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At Plastic Surgery Associates of Tidewater, we specialize in breast reconstruction using the latest methods in plastic surgery. Using a woman’s own tissue we can create a new breast that closely matches a natural breast. Tissue can be used from the lower abdomen (DIEP flap – Deep Inferior Epigastric Perforator flap) or the buttock area (GAP flap – Gluteal Artery Perforator flap). These methods are similar to traditional procedures such as the TRAM, but no muscle is used for the reconstruction. By not disturbing the underlying muscle we can create a natural breast and avoid many of the complications associated with traditional breast reconstruction.

MAKING THE DECISION

Breast reconstruction is an important part of the treatment of breast cancer. When the diagnosis of breast cancer is made a woman is faced with numerous decisions. This is a difficult time. With the guidance of the breast surgeon and oncologist plans are made for a mastectomy. It is at this time the plastic surgeon is involved and the decision for immediate or delayed reconstruction is made. 

A woman may elect to have her breast reconstruction performed during the same surgery as her mastectomy. There are many advantages to this. After the surgery the patient does not experience a loss of part of her body. She awakes feeling whole. This also reduces the total number of surgeries and hospitalizations necessary to complete the reconstruction.

Immediate reconstruction may not be best for all patients. You may decide to have reconstruction after all therapy is completed or years later. Breast reconstruction is a personal decision and it should be the right time for you.

The Deep Inferior Epigastric Perforator Flap (DIEP)

The lower abdomen has been a preferred donor site for breast reconstruction for many years. This area of the woman’s body provides skin and fatty tissue that is similar to breast tissue. Traditionally, transferring the lower abdominal tissue to the chest involved bringing a portion or all of the rectus abdominis muscle with the skin and fatty tissue. This technique is called a TRAM flap. Although this allowed reconstruction of a natural looking breast, unfortunately many women had complications. These included weakness in the abdomen (making it difficult to sit form a laying down position) and abdominal hernias.

New advances in plastic surgery provide the benefits of reconstructing a breast with a woman’s own tissue without sacrificing the rectus muscle. This technique, called the DIEP flap, uses the same blood supply (the deep inferior epigastric vessels) but does not require transfer of the rectus muscle. 

The DIEP Flap Procedure

The lower abdominal tissue is transferred, based on its own blood supply, to create a new breast. By sparing the muscle we are able to decrease the pain after surgery. This lets the patient return to normal life quicker. It also lessens the chances of developing a hernia or a bulge in the abdomen, a complication that has been associated with the TRAM flap.

Illustration depicting the donor area (the lower abdomen) and the blood vessels that supply the flap. The rectus muscle is shown as the vessels travel through the muscle. The muscle is not removed in this surgery. The middle figure shows the flap anastomosed (microsurgically attached) to the internal mammary vessels (the chest wall vessels that will nourish the flap). At a later stage the new nipple and areola are created completing the reconstruction.

The Gluteal Artery Perforator Flap (GAP)

The gluteal area (buttock) provides tissue for reconstruction when the lower abdomen is unavailable. Using the concept of no muscle sacrifice, only the skin and fat are used for reconstruction. The gluteus muscle extends and rotates the thigh laterally, an important function when running and jumping. This flap may be used in athletes who often have insufficient lower abdominal tissue for reconstruction. The resultant scar is well hidden in bathing suits and undergarments.

Illustration above represents a flap taken from the buttock and used to reconstruct the right breast. The recipient vessels are the same as for the DIEP flap.

For a complimentary consultation to learn how Dr. Billet or Dr. Guarda can help with your needs click here

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phone 757.673.6000

Plastic Surgery Associates of Tidewater, Inc.