Autologous Breast Reconstruction & Microsurgery in Washington DC
Not long ago, mastectomy patients had few options for autologous breast reconstruction, or reconstruction using a patient’s own tissue from another area of the body. As surgical techniques have advanced, it is now possible to create a natural looking and feeling breast shape for many patients without using breast implants.
What is Microsurgery?
Microsurgery is a specialized technique that involves taking tissue from one part of the body, along with its small blood vessels, moving that tissue to another part of the body, and then using a microscope and fine instruments to reconnect these small blood vessels to other small blood vessels at the new site. Through microsurgery, surgeons have successfully performed complex tissue flaps, restored severely injured limbs, and even completed intricate transplants using donor tissue.
When used in breast reconstruction, microsurgery allows a surgeon to successfully transfer tissue from one area of the body, such as the abdomen, without being limited to the donor area’s original blood supply. This advancement has resulted in a number of new, less invasive techniques that achieve an aesthetically pleasing result in only one surgical procedure.
Center for Plastic Surgery breast reconstruction specialist Dr. Samir Rao is highly skilled in microsurgical techniques for autologous breast reconstruction, including DIEP and SIEA flap procedures, which are described below.
Latissimus Dorsi Musculocutaneous Flap Technique
In this procedure, a block of skin and muscle from the patient’s back is used to replace the skin removed during the mastectomy. This technique makes a one-stage breast mound reconstruction possible for most patients because it does not require tissue expansion. The latissimus dorsi flap usually does not carry much tissue bulk with it, so a small implant is often inserted behind the flap to regain the desired breast shape and size.
In addition to one-stage breast mound reconstruction, the additional tissue brought by the latissimus dorsi flap provides most patients with adequate tissue for a full breast reconstruction. This procedure is good for patients who had radiation following a mastectomy or for those who had a significant amount of skin taken during the mastectomy. It is also a good option in patients who have not had success with prosthetic reconstruction or those who want to use their body’s own tissue for breast reconstruction but are not good candidates for a microsurgical reconstruction.
The latissimus flap, however, a more involved procedure than tissue expansion, and it requires more surgery and hospitalization time. It also results in an additional scar on the back.
Transverse Rectus Musculocutaneous Flap (TRAM)
This technique uses the lower abdominal skin and fat to rebuild the breast. The primary advantage of the abdominal flap technique is that the entire breast mound can generally be reconstructed from the patient’s own tissue, without the need for an implant. Most patients have adequate abdominal skin and fat to allow for the reconstruction of one breast.
In this procedure, the surgeon elevates a large block of tissue from the lower abdominal area but leaves it attached to one of the two rectus muscles in the abdominal wall. This tissue is then tunneled under the skin up to the area where the breast will be reconstructed. It is then sculpted and fashioned to form a breast mound. When abdominal incision is closed, the result is similar to an abdominoplasty (tummy tuck). This approach not only avoids a major second stage surgery for reconstruction, but also results in a soft breast consistency, similar to breast tissue.
Not all patients are good candidates for this procedure, particularly those who are excessively overweight, heavy cigarette smokers or who have had multiple abdominal surgeries and abdominal scars. Because the abdominal flap technique is a more extensive operation, it does carry slightly higher wound healing risks and requires longer hospitalization and recuperation.
Deep Inferior Epigastric Perforator Flap (DIEP)
The DIEP flap technique is a more recent advancement that offers many advantages over other autologous methods of breast reconstruction. Like the TRAM flap technique, the DIEP flap uses fat and skin from the abdomen to recreate a more normal breast shape. However, the DIEP flap leaves the abdominal muscles behind and is thus considered a “muscle-sparing” technique, which can help a patient keep her abdominal muscle strength after surgery.
During the procedure, the surgeon removes excess skin, fat and tissue from the lower abdomen, along with the blood vessels from the surrounding area. He then transfers this tissue to the chest wall to create a new breast shape, using microsurgery to connect the blood vessels in the transferred tissue to those in the chest, providing necessary blood supply to the reconstructed breast. With excess skin gone from the abdomen, patients also gain the benefit of an improved tone to the lower belly.
The DIEP flap is a complex procedure that requires a surgeon who has specific training and experience performing microsurgical breast reconstruction. A patient must also have adequate skin and fat on the abdomen to recreate the breast shape. It also requires more time in surgery than some other methods of breast reconstruction, and patients will have a scar similar to that resulting from a tummy tuck. Because it is such an involved procedure, it is best for women who are nonsmokers and in otherwise good health after mastectomy.
Superficial Inferior Epigastric Artery Flap (SIEA)
This muscle-sparing technique is similar to DIEP flap breast reconstruction in that it involves the transfer of skin and fat from the abdomen to the chest wall and requires microsurgery to connect to the blood vessels in the abdominal tissue to its new blood supply. However, because the superficial inferior epigastric artery does not travel through the abdominal muscles, the SIEA flap technique does not require the surgeon to make any cuts in the abdominal muscles, so theoretically the abdominal strength can be completely preserved.
Despite its advantages, this technique is only possible in patients whose superficial inferior epigastric blood vessels are of adequate size. More often than not, this artery is too small for a SIEA flap to be possible. In these cases, the surgeon will usually proceed with a DIEP flap reconstruction. The best candidates for SIEA flap reconstruction are at a healthy weight, do not smoke, and are not diabetic. Additionally, like the DIEP procedure, it is required that your surgeon have specialized training and experience in microsurgery.
If you are considering your options for autologous breast reconstruction in the Washington DC area, we invite you to contact us for a consultation to discuss any of these procedures in greater detail.
For more information about the breast reconstruction process, please click here to read our patient overview.†Cost estimates are all-inclusive ballpark figures. Actual procedures to be performed and costs vary depending on individual patient needs. Our Patient Coordinator will provide a fee quote after your consultation with the physician.