FREE FLAP RECONSTRUCTION USING THE ABDOMINAL TISSUE
It is generally believed that breast reconstruction using the tissue from the abdomen can provide the most natural feeling and appearing reconstructed breasts. The scars are usually well hidden beneath underwear and often offer improvements to abdominal contour. These procedures, however, can take considerable operative time as well as recovery time. For these reasons, free flap breast reconstruction is not the ideal choice for every woman.
With the advancement of microsurgery, we have seen significant strides in breast reconstructive techniques using the abdomen. The procedures include moving the skin and fat of the abdomen to the chest and reconnecting the blood vessels that supply the tissue with blood. Techniques range from taking all of the muscle which supplies blood to the fat and skin (TRAM flap), some of the muscle (msTRAM flap) and none of the muscle (DIEP flap). Dr. Ellsworth is dedicated to providing the safest and most advanced technique that is appropriate for each woman, and he is a national leader in DIEP flap reconstruction. In your consultation, Dr. Ellsworth will discuss each option in depth.
The initial microsurgical procedure can take many hours. Hospital stays range from 2-4 days depending on speed of recovery and patient co-morbidities. Often the patient will need help with daily activities for 1-2 weeks post-operatively; however, many women recover more quickly. Drains will be removed in clinic during post-operative visits.
Patients should understand that breast reconstruction involves at least two surgeries. The first is the major procedure where the tissue is transferred to create the breast mound. In a second, out-patient procedure, revisions to achieve symmetry and nipple reconstruction are undertaken.
TISSUE EXPANDER / IMPLANT BASED BREAST RECONSTRUCTION
Tissue expander reconstruction is often the procedure of choice for patients that require a speedy recovery. Also, women often choose this procedure when they are not medical candidates for lengthy procedures or do not have appropriate donor site tissue for free flap transfer from the abdomen.
Generally, this is a two-staged procedure. In the first stage, after the mastectomy, a tissue expander (TE) is placed underneath the muscle of the chest wall. After a two week healing period, Dr. Ellsworth expands the TE with saline using a small needle during a clinic visit. The expansion phase continues for several weeks until the patient is pleased with the volume of the breast reconstruction. Often there are imperfections and irregularities at this stage that will be corrected with the placement of a more natural implant.
In the second stage (at least 4 weeks after the final expansion), Dr. Ellsworth will schedule you for an out-patient implant exchange, where the expander will be removed and a permanent implant placed. In clinic, Dr. Ellsworth will help you in your choice between saline or silicone implants; however both can be excellent options.
Occasionally patients with larger breasts undergoing mastectomy can accommodate immediate placement of permanent implants, without a tissue expansion phase. This is not a good option for smokers, diabetics or patients with multiple medical problems as outcomes are less ideal. In addition, patients who require radiation therapy are not ideal candidates for tissue expansion or implants as complication rates are excessively high.
NIPPLE RECONSTRUCTION AND FINAL TOUCHES
After reconstruction of either one or both breasts, Dr. Ellsworth will offer nipple reconstruction and tattooing to all patients as the final stage of reconstruction. Usually, these procedures are planned 3 months after the last surgical procedure and can often be completed in the office setting, avoiding anesthesia. Nipple guards are worn for two weeks and tattooing starts 6-8 weeks after nipple reconstruction. Usually tattooing takes approximately 2 treatments to achieve a deep pigment, and touch-ups are often needed.