Breast reconstruction is elective surgery that involves recreating a breast which has been removed in part (lumpectomy) or in its entirety (mastectomy), usually secondary to treatment of cancer or prophylactic removal of the breast for patients who are at high risk of developing breast cancer. There are many types of breast reconstruction, but today we’re talking about microsurgical breast reconstruction.
What is microsurgical breast reconstruction?
Microsurgical breast reconstruction is a state of the art technique used to restore the appearance of a patient’s breasts after mastectomy. This very specialized, complex type of procedure involves the use of excess skin and fat (flaps) harvested from other areas of the body including the abdomen, buttocks, and inner thighs to reconstruct the breast. Once these tissues are removed from their location on the body and transferred to the breast, a microscope is used to join the blood vessels from these tissues to the breast reconstruction site. These tissues are then shaped to look like a breast.
What are the benefits of microsurgical breast reconstruction?
Microsurgical breast reconstruction provides outcomes that are both enduring and aesthetically pleasing. Additionally, using your own tissue can result in a more natural feeling and appearing breast, and in the case where the reconstruction of only one breast is required, can be more easily matched to your contralateral ‘normal’ breast. Since this is your own tissue, it will age and change with the rest of your body, often with less need for revisionary surgery in the future.
Who is a good candidate for microsurgical breast reconstruction?
An in-depth consultation with your surgeon at FORM Face + Body will determine whether you are a good candidate for microsurgical breast reconstruction. Many factors will come into play, including your health, medical history, oncologic factors, and availability of donor tissues, as well as breast size, body shape, lifestyle habits, fears and goals.
How is the donor tissue area selected?
Common donor tissue areas used in microsurgical breast reconstruction include the abdomen (DIEP or SIEA flap procedure), and following that, second line options include the inner thighs (PAP or TUG flap procedure). Your surgeon will select the appropriate area based on several factors including your individual anatomy and surgical goals. Here is an overview of the options available at FORM Face + Body:
DIEP Flap
At FORM Face + Body, we most commonly perform the deep inferior epigastric perforator (DIEP) flap procedure. This procedure involves removing tissue from the lower abdomen and transferring it to the chest for the purpose of reconstructing new breasts. Microsurgical techniques are used to disconnect abdominal skin and fat from its blood supply, and reconnect it to a new blood supply in the breast area for reconstruction.
PAP Flap
PAP stands for Profunda Artery Perforator, a blood vessel that runs through the upper thigh. The PAP flap procedure uses excess skin and fat from the inner thigh/lower buttock area. PAP flap reconstruction may be recommended for patients who don’t have enough abdominal tissue, who have had previous abdominal surgeries, or who have undergone previous reconstruction using abdominal tissue.
TUG Flap
The transverse upper gracilis flap procedure uses a flap of skin, fat, muscle, and blood vessels from your gracilis muscle—located in the upper inner thigh—to reconstruct the breast. Once the flap is moved up to the breast, the surgeon carefully reattaches the blood vessels of the TUG flap to the blood vessels in the chest. This may be an option for patients with excess tissue in this area, and small to medium-sized breasts.
What is recovery like?
Recovery from microsurgical breast reconstruction varies between patients and depends on the chosen donor sites. In general, you can expect a 3-4 day hospital stay to allow for close monitoring, and a return to normal activities by 6-8 weeks following your surgery. Your recovery will be gradual from day one after surgery and your surgeon will guide you through this process.
You will have bandages that will remain in place until your first follow-up visit. Intravenous pain medication will be administered throughout your stay in hospital, and you will be given oral pain medications and antibiotics for your initial recovery at home. You will also likely have drains that can be removed at home by a home care nurse or during one of your follow up visits.
If you’re interested in learning more about microsurgical breast reconstruction, our surgeons Dr. Somogyi and Dr. Jalil have extensive experience and would be happy to walk you through the decisions to be made—don’t hesitate to book a consultation.
