The Different Types of Breast Reconstruction Surgery
- 21 October 2016
- Dr. Nidal (Nick) Masri
Most women automatically think of breast implants when it comes to breast reconstruction Miami post-mastectomy. But there is more to breast reconstruction than just implants.
Below are some of the most common techniques used for breast reconstruction surgery, with implant and flap reconstruction being the two main categories.
The biggest advantage of an implant reconstruction over a flap reconstruction is that it requires less surgery. It results in fewer scars and a lower risk of infection. However, its results are not as natural-looking as a flap reconstruction.
There are two sub-types of breast reconstruction that require the use of implants: immediate implant breast reconstruction and tissue expander with implant.
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The implant only reconstruction is best suited for women with small to medium-sized breasts and with enough skin left over after mastectomy. It is done immediately at the time of the mastectomy, ensuring no extra scars, fast placement, and immediate results.
However, implants are the most unnatural-looking of all the breast reconstruction techniques. It also carries the risks commonly associated with breast implants, such as wrinkling, dislodgement, leaking, capsular contraction, and pain. It also has to be replaced within 10 to 20 years to avoid complications. Radiation may also compromise the cosmetic outcome of this technique.
Tissue expander followed by implant
For women who do not have enough excess fat and skin to support flap reconstruction, the administration of a tissue expander followed by an implant may be the technique of choice.
In this procedure, your surgeon places a balloon-like tissue expander under your chest muscles to gradually stretch your skin and make room for an implant. Saline solutions are injected at weekly intervals into the tissue expander until it stretches sufficiently and the implant can finally be inserted. Because of this, final results can only be seen months after your breast reconstruction.
Also known as autologous reconstruction, flap reconstruction uses tissues from another place in your body to form a breast shape. The tissue – called a flap – is composed of skin, fat, and muscles, and usually comes from the abdomen, back, buttocks, and thighs.
Flaps can either be free – completely separated from its original blood vessels – or pedicled – still attached to its original blood vessels and moved under your skin to your chest.
The TRAM flap involves the use of the transverse rectus abdominis muscle (TRAM) in the lower abdomen to reconstruct the breast. A flap of the skin, fat, and all or part of the underlying TRAM are used in the creation of a flap. You can either opt for a pedicle or free flap TRAM reconstruction, with the former maintaining as much sensation as possible.
However, the TRAM flap can also result in decreased abdominal muscle strength, especially since the six-pack muscles are transferred to the breast area. It can also make you more at risk for hernias.
The DIEP flap, which stands for deep inferior epigastric perforator flap, is one of the most advanced breast reconstruction Miami post-mastectomy techniques. It involves the transfer of skin and fat from the abdomen to the chest without disturbing the muscles. Your surgeon then carefully reattaches the blood vessels of the flap to blood vessels in your chest during microsurgery. The surgery can take anywhere from five to eight hours.
The DIEP flap is less taxing than the TRAM flap, plus it also preserves abdominal strength. But since it is a highly specialized procedure, not all surgeons can perform it well.
Gluteal techniques can either be superior gluteal artery perforator (SGAP) or inferior gluteal artery perforator (IGAP) flaps. Their main difference is where the tissue is taken from. In SGAP, skin and fat are taken from the top area of the buttocks, while in IGAP, these are taken from the lower area of the buttocks.
Gluteal flaps are one of the most complicated microsurgical breast reconstruction techniques. Yet it has a high success rate because there is no muscle transfer involved, hence allowing for faster healing. Furthermore, IGAP scars are easily hidden from view.
Latissimus dorsi flap
In this latissimus dorsi flap reconstruction, the surgeon uses the skin and long muscle that runs beneath the armpit and diagonally across the back to build a new breast. This muscle, called the latissimus dorsi muscle, can be felt along the side of the rib cage.
Since the tissue source is near the chest, it is a simpler operation than a TRAM flap. The latissimus dorsi flap can also remain attached to its natural blood supply. It is a good choice for patients who still want to get pregnant or have had abdominal surgery already. However, it can limit back and shoulder activity, plus it can only be done once.
SIEA stands for superficial inferior epigastric artery, the blood vessel that runs just under the skin in the lower abdomen. The SIEA flap is pretty much the same as the DIEP flap, except that a different section of blood vessels in the belly are moved with fat and skin. Also, it does not require an incision, unlike the DIEP flap. Most women recover more quickly with this technique.
However, many women are not good candidates for a SIEP flap because their blood vessels may be too small to support the flap. It is also possible that these blood vessels have been cut during a previous C-section or hysterectomy.
A PAP flap uses the profunda artery perforator (PAP) blood vessel in the thigh, as well as a section of skin and fat from the back of the upper thigh, to reconstruct the breast. It is considered as another muscle-sparing flap because no muscle is used.
The procedure is recommended for women with small to medium breasts, as well as those who still want to become pregnant in the future or have already had abdominal surgery. But since it is a relatively new treatment, a lot of surgeons may not be familiar with it. The skin texture of the thighs may also be different from the chest’s.
The TUG flap also harvests skin, fat, and blood vessels from thighs, just like the PAP flap. However, it also uses the transverse upper gracilis (TUG) muscle in the upper inner thigh to reconstruct the breast. After the surgery, you may no longer use this muscle.
Women who are not good candidates for TRAM, DIEP, or SIEP flaps usually go for the TUG flap. It is also the technique of choice for those who already underwent flap reconstruction before but failed, and are now seeking a secondary alternative.
With all the different options for breast reconstruction Miami post-mastectomy, it can be confusing to figure out which one suits you best. Schedule a Free Consultation with one of Face + Body Cosmetic Surgery’s board-certified plastic surgeons and discuss which technique will work for your individual case.