Reconstructive Breast Surgery
- DIEP Flap
- Candidates for DIEP Flap Breast Reconstruction
- The DIEP Flap Procedure
- SIEA, SGAP & TUG Flap
- SGAP Flap Surgery
- TUG Flap Surgery
- TRAM FLAP
- Candidates for TRAM Flap Breast Reconstruction
- TRAM Flap Breast Reconstruction Procedure
- Pedicle Flap
- Free Flap
- Latissimus Dorsi Flap
- Latissimus Dorsi Flap Procedure
- Tissue Expansion
- Implant Reconstruction with Tissue Expansion
- Implant Reconstruction
AAMC’s Oncoplastic and Breast Microvascular Reconstruction Surgery Program is focused on helping women rebuild the breasts after mastectomy or injury. Part of our mission is to help women by offering the latest, most advanced techniques in the field of breast reconstruction, such as those listed above, performed by some of the most experienced plastic and reconstructive surgeons in the area. Oncoplastic surgery is designed to maximize aesthetic outcome by performing tumor removal and plastic surgery during the same operation. Breast surgeons and plastic surgeons are now working together to use cosmetic-style incisions during the combined oncoplastic procedure to remove tumors and perform breast reconstruction surgery consecutively.
Our doctors are specialty-trained in breast reconstruction surgery. Our surgeons are experienced in some of the most complex areas of breast reconstruction, including microsurgery. We offer skilled, compassionate care from a group of medical professionals who remain dedicated to repairing the emotional and physical pain that accompanies losing one or both breasts.
Our entire team is here to help each patient through this trying process, and ensure they receive the best care possible, which is why one of our main goals is to work with our patients from the initial stages of education to the final stage of recovery. Through the formation of a collective partnership, our surgeons and patients will create the treatment option that best fits their needs, which will be further enhanced by the collaborative approach we strive for with all other specialists involved, including oncologists, radiologists, breast surgeons, and primary care physicians. Our entire team of doctors, nurses, and support staff are committed to helping every patient through the next step in the recovery process by supporting their emotional, mental, and physical well-being.
At the initial consultation, one of our plastic surgeons will go over all available breast reconstruction options and answer any questions or concerns.
DIEP Flap
The DIEP Flap is one of the most innovative breast reconstruction techniques. This procedure requires the expertise of an experienced and highly trained plastic surgeon. The Deep Inferior Epigastric Perforator Flap procedure (DIEP Flap) is designed to take tissue from the abdomen to form a new breast mound. This microsurgical breast reconstruction technique allows patients to rebuild a natural-looking breast after mastectomy, while simultaneously undergoing a procedure akin to a tummy tuck. What distinguishes DIEP Flap breast reconstruction from other procedures, such as TRAM Flap surgery, is that DIEP Flap surgery keeps the abdominal muscles in place using microsurgical techniques to attach blood vessels in the transplanted skin to those in the chest area. Sparing the abdominal wall musculature may reduce abdominal problems associated with the more traditional techniques.
Our breast reconstruction surgeons are some of the most experienced and well-trained in the region, many of whom have attained extended fellowship training in microsurgery and breast reconstruction from prestigious medical institutions. Please contact us to schedule a consultation for DIEP Flap breast reconstruction surgery at Anne Arundel Medical Center.
Candidates for DIEP Flap Breast Reconstruction
Candidates for DIEP Flap Breast Reconstruction include:- Patients who have a sufficient amount of tissue in the lower abdomen to create the new breast or breasts
- Patients who are very physically active and wish to preserve their abdominal muscles
- Patients who have had previous radiation therapy
- Patients who have had a previous implant reconstruction procedure with unsatisfactory results.
During the initial consultation with our plastic and reconstructive surgeons, we will cover the many breast reconstruction options available. Our surgeons work with each patient, in addition to their oncologists, radiologists, and breast surgeons to form a collaborative partnership designed to give them the best possible care. Together, we rebuild our patients’ physical, mental, and emotional well-being, whether the breast reconstruction is performed in conjunction with a mastectomy or after recovery, by creating a treatment plan based entirely on the best interests of the patient.
The DIEP Flap Procedure
The DIEP Flap procedure is a complex technique that very few reconstructive surgeons are trained to perform. Here at AAMC, our reconstructive surgeons are part of a small group of doctors in the country who have the experience, skills, and track record necessary to perform this procedure.
The DIEP Flap procedure is a technique that completely removes tissue from the abdomen and relocates it to form a new breast mound. That tissue is microsurgically connected to a new blood supply in the area where the breast will be rebuilt. Typically, the donor tissue will be connected to blood vessels near the sternum or in the armpit region. The abdomen is closed leaving an incision similar to that of a tummy tuck.
One of the chief advantages of this procedure is that fat and skin can be removed from the abdomen without having to use any of the underlying muscle. The blood supply to the new breast will be directed through perforator vessels that are taken from the rectus abdominis muscle (one of two such muscles that make up the abdominal wall), but the muscle itself will not be removed. This technique is known to be more complex than other breast reconstruction procedures; however, since the abdominal muscle is not being utilized in the tissue transfer, there is thought to be a lower risk of developing abdominal wall weakness or hernias than with the free or pedicled TRAM techniques.
DIEP Flap breast reconstruction typically takes anywhere from six to eight hours to complete, and is performed under general anesthesia.
SIEA, SGAP & TUG Flap
The SGAP, SIEA, and TUG Flap procedures are all effective avenues of treatment for women in need of breast reconstruction following a mastectomy or injury. The SGAP (superior gluteal artery perforator) procedure is designed to take tissue from the buttock region to form the new breast mound, and requires significant microsurgical experience from board-certified reconstruction surgeons. The SIEA (superficial inferior epigastric artery) flap breast reconstruction procedure is very similar to the DIEP flap procedure, as it involves the same area of skin in the abdominal region that the tummy tuck procedure is designed to remove and tighten; however, in the SIEA flap procedure, the surgeons use the blood vessels in the fatty abdominal tissue, instead of tunneling the blood vessels within the muscle as the DIEP flap procedure employs. The TUG (transverse upper gracilis) flap procedure is designed for patients that may not have enough skin and tissue in the abdominal or buttock region to create a successful breast mound. Instead, the TUG flap procedure involves a process similar to the SGAP or SIEA flap procedures, but uses skin from the patient’s inner thigh to create the breast mound. Each of these breast reconstruction procedures serve as good alternatives for women who may not be candidates for other techniques such as implant reconstruction.
SGAP Flap Surgery
SGAP (Superior Gluteal Artery Perforator) Flap reconstruction surgery involves taking skin and tissue from the top of the buttock and relocating it to the breast area, which is beneficial for patients who do not have enough tissue in the abdominal region to provide donor skin for the breast reconstruction procedure. One of our reconstructive surgeons will microsurgically reconnect the artery and vein from the donor tissue to its new placement on the chest, which establishes a new blood supply to the donor tissue, and allows the surgeon to then reshape and mold the skin and tissue to form the breast mound.
A secondary benefit of the SGAP Flap surgery is that in addition to breast reconstruction, the process of taking donor skin from the buttocks results in a buttock lift. In addition, this procedure does not utilize muscle in the relocation of tissue, which can provide a more comfortable recovery after surgery.
SIEA Flap Surgery
Similar to a DIEP Flap surgery, SIEA Flap breast reconstruction takes donor tissue from the abdominal region to form the new breast. Skin and fat from the abdomen is moved to the breast area, with blood vessels microsurgically reattached to create a new blood supply to the reconstructed breast. After this is achieved, the donor skin will be reshaped to form the new breast.
As with a DIEP Flap procedure, the SIEA Flap technique also results in a form of tummy tuck. The remaining skin from the donor site in the abdomen will be lifted and tightened for a more toned appearance. A main difference from the DIEP flap procedure is that the blood vessels in the fatty tissue are used in the SIEA procedure, as opposed to the DIEP procedure, which tunnels the blood vessels below and within the abdominal muscles.
Similar to the SGAP Flap surgery, an advantage of the SIEA Flap breast reconstruction procedure is that the surgeons can avoid removing muscle from the abdomen, which typically results in less pain during recovery, and a decreased risk of developing hernias.
TUG Flap Surgery
The TUG flap procedure can be an effective option for patients who have had a previous tummy tuck or buttock lift, or for patients who are very thin and/or athletic, and simply do not have enough skin and fat to accommodate the SGAP or SIEA flap procedures. The TUG flap procedure, also known as an inner thigh breast reconstruction procedure, takes skin and muscle from the inner thigh and transfers it to the chest to create a new breast mound. The shape and composition of the donor tissue allows for very effective natural-looking results, as it creates a greater potential for fat sculpting when compared with the DIEP, SGAP, or SIEA flap procedures.
Although TUG Flap surgery utilizes muscle from the thigh, there is not a significantly increased risk of developing hernias as with procedures that utilize a portion of the abdominal muscles, and typically provides patients with results similar to a thigh lift.
TRAM FLAP
The TRAM flap is one of the most common techniques utilized for reconstruction of the breast after mastectomy. This procedure involves the creation of a new breast mound using skin and tissue taken from the abdominal region and has proven to be very effective in many patients who have been affected by breast cancer. The results of TRAM Flap breast reconstructions are known to look very natural, and the procedure is a time tested technique with proven efficacy.
Our doctors are experienced with every breast reconstruction technique in use today, and a number of our surgeons have attained fellowship training in breast reconstruction at prestigious medical institutions. At AAMC, we forge collaborative partnerships with breast surgeons, oncologists, radiologists, and other medical professionals involved in each patient’s treatment to provide the best possible care and ensure the most successful, natural-looking breast reconstruction results.
Candidates for TRAM Flap Breast Reconstruction
Candidates for TRAM Flap breast reconstruction surgery include:
- Patients who have an adequate amount of tissue in the lower abdomen to provide donor skin for the new breast
- Patients who have had radiation therapy targeted in the chest wall
- Patients who have not undergone previous abdominal surgery that resulted in large scars across the upper abdominal area
During the initial consultation, our plastic surgeons will discuss a variety of breast reconstruction options, and together, in the pursuit of enhancing the collaborative approach to the entire breast reconstruction treatment plan, will both decide on the procedure that will lead to the best results.
The thing to remember is that our entire team – including plastic and reconstructive surgeons, physicians’ assistants, registered nurses, and support staff – is dedicated to rebuilding the emotional, mental, and physical well-being of women during this very difficult period. We are here to answer any questions and address all concerns,as we help guide our patients through the decision process to identify the best possible options to restore their breasts.
TRAM Flap Breast Reconstruction Procedure
There are two basic methods of performing the TRAM Flap breast reconstruction procedure: the pedicle flap procedure, and the free flap procedure.
Pedicle Flap
This procedure is often called the “standard” in breast reconstruction and has been in use for more than twenty years. Pedicle Flap breast reconstruction involves a technique called “tunneling,” utilizing tissue and part of the abdominal muscles to create a reconstructed breast mound. An added benefit to the pedicle procedure is that through the process of taking skin and fat from the abdomen, patients may have a flatter midsection. In order for the transfer of the flap to the chest to work, the abdominal muscle must be tunneled under the upper abdominal skin and connected to the breast site, where the tissue from the donor site will be used to create the new breast. The pedicle flap technique allows many of the blood vessels to remain intact, therefore does not require microsurgery. This procedure is often quicker to perform, and has proven itself to be a remarkably successful technique for rebuilding the breasts with natural-looking results.
Free Flap
The free TRAM flap is a microsurgical technique, requiring the meticulous connection of blood vessels under microscopic magnification. In this procedure, abdominal skin, fat and a portion of the muscle (along with its blood vessels) are removed and placed in the chest area, where it is shaped to create a new breast. The artery and vein of the donor tissue are reconnected to blood vessels in the chest, creating a healthy blood supply to the new breast.
At the initial consultation, our reconstructive surgeons will explain all the breast reconstruction procedures available, to ensure each patient is informed and aware of all their options. At our Breast Reconstruction Program, we have plastic surgeons that are specialty-trained in both TRAM Flap techniques, and they are able to perform either procedure with successful results.
Patient Considerations
TRAM Flap breast reconstruction surgery will typically take five to seven hours to complete, longer if both breasts are being recreated. Patients can expect a hospital stay of at least three to five days, and several weeks of recovery before resuming normal daily routines. Once the initial recovery period is complete, patients may be able to undergo nipple reconstruction. Since TRAM Flap breast reconstruction uses tissue and fat in the abdominal region to form the new breast mound, patients attain the added benefit a reduction in abdominal girth. Scars are very similar to those utilized for a tummy tuck procedure.
Latissimus Dorsi Flap
The Latissimus Dorsi Flap procedure is an effective breast reconstruction technique to help patients regain their confidence and well-being while recovering from a mastectomy or injury. The procedure involves taking skin and muscle from the back to create a natural-looking breast mound. The Latissimus Dorsi Flap breast reconstruction procedure is known to be less complicated than other procedures, which can reduce recovery time and lessen the overall impact of the entire breast reconstruction process.
The surgeons of AAMC’s Breast Reconstruction Surgery Program have been educated and specialty-trained at some of the world’s most respected medical institutions and cancer centers, we make every effort to ensure each patient is well-educated on all aspects of procedures, from the pre-operative period through to the last step in recovery.
Latissimus Dorsi Flap Procedure
The position of the Latissimus Dorsi (the muscle that runs along the back to the armpit) muscle and surrounding tissue can be ideal in breast reconstruction procedures because the skin retains the natural consistency and feel of normal tissue, while providing ample amounts of tissue to create the new breast mound. The Latissimus Dorsi Flap breast reconstruction procedure involves a “tunneling” technique, which allows the donor tissue to remain connected to its original blood supply. Once skin and muscle have been taken from the upper to mid-back area on the patient’s posterior trunk, the donor tissue is attached to the chest area, while remaining connected to the original blood vessels, which typically limits the need for microsurgery to several blood vessels to ensure the acceptance of the transferred skin.
Known for its effectiveness and natural-looking results, the Latissimus Dorsi Flap technique typically takes two to three hours to complete. Patients can expect a one-to-three day hospital stay, but this will vary depending on the patient. Most patients do not experience any long-term limitations stemming from the relocation of the skin and tissue from the latissimus dorsi area, and patients who have had this procedure typically resume their normal activities once recovery is complete.
Tissue Expansion
Tissue expansion with breast implantation is a form of breast reconstruction technique commonly used by plastic and reconstructive surgeons when our patients do not have enough skin to support typical breast reconstruction procedures following a mastectomy. The technique involves using the patient’s remaining skin in combination with a breast implant to create the new breast. As a two-step procedure, tissue expansion entails the use of skin expanders to create a breast pocket, followed by the placement of a breast implant. Once the implant has been placed and time has been allowed for healing, nipple reconstruction can be performed to create a beautiful, natural-looking new breast.
In an effort to create the best results possible, our surgeons strive to develop a collaborative approach to the entire breast treatment and reconstruction plan by involving our patients in the decision-making process, as well as their breast surgeons, radiologists, oncologists, and all other physicians involved in their treatment. To further support the success of seamless reconstruction results, our surgeons employ oncoplastic incisions to limit the effects of scars resulting from the procedures to create natural-looking breasts.
The following information provides details concerning Implant Reconstruction with the Tissue Expansion and its role in breast reconstruction from our Breast Reconstruction Surgery Program. Please contact us to schedule a consultation with one our surgeons to discuss the breast reconstruction process and address any and all questions concerning the procedure as a whole, as well as tissue expansion and breast implantation, at AAMC.
Implant Reconstruction with Tissue Expansion
Tissue expansion involves the rebuilding of the breast by expanding the remaining skin following a mastectomy or injury. The insertion of the tissue expander can often be done during the mastectomy, working in conjunction with our patient’s breast surgeon. The procedure involves the placement of a small, silicone balloon just under the surface of the skin, and then the injection of a saline solution into the balloon in a number of sessions over a period of several months to continue to gradually expand the skin. After the initial surgery to place the tissue expander, the progressive expander injections can typically take place in a quick procedure in the convenience of one of our 5 offices, and only lasts about 10 to 15 minutes.
Over time, the balloon will expand the skin, ultimately creating a breast mound and a pocket to house an implant. After the skin has grown sufficiently to accommodate the implant, the balloon expander is removed and the breast implant is placed to create the breast mound permanently.
Breast Implant Placement
In the second operational phase of Tissue Expansion breast reconstruction, a saline or silicone breast implant is placed. During this procedure, the tissue expander is removed, our plastic surgeon will replace it with the implant. The exact type, shape, and size of the breast implant will be decided by our patients and surgeons. After the implant has been placed, the incisions are closed and the recovery process begins. Once the breast has healed properly, our surgeon can reconstruct the nipple to complete the breast reconstruction with results that look as natural as possible.
As an additional option to improve the effectiveness and possibly alleviate the need for a separate procedure, the Tissue Expansion breast reconstruction method can be performed during a mastectomy. However, for our patients who have opted for delayed reconstruction, the tissue expansion method can just as easily be performed following the recovery period for the initial reconstruction procedure.
Direct-to-Implant Breast Reconstruction
In some cases, patients have enough skin left in the breast area following a mastectomy to allow for the insertion of a breast implant without the need for tissue expansion. In Direct-to-Implant breast reconstruction, the implant can be placed inside the remaining skin immediately following a mastectomy, therefore does not require multiple treatment sessions to expand the skin in order to accommodate the implant. While our surgeons and patients will discuss every breast reconstruction option available, the direct-to-implant method is dependent on the amount of skin remaining after the initial breast reconstruction procedure.
Implant Reconstruction
After a mastectomy, women who are considering breast reconstruction can often achieve a natural-looking, beautiful new breast with the placement of a breast implant. Implant reconstruction can be performed in one of two ways: the placement of the implant under the remaining skin in the breast area after mastectomy (direct-to-implant breast reconstruction); or the placement of the implant after tissue expansion to form a breast pocket. Both methods of breast reconstruction are very common and are known to yield effective results.
Implant Reconstruction Procedure
Implant reconstruction is an increasingly popular technique due to the advancements of implants that now allow for safe, natural-looking reconstruction. Additionally, implant reconstruction does not require microsurgery, thus reducing the actual procedure and recovery period. Whenever possible, our doctors work with breast surgeons to begin the reconstruction process at the time of cancer removal or prophylactic mastectomy. This collaboration is crucial to the overall success and natural appearance of the breast reconstruction through innovative techniques, such as oncoplastic incisions.
Breast Implant with Tissue Expansion
This procedure is designed for patients who need to expand the skin in the breast area in order to accommodate a breast implant. Tissue expansion involves the placement of a silicone balloon under the skin. After the balloon has been inserted, it will be filled with saline over a series of in-office treatment sessions in the ensuing months. The balloon causes the skin to grow and expand, stretching the skin to the point where a breast implant can be comfortably placed. The nipple and areola (the dark-pigmented area surrounding the nipple) can be recreated in a later procedure. The tissue expansion portion of this procedure typically takes about six to eight weeks, followed by the placement of the breast implant.
Breast Implant without Tissue Expansion
(Direct-to-Implant Reconstruction)
For some patients, there is enough remaining skin in the breast area to accommodate an implant without the need for tissue expansion. In these cases, an implant may be placed either during or after a mastectomy procedure depending on the particular treatment plan.
Whether our patients have undergone implant reconstruction with or without tissue expansion, the next phase in the treatment process can usually occur about two to three months after the implant has been placed. This usually involves nipple reconstruction or nipple tattooing, and some patients may require additional contouring and shaping of the new breast at this stage.
When the breast implantation procedure without tissue expansion is possible, patients can typically expect a shorter recovery time because the procedure can be completed in conjunction with the mastectomy, allowing patients to avoid the need for repeated visits to expand the tissue and a follow-up procedure to place the implant.
Types of Breast Implants
In a collaborative approach to the entire procedure, our patients and surgeons will decide which type of implant will best meet all surgical goals and expectations. Breast implants come in a variety of sizes, shapes, and types, and both saline and silicone-filled breast implants have been approved by the U.S. Food and Drug Administration for use in breast reconstruction procedures.
Nipple Tattooing
The final step in breast reconstruction is often recreating the nipple and the areola, which is the dark-pigmented area that surrounds the nipple. This can be achieved by nipple reconstruction procedures and nipple tattooing. We offer nipple tattooing on an outpatient basis, which is the final step in the nipple reconstruction process.
Nipple tattooing involves the medical use of typical tattooing equipment, with the ultimate goal of creating a natural-looking nipple, which compliments skin color and tone. Our team here at AAMC will mix a variety of pigments to match the color of the remaining nipple, or in the case of a bilateral reconstruction, to the patient’s pre-operative photos, as the color of the skin before the tattooing process depends on where the initial skin graft comes from. While nipple tattooing can create the appearance of a realistic nipple, patients should understand that tattooing alone will not create the same natural-looking appearance as a complete nipple reconstruction, and may require multiple treatment sessions to achieve the correct color as our surgeons and patients strive for the best possible reconstruction results. Regardless of whether our patients decide to include nipple tattooing or a complete nipple reconstruction in their breast reconstruction treatment plan, our surgeons at AAMC will provide comprehensive educational information during the initial consultation to ensure the correct decision is made for each individual patient.
Nipple Reconstruction
Nipple reconstruction is performed as a separate surgery after the implant or flap breast reconstruction surgery is complete. The reconstruction of the nipple and areola (the pigmented area surrounding the nipple) afford our plastic and reconstructive surgeons the ability to create the most natural-looking breast reconstruction results possible.
Graft Nipple Reconstruction
In a graft nipple reconstruction, our plastic surgeon will take skin from a donor site and attach it to the newly constructed breast. The donor site for the nipple can come from the nipple of the other breast in cases of a single-breast mastectomy, or from the earlobe or labia if a double mastectomy is being performed. The donor site for the areola can come from a variety of areas, including the scar from a flap reconstruction procedure, the crease of the buttock, or the inner thigh.
Flap Nipple Reconstruction
Flap nipple reconstruction involves the creation of the nipple from a skin flap taken from the area directly beside the region where the new nipple will be placed. Flap nipple reconstruction can be advantageous over the graft technique in that it keeps the original blood supply flowing into the new nipple and provides a greater chance for the successful acceptance of the graft. As the flap approach does not require a donor site, it typically results in less scarring around the area of the reconstructed nipple and areola.
Nipple and areola reconstruction is typically performed about three to six months after the first stage of breast reconstruction, depending on each individual patient’s timeline for a full recovery. At the initial consultation, our doctors will discuss which of the two main approaches to nipple reconstruction will best fit each patient’s breast reconstruction treatment plan, as well as what can be expected from the recovery period.
Ready for a Consultation?
Our doctors are not only experts in the field of breast reconstruction; they also understand the physical and emotional turmoil that breast cancer can cause. We will work with each patient to determine the best treatment options, and we look forward to answering any questions and addressing all concerns. With these doctors, our patients can take comfort in the fact that our doctors are specialty-trained and have extensive experience in all breast reconstruction procedures available.