The reasons women choose to have restorative breast procedures are well stated in these quotes …

“I need to feel whole again,” –  “You have given me back what cancer took away,” – “The reconstruction of my breasts made me feel restored…not reconstructed,”  –  “I want to look as good as I feel,”  –  “I want to look and feel sexy again…and want my husband to see me as sexy.” 

These are but a few of many thousands of thoughts from women who wanted to fully recover from their breast cancer…with a whole body.

Today, I review Flap Procedures (Stage II Breast Reconstruction/Restoration).  There are a variety of Flap Procedures used to restore breasts…not every type is right for every woman, but we determine this after careful and thorough evaluation of your needs and goals.  I tailor each flap procedure to achieve beautiful natural looking breasts. There are four muscle flap techniques as follows:

1) Latissimus Dorsi Flap uses a flap of skin and muscle from the back on the same side as the operated breast.  This is transferred forward to form a breast mound that will look and feel natural since it is your own living tissue.

2) TRAM Flap is the most common form of living tissue  breast restorative techniques used today.  It creates a natural looking, soft, warm breast.  TRAM Flap involves either free flap or pedicled flap techniques.  Pedicled flap means the tissue remains attached to its blood supply.  TRAM Flap procedures employ skin, fat and muscle removed from the lower abdomen and transferred to the chest.

3) DIEP Flap reconstruction employs excess skin and fat from the lower abdominal area, through an incision similar to that used for Tummy Tucks. This is a “perforator flap” technique that is muscle sparing…meaning no muscle function is sacrificed, but warm living tissue is used instead.

4) Gracilis Flap harvests excess skin and fat from the inner thigh to restore natural looking, soft, warm breasts.  This may be a TUT Flap (without muscle) which is referred to as a Transverse Upper Thigh Flap. When a small amount of muscle is required…a TUG Flap is employed.  Either flap can be harvested so the donor scar is discretely hidden inside the upper thigh.

This is a brief overview of the 4 Flap techniques used for restorative breast reconstructions.  Each of them has it’s own virtues… and all offer beautiful, natural looking and feeling breasts.  I have guided many women through making the right choices so as to ensure optimum results.

GOALS of RESTORATIVE BREAST PROCEDURES

Goals are critical to good outcomes.  You must have yours…here are mine: “all cosmetic surgery should be functional & all reconstructive surgery should be aesthetic & look as natural as possible.”  

ADVICE TO MY PATIENTS

Always ask me questions; ask to see pictures of my patients, gather information and consults with trusted mentors, make your decision.   There are NO wrong decisions. Choose a qualified, Board Certified surgeon with specialized training and expertise in reconstructive surgeries.

Next blog will cover Implant Breast Restoration.

Dr. Steven Davison

“At DAVinci…we combine the supreme elements of art & surgical science.”

STAGE I – Mastectomy & Expander

Breast Reconstruction usually occurs as a two-stage procedure – starting with the placement of a breast tissue expander – which is replaced several months later with a breast implant. Dr. Davison will place the tissue expander under the same anesthesia as your mastectomy surgery if possible. This is called immediate reconstruction since the process is started at the time of your mastectomy.  You may choose to “delay” the start of reconstruction and wait for a few weeks or months.  This is called delayed breast reconstruction.

Here are the steps involved in mastectomy with expanders:

1.  During the mastectomy your breast surgeon removes skin and breast tissue – leaving the chest tissue flat and tight.  An expander (balloon type expandable device) is put into place under the chest muscle and skin – to serve as a space saver – into which a breast implant is later placed.  The expander is gradually filled with saline solution – over several weeks – and slowly stretches the remaining chest skin and muscle to allow for the future breast implant.
2.  Expander surgery is performed under general anesthesia in an operating room. Often a Biologic tissue barrier is used to create an inner Bra to cradle the expander.
3.  The incision used to perform your mastectomy is used for the expander placement
4.  After placement – the incision is closed
5.  Drains are left in place – and are removed when only 30cc fluid comes up
6.  Healing takes 4-6 months – the surgery takes several hours and is done under one anesthesia.  If delayed expander placement is done – surgery takes 1-2 hours.
7.  Breast implant is placed when Dr. Davison determines the space is sufficient and the expander is removed.  The same incision is used to do implant placement.
8.  A nipple and areola is created typically 3 months later – with additional beautification for both breasts.
9.  Dr. Davison becomes your primary care physician over the next year during this entire process.