There are many different ways that a plastic and reconstructive surgeon is able to reconstruct the breast after a mastectomy. Which breast reconstruction method you and your surgeon decide upon depends upon factors such as general health, history or radiation to the mastectomy site, smoking history, and prior operations. Below are some of the more common types of breast reconstruction:
- TRAM Flap Breast Reconstruction Methods:
- Pedicled TRAM flap
- Free TRAM flap
- Muscle sparing free TRAM flap
- DIEP Flap Reconstruction
- Implant Breast Reconstruction
- Tissue Expander/Breast Implant Reconstruction
Of the different types of patients we encounter in consultation, the breast reconstruction consultation is always the most dynamic. It takes place in our Newport Beach office with Board Certified, Plastic & Reconstructive Surgeon, Dr. Brian Dickinson. During the consultation we draw or place markings on the patient as we discuss different options.
When the breast has been removed for cancer and the remaining skin on the chest has been radiated, my preferred method of breast reconstruction is to use tissue from the lower abdomen. The DIEP flap allows the reconstructive surgeon the opportunity to utilize the skin and fat from the lower abdomen while attempting to spare muscle. The end results is that the mastectomy defect can be reconstructed and the patient can have the lower abdomen contoured.
Operations such as these are variations of a TRAM flap breast reconstruction. TRAM stands for Transverse Rectus Abdominus Myocutaneous flap. The blood supply to the skin and fat on the lower abdomen is derived from blood vessels that traverse through the muscles of the abdomen.
The skin and fat of the lower abdomen can be transferred to the site of your mastectomy. This can be done with a TRAM flap where the skin, fat, and muscle remains connected to an original blood supply. There are varying degrees of modification of the donor site in breast reconstruction. The DIEP flap is a variation where muscle is spared from the lower abdomen with the intent of transferring only the skin and fat from the lower abdomen and minimizing the donor site.
This type of DIEP flap breast reconstruction procedure can be performed in Newport Beach.
With patients who previously had abdominal operations, I find the CT-angiogram to be extremely helpful in determining the integrity of vessels as well as in determining which flap may be an appropriate option for the patient such as TRAM, TRAM flap with pre-delay procedure, free TRAM, DIEP, or SIEA.
For any additional questions and answers, you may visit dickinsonbreastreconstruction.blogspot.com.
The CT-angiogram allows the operative surgeon to have a road map for vessel selection, may facilitate orientation of the flap for breast reconstruction, as well as facilitate positioning of the scar on the abdominal wall for flap harvest.
My friend is a very athletic woman and she mentioned she had a special type of TRAM flap called a DIEP flap where she had some of her muscle preserved. Can I have this done?
Autologous reconstruction, such as DIEP flaps, are a great alternative to implant-based reconstruction if the patient has enough tissue on their abdomen to donate to one or both reconstructed breasts. In patients who have had repeated infections or capsular contracture with implants, DIEP flaps represent a great method for reconstruction.
The DIEP flap procedure involves sparing the rectus abdominus muscle. Not everyone is a candidate for different types of TRAM flap breast reconstructive procedures. Your candidacy will depend on your individual situation and general health.
DIEP flap and TRAM flap breast reconstruction procedures are performed in the hospital and require an inpatient stay. We discuss all of your surgical options at the time of your consultation.