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Plastic Surgery
> Breast
Breast
Reconstruction Before
and After Photos
Breast
Reconstruction
Reconstruction of a breast that has been removed due to cancer or other disease is one of the most rewarding surgical procedures available today. New medical techniques and devices have made it possible for surgeons to create a breast that can come close in form and appearance to matching a natural breast. Frequently, reconstruction is possible immediately following breast removal (mastectomy), so the patient wakes up with a breast mound already in place, having been spared the experience of seeing herself with no breast at all.
With the Deep Inferior Epigastric Perforator no muscle is removed. The perforating vessels with the overlying flesh are removed and the muscle is left in place. Patients recover quickly with usually only a three-day hospital stay. The abdominal scar is placed low on the abdomen because no muscle is removed. The perforator blood vessel dissection increases operating time but the body tolerates superficial surgery well.
There are very few surgeons who are capable of performing this reconstruction and Dr. Snyder is proud to be one of the pioneers in this new technique.
Candidates for breast reconstruction
in Austin, Texas
Most mastectomy patients are medically appropriate for reconstruction, many at the same time that the breast is removed. The best candidates, however, are women whose cancer, as far as can be determined, seems to have been eliminated by mastectomy.
SURGICAL TECHNIQUES
Recent advances in surgical techniques have made it possible to reconstruct a breast mound using only the excess skin and fat from the lower belly, without needing to cut any of the important abdominal muscles. The Deep Inferior Epigastric Perforator (DIEP) flap allows for a natural breast reconstruction using your own tissues, without the need for implants and without the need to cut your rectus muscle. And because the abdominal muscles are not sacrificed as they are in a TRAM flap, the post-operative pain is less and the recovery time is quicker.
The Deep Inferior Epigastric Perforator (DIEP)
Because the DIEP is a more complex operation, extra operative time is required. However, the recovery time and amount of post-op pain are reduced, leading to shorter hospital stays and quicker return to activities and work. There are very few surgeons who are capable of performing this reconstruction and Dr. Snyder is proud to be one of the pioneers in this new technique. Perforator flaps represent the state of the art in breast reconstruction. Replacing the skin and soft tissue removed at mastectomy with soft, warm, living tissue is accomplished by borrowing skin and fatty tissue from the abdomen.
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Superficial Inferior Epigastric Artery Flap (The SIEA flap)
The main difference between the SIEA flap and the DIEP flap is the artery used to supply blood flow to the new breast. The SIEA blood vessels are found in the fatty tissue just below skin whereas the DIEP blood vessels run below and within the abdominal muscle (making the surgery more technically challenging). While the surgical preparation is slightly different, both procedures spare the abdominal muscle and only use the patient's skin and fat to reconstruct the breast.
Though the SIEA is similar to the DIEP, it is used less frequently since the arteries required are generally too small to sustain the flap in most patients. Less than 20% of patients have the anatomy required to allow this procedure. Unfortunately, there are no reliable pre-operative tests to show which patients have the appropriate anatomy. The decision as to which type of reconstruction to perform is therefore made intra-operatively by the plastic surgeon based on the patient's anatomy.
Gluteal Artery Perforator Flap (The GAP flap)
The gluteal artery perforator flap (GAP) flap is another sophisticated perforator flap that utilizes the skin and fat from the upper portion of the buttock. Again, no muscle is utilized. For women who lack sufficient flesh for the DIEP flap reconstruction this is a very good alternative. Additionally, we have utilized the GAP flap in situations where the abdominal flap (either TRAM flap or DIEP flap) has already been utilized, or scars on the abdomen preclude its use for breast reconstruction. The breast reconstructed with the GAP flap is soft, natural, and with very little droop or ptosis. The buttock is left slightly flatter, but there is no great depression where the flesh has been removed. This can be improved if necessary with liposuction of the opposite buttock. Most women need a relatively small amount of buttock removed to make a moderate sized breast. Because the flesh utilized is from the upper buttock, sitting is not interfered with. Recovery times are slightly shorter than with the DIEP flap.
Inner Thigh Flap Microsurgical Breast Reconstruction (The TUG or TMG Flap)
Other tissue reconstruction options are available to patients that have had previous abdominoplasty (tummy tuck surgery) or other surgical procedures that preclude the use of abdominal tissue for breast reconstruction. In addition, very thin or athletic patients may not have enough abdominal subcutaneous fat to be a candidate for SIEA or DIEP breast reconstruction. In many of these patients, the Inner Thigh Flap can be used to reconstruct small and medium breasts. Skin from the inner thigh along with the underlying gracilis muscle is used to provide a well vascularized and shapely reconstruction. Unlike loss of the rectus muscle, loss of the gracilis muscle does not result in any significant increase in hernias or functional loss in the legs. Although the Inner Thigh Flap is not performed widely in the United States, we believe this reconstruction is an excellent choice for many patients and provides some of the best aesthetic results we have seen. The unique shape of the tissue removed from the inner thigh allows shaping of a breast with an almost ideal contour and projection. And, this flap uniquely provides the potential for immediate nipple areola reconstruction, without tattooing in some cases.
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