Flap reconstruction uses your own tissues (skin, fat, muscle) to recreate breast volume, by moving them from another part of the body (back, stomach).This technique is also called autologous reconstruction.It is contraindicated in smokers (who have poorer tissue vascularization).Different types of flaps are used depending on the ...
Flap reconstruction uses your own tissues (skin, fat, muscle) to recreate breast volume, displacing them from another part of the body (back, stomach).
This technique is also known as autologous reconstruction.
It is contraindicated in women smokers (who have poorer tissue vascularization).
Different types of flap are used depending on the case: the flap of the large dorsal muscle, the flap of the large rectus abdominis muscle, or a flap of skin and fat taken from the abdomen known as DIEP (Deep Inferior Epigastric Perforator).
Advantages and disadvantages
ITS ADVANTAGES
The results of this technique are often aesthetically pleasing.
The shape and flexibility of the breast are more natural and less rigid than with a breast implant, since the breast is made up of the patient's own tissue.
ITS DRAWBACKS
The procedure is more complex and time-consuming than breast implant surgery.
It usually takes 12 to 18 months to achieve a satisfactory physical and psychological result.
Although it usually fades over time, a new scar is created where the flap is removed.
Reconstruction using a dorsalis major muscle flap
The latissimus dorsi is a slender, extended muscle in the back region.
In dorsalis major muscle flap reconstruction, the surgeon removes almost all of the muscle and the amount of skin required to reshape the removed breast.
This musculocutaneous flap remains connected to the axilla by the artery, nerve and vein of the axillary fossa, keeping it alive.
The surgeon introduces the flap through the armpit and slides it under the skin of the thorax to the breast to be reconstructed.
The surgeon adapts the amount of skin he removes to the amount of skin removed from the chest during non-conservative breast surgery (or mastectomy).
If the skin sheath is retained, the amount of skin brought back from the back will be less than if a larger area of skin had to be removed (particularly if radiotherapy had been performed).
When the volume of muscle transferred is insufficient in relation to the volume of the other breast, an implant is added to complete the reconstruction.
Reconstruction using a dorsalis major muscle flap ensures good-quality reconstruction.
Its main disadvantage is that it creates an additional scar on the back, with less muscle strength on the operated side.
The color and texture of the skin on the back may also vary from that of the skin in the breast area, creating differences in hue or appearance on the bust after reconstruction.
However, this technique is less restrictive and less time-consuming than reconstruction using a flap of the rectus abdominis muscle.
Reconstruction using the rectus abdominis muscle flap (streetcar)
This technique is often referred to as TRAM, which stands for Transverse Rectus Abdominis Myocutaneous flap.
The rectus abdominis muscle extends from the pubis to the thorax.
In rectus abdominis flap reconstruction, the surgeon removes a large area of skin (from above the pubis to above the navel) to which a piece of rectus muscle is attached, in order to reshape the breast removed during non-conservative breast surgery (or mastectomy).
The surgeon brings this musculocutaneous flap up towards the breast to be reconstructed, sliding it under the skin of the abdomen.
The surgeon always removes the same amount of skin to cover the fat he needs to create the volume of the breast to be reshaped.
He then adapts by removing epidermis (the most superficial layer of skin) if there is too much skin, or fat if the volume of the flap is greater than that of the breast to be reshaped.
The rectus abdominis flap is best suited to women with excess abdominal fat.
It allows the breast to be reconstructed without the use of a prosthesis.
It is, however, more restrictive and time-consuming than dorsalis major flap reconstruction.
Its major disadvantages are that it creates an additional scar in the abdomen and weakens the abdominal wall.
To consolidate this, a synthetic reinforcement (flexible mesh plate) is often used.
DIEP flap reconstruction
DIEP stands for Deep Inferior Epigastric artery Perforator flap.
DIEP reconstruction is a variant of rectus abdominis flap reconstruction.
With DIEP, only a skin and fat flap with an artery and a vein are removed from the lower abdomen, then slid under the abdominal skin to the breast to be reconstructed. The surgeon leaves the rectus abdominis muscle in place.
As the skin and fat removed in this way are no longer nourished by the muscle to which they were attached, the surgeon must connect their blood vessels to those of the thorax region to which they will now be attached.
This technique is designed for patients with excess abdominal fat.
However, it is not recommended for women who are severely overweight.
The advantage of this technique is that it allows you to recreate a large, natural-looking breast without affecting the muscles of the abdomen.
The disadvantage of this procedure is that it is time-consuming and complex, and requires the skills of a plastic surgeon experienced in microsurgery.
To find out more about this technique, visit the Association pour la reconstruction du sein par DIEP website: doctoroukachanadia.com
Postoperative complications
The main possible complications are :
- Infection; ;
- Hematoma; ;
- An accumulation of fluid (lymphorrhea) where tissue has been removed or replaced; ;
- Flap death due to lack of blood supply (necrosis). This risk is increased in cases of overweight or smoking. It is greater in the case of reconstruction by Dr Oukacha Nadia;
- An eventration in the case of reconstruction using the rectus abdominis flap; ;
- Complications specific to an internal prosthesis when used as part of a dorsalis major flap reconstruction.
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