Microsurgical Breast Reconstruction
Microsurgical Hand and Upper Limb Reconstruction
Microsugical Lower Limb Reconstruction
Craniofacial Surgery
Other Microsurgical Procedures
Surgial Foundation
Contact
Our dedicated team
Surgical Foundation
Educational Resources for Residents
 
Your Privacy Policy


Sociedad Española de Cirugía Plástica, Estética y Reparadora



Asociación Americana de Cirujanos Plásticos



Asociación Americana de Cirujanos de la Mano

 


Microsurgical Breast Reconstruction :

 

[ Home   I Contact ]


Case 1
Case 2
Case 3
Reconstruccion Mamaria DIEP
DIEP
Reconstruccion Mamaria DIEP
DIEP

Reconstruccion Mamaria LAT+Protesis

Latissimus Dorsi
+ Prótesis


  1. What is autogenous breast reconstruction?

  2. What are the benefits of autogenous reconstruction versus implant reconstruction?

  3. Are there any benefits of implant reconstruction over autogenous?

  4. What is a DIEP flap?

  5. How does it differ from the TRAM flap?

  6. What is the success rate of the DIEP flap?

  7. Can I be reconstructed at the same time as my mastectomy?

  8. How long after chemotherapy or radiation therapy do I need to wait before reconstruction?

  9. Why don't more surgeons perform the DIEP flap procedure?

  10. Will my insurance cover DIEP flap reconstruction?

............................................................................................................................

1) What is autogenous breast reconstruction?

Autogenous breast reconstruction is the use of your own body's tissue to reconstruct the breast. This includes the TRAM (transverse rectus abdominus myocutaneous flap), gluteal flap (gluteus maximus myocutaneous flap), latissimus dorsi flap, DIEP (deep inferior epigastric perforator flap), SIEA (superficial inferior epigastric artery flap) and GAP (gluteal artery perforator flap) techniques.

............................................................................................................................

2) What are the benefits of autogenous reconstruction versus implant reconstruction?

Since autogenous reconstruction uses your own body's tissue to reconstruct the breast, the tissue is there for life. You cannot reject it. It will change in volume as your normal weight fluctuations occur throughout life and often tends to improve in shape over time. The breast is reconstructed with fat, which is similar in density to breast tissue, thus the "feel" is similar to that of a normal breast.

Implant reconstructions tend to require multiple operations prior to achieving the final result. These could include sequential expansion of breast skin, repositioning of the implant, correction of infra-mammary fold distortion, correction of shape deformity, correction of implant extrusion, correction of implant leakage, correction of capsular contracture, removal of implant because of infection, replacement of temporary implant or expander with permanent implant. If a patient has had radiation or is planning to have radiation, implant reconstruction is discouraged because of the unacceptably high complication rate. The implants often require replacement. Implant manufacturers do not consider them "lifetime devices". Their life expectancy is <10 years per manufacturer documentation. The occurrence of capsular contracture is often a concern with implant reconstructions. It is the result of your body's recognition of the implant as a foreign material. A capsule of scar is layed down around the prosthesis to cut as a barrier to contact with the body. The capsules vary in thickness and can sometimes calcify and become hard. As a result implant reconstructions tend to be more firm than a normal breast, thus feeling more artificial and remaining somewhat immobile to normal activity.

............................................................................................................................

3) Are there any benefits of implant reconstruction over autogenous?

Implant reconstructions are typically shorter operations (1-2 hours) and do not prolong hospitalisation. Autogenous reconstruction, specifically perforator flap reconstruction, typically takes 4-5 hours for a single reconstruction and 5-7 hours for a bilateral breast reconstruction. The hospital stay is 3-4 days for perforator flap reconstruction and may be slightly longer with TRAM flap procedures. Implant reconstructions also do not require a donor site and recovery is therefore usually shorter.

............................................................................................................................

4) What is a DIEP flap?

DIEP stands for Deep Inferior Epigastric Perforator. This is the named vessel for which the tissue to be transferred is based. "Flap" is a plastic surgery term referring to the tissue which is to be transferred.

The deep inferior epigastric vessels arise from the external iliac vessels (the external iliac vessels become the femoral vessels in the leg). The deep inferior epigastric vessels course beneath the rectus abdominus (the major abdominal "six pack" muscle) on each side. These vessels send off branches to the muscle as well as through the muscle into the overlying fat. These perforating branches are those which are identified, preserved and transferred with the overlying tummy fat to reconstruct the breast.

............................................................................................................................

5) How does it differ from the TRAM flap?

The TRAM and gluteal flaps take the underlying muscles with the skin and fat for the breast reconstruction. This can lengthen recovery and and in the case of the TRAM flap may increase your risk for hernia or abdominal "bulge". Taking the gluteal musculature may result in some weakness in the buttocks.

............................................................................................................................

6) What is the success rate of the DIEP flap?

Surgeons who perform the operations routinely may have success rate exceeding 99%. The success rate equals that of the TRAM and gluteal flaps depending on the surgical team.



............................................................................................................................

7) Can I be reconstructed at the same time as my mastectomy?

Yes. This is referred to as "immediate reconstruction". Some of the best aesthetic results are accomplished when the reconstructions are performed at the time of mastectomy in conjunction with a skin-sparing mastectomy. The total surgical time is unchanged because the breast surgeon and the reconstructive surgeons work together at the same time.

............................................................................................................................

8) How long after chemotherapy or radiation therapy do I need to wait before reconstruction?

You shoud wait 3-6 months following chemotherapy. This allows your body time to recover from the chemotherapy before stressing it with an operation. You shoud wait 6 months or more following radiation therapy. This allows your chest skin to recover from the effects of radiation before your reconstruction.

............................................................................................................................

9) Why don't more surgeons perform the DIEP flap procedure?

Most plastic surgeons do not perform perforator flap breast reconstruction due to its complexity. It is technically very difficult and time consuming. Best success rates and efficiency are afforded when performed by a team of microsurgeons. There are very few microsurgical breast reconstruction teams committed to such an endeavor.

............................................................................................................................

10) Will my insurance cover DIEP flap reconstruction?

Conditions may vary from country to country. However, if your insurance covers mastectomy, they must by law cover the reconstruction method of your choice. If you do not have a surgeon in your community who performs the type of reconstruction you are seeking, your insurer will often pay for surgery in another city or country if required.


Go Up


.............................................................................................................................

 
Microsurgical Hand and Upper Limb Reconstruction

Amputations

Thumb Reconstruction

Injury Secuelae

Braquial Plexus

Nerve Microsurgery

Wrist and Elbow Arthroscopy

Carpal Tunnel and Dupuytren Disease

Hand and Wrist Pain

Congenital Hand

Rheumatoid Hand

Spastic Hand

 

Acute Injury

Injury Secuelae

Diabetic Foot

Tibial Fracture

Chronic Osteomyelitis

Complex Wounds

DIEP/TRAM

Latissimus Dorsi

Breast Implants

 

Craniosynostosis

Injury Secuelae

Hypertelorism

Orbital Surgery

Facial Palsy

Facial Microsomia

Facial Atrophy (Romberg)

Down Syndrome

Ear, Nose, Eyelid and Scalp Reconstruction

Facial Cleft

Head & Neck Surgery

Burns

Lymphaedema

Abdominal Wall Reconstruction

Genital Malformation

Sex Reassignment

Vasectomy Reconstruction

 


Clínica Cavadas
Paseo de Facultades 4, bajo
46021 Valencia
Telf: +34 963628861
Fax: +34 963628870
Emergencias: +34 667246394
email pacientes: [email protected]
---
                                  

© Pedro Cavadas - Luis Landín, 2004 - 2007