, SGAP, TUG, or ALT flap (DIEP – abdominal skin/tissue only; SIEA – abdominal skin/tissue only; SGAP – buttock skin/tissue only; TUG – groin skin/tissue only; ALT – lateral thigh skin/tissue only). These flaps spare muscle and are arguably the best reconstructive options that we have today. To find a surgeon near you who perform such free tissue transfer breast reconstructions, see the links provided to the right.
Breast reconstruction does not delay treatment for your cancer, if necessary, such as chemotherapy or radiation therapy. Literature shows no increase in recurrence rate or survival rate nor any decreased ability to diagnose such cancers. n fact, the most recent literature has even shown a decreased recurrence rate with immediate breast reconstruction. With all of this in mind, as well as knowing the the superior aesthetic results that are associated with immediate breast reconstruction (reconstruction performed at the same time as your mastectomy), I recommend discussing all of your breast reconstruction options with a plastic surgeon who specializes in breast reconstruction before your mastectomy procedure…please refer to my earliest posts on breast reconstructive options and understanding all of your options.
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