What is a Breast Reconstruction Surgery?
After Mastectomy one of the many concerns women have is regarding the appearance of the breast. The surgical treatment for this is Breast Reconstruction Surgery. This is a surgery that recreates the breast to give it back the natural contour and can be performed either right after Mastectomy or months or years later.
Image Source: Anna Tarazevich from Pexels
What are the various types of Breast Reconstruction Surgery?
Flap reconstruction - In this, the surgeon uses your body's tissue (usually from the back or abdomen) to recreate your breast.
Implant reconstruction - In this, the surgeon uses silicone or Saline implants to reconstruct your breast.
In this article, we are going to discuss the various options for Flap Reconstruction.
What is a Flap?
A Flap is a piece of healthy tissue removed from one side of the body (donor site) and is used to repair the wound (recipient site) somewhere else in your body. The Flap is usually still attached to the body by a major artery or a vein at its base.
What are the various types of Flap?
Local Flaps: From the name, you can guess that these kinds of flaps are made from tissue near the wound site.
Regional Flaps: These are made from the healthy tissues from the same region, for example, for the nose a nose wound, and a forehead flap might be used which also belong to the same region that is the face area.
Distant Flaps: These Flaps are usually not in the same region and are taken from a distant site.
They are further divided into:
1. Pedicle Flap:
They are attached to the Donor site by a major blood vessel.
Types of Pedicle Flap:
Advancement flap: The flap is directly moved from the Donor site without any lateral movement.
Rotational flap: The flap is rotated at a pivot point and placed next to the wound or recipient site.
Transposition flap: The flap is moved side-way to reach the recipient site
2. Interpolation flap: The flap forms a skin bridge. A part of a Flap is passed above or below intact tissue.
3. Free Flap: A Flap that is detached from the donor site and transplanted to the recipient site. The blood vessels are surgically reconnected to the vessels adjacent to that Wound site or Donor site.
Flaps in Breast Reconstruction Surgery
Image source: Pristine Cosmesis
1. DIEP Flap (Deep Inferior Epigastric artery Perforator Flap)
A type of free flap that is considered the best method for breast reconstruction surgery. The Donor site for such a flap is the abdominal wall below the bikini line.
An elliptical incision is taken over the lower abdomen and skin and fat is dissected. No muscles are cut in a DIEP Flap. The healthy tissue is cut from the site and then transplanted to the chest for breast reconstruction. The vessels are reconnected to the vessels at the recipient site using a microscope. As no muscles are cut, this kind of flap doesn't lead to the formation of any bulge at the donor site (Abdomen in this case).
Image source: Baylor College Of Medicine
2. SIEA Flap (Superficial inferior Epigastric artery Flap)
Similar to DIEP Flap, the only difference is the blood vessel. In this case, it is a superficial artery and might not be present in every patient.
3. TRAM Flap (Transverse Rectus Abdominis Myocutaneous Flap)
This is a type of Pedicle Flap. The donor site for such a flap is similar to a DIEP abdominal wall flap. Since it is a pedicle flap, it is connected to the donor site with a vessel at its base. In this case, it's the 'Superior Epigastric Artery' which supplies the wall of the abdominal wall and rectus abdominis muscle (Commonly known as the 6-pack muscle).
An elliptical incision is made over the lower abdomen and skin, fat along with most of the Rectus Abdominis Muscle is cut and moved to the breast. This surgery poses a risk of weakness in the lower abdominal wall leading to the form of a bulge.
4. FREE TRAM Flap
This is a Modified form of a TRAM FLAP in which the flap tissue is completely detached from the Donor site unlike the pedicle flap and then reattached with the vessels in the breast. It is similar to a DIEP Flap. The benefit of such a Flap is better vascularisation which prevents flap necrosis.
5. Latissimus Dorsi Flap
Latissimus Dorsi is a muscle of the upper back. The muscle is dissected along with fat, skin, and blood vessels. It is then moved anteriorly towards the chest to do breast reconstruction. It is also a type of Pedicle flap which is usually used along with an implant as the volume of tissue here is comparatively lesser than in the abdomen or tummy to provide a natural contour.
6. TDAP Flap (Thoraco-Dorsal Artery Perforator Flap)
This is also a pedicle flap from the upper back but in this, no muscle is cut. The Flap only takes the skin and fat. Such type of flap is used for breast reconstruction after lumpectomy or partial mastectomy where the volume of tissue loss at the wound site is less.
Image Source: Shri Chaitanyahospital
7. LAP FLAP (Lumbar Artery Perforator Flap)
It is a new procedure where a free flap is taken from the lower back (Love handle area). The skin and blood vessels are cut and moved to the chest for reconstruction.
8. GAP FLAP ( Gluteal Artery Perforator Flap)
This is a free flap and the donor site is the buttock. Only skin, fat, and blood vessels are cut without dissecting the muscles and used for breast reconstruction. This is performed usually in thin women or women who had previous abdominal surgeries and flaps cannot be taken from the abdominal wall.
Apart from these, thighs can also be used for breast reconstruction.
Disclaimer: Your surgeon will discuss with you the suitable Donor site and explain to you the procedure before the surgery.
References
American Society of Plastic Surgeons. Breast Reconstruction [Link]
Farhangkhoee H, Matros E, Disa J. Trends and concepts in post-mastectomy breast reconstruction. J SurgOncol. 2016;113(8):891–894 DOI: 10.1002/jso.24201 [PubMed]
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