• Breast Microvascular Surgery

    Performed by plastic surgeons who are also trained microvascular surgeons

    AAMC’s Reconstructive Plastic Surgery Program is truly comprehensive. When you receive your breast care at Anne Arundel Medical Center, you will never need to be referred elsewhere for more advanced care. And while we can offer you the most complex procedures, we remain committed to what we call the reconstructive ladder: if a simple approach to your case can be highly effective, we will always suggest starting there.

    At Anne Arundel, every breast free flap is performed by two fellowship trained microsurgeons. This team approach improves outcomes and greatly decreases the time that you spend in the operating room. Our reconstructive surgeons are part of a small group of doctors with the skills, experience and track record needed to perform these complex free flap procedures reliably.

    DIEP flap

    The Deep Inferior Epigastric Perforator (DIEP Flap) is one of the most innovative breast reconstruction techniques. It’s designed to take tissue from the lower abdomen to form a new breast mound. The result is breast reconstruction and a tummy tuck. It’s different from TRAM flap surgery because, with the DIEP flap, most or all of the abdominal muscles stay in place and remain functional.

    The two microsurgeons open the covering around the muscle and carefully remove just the blood vessels that run through the muscle to the overlying skin and fat. Then, using high magnification, they carefully reconnect these blood vessels to other vessels of a similar size that are prepared and waiting near your new breast. Then they will close the incision in your abdomen with the same technique used during a cosmetic tummy tuck.

    The DIEP flap reduces risks associated with the TRAM flap (such as bulging, hernia or weakness). Because it’s complex, the DIEP flap surgery takes more time — usually four to five hours for each breast. But the DIEP surgery is usually easier to recover from, with less pain and weakness and a shorter hospital stay and recovery.

    If you have enough extra skin and fat in the lower abdomen (from the level of your belly button to just above the top of your pubic hair) to make a breast that is an acceptable size for you, then a DIEP operation may be a good option. It’s especially suitable if you:

    • Are physically active and want to keep your abdominal muscles
    • Have had radiation therapy
    • Have had a previous breast reconstruction with an implant with unsatisfactory results

    DIEP flap surgery may NOT be for you if:

    • You have a severe blood clotting disorder
    • You have many severe or uncontrolled medical problems
    • You have had radiation therapy to the chest in the last six to 12 months
    • You are severely overweight, which can lead to wound healing problems
    • You smoke cigarettes
    • You cannot accept the small likelihood of failure of the DIEP flap
    • You’ve had a tummy tuck, an open gall bladder removal or other surgery through a large incision across the upper right abdominal wall

    SIEA flap

    The SIEA (superficial inferior epigastric artery) flap breast reconstruction procedure is very similar to the DIEP flap procedure. It uses the same area of skin and tissue, but 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. This procedure is only possible in select patients with very specific blood vessel networks. When it is possible, this operation tends to be quicker and easier than other methods.

    Similar to the DIEP Flap surgery, an advantage of the SIEA Flap breast reconstruction procedure is that the surgeons can avoid removing muscle, which typically results in less pain during recovery and a decreased risk of hernia.

    TUG flap

    The TUG (transverse upper gracilis) flap procedure works well if you don’t have enough skin and tissue in your abdomen or buttocks to create a breast — for instance, if you have had a tummy tuck or butt lift, or if you are very slim. The TUG flap procedure, also known as an inner thigh breast reconstruction procedure, uses a process similar to the SGAP or SIEA flap, but uses skin from your inner thigh. It does relocate muscle from your thigh, but there is no risk of hernia.

    Pre-pectoral breast reconstruction

    Pre-pectoral (over the muscle) breast reconstruction is a newly developed technique that has several advantages over standard reconstruction. Instead of cutting the muscle to create a pocket or stretching the muscle to insert an implant or flap underneath it, this new technique uses a purified human skin product to support the front of the implant. Pre-pectoral reconstruction keeps the surrounding skin intact. Some of the advantages of this method include:

    • Less pain after the surgery
    • Quicker recovery
    • More comfort and mobility
    • A reduced chance of chronic breast pain
    • A more natural look, even during physical activity

    Pre-pectoral reconstruction works best if you are fairly small-breasted and are seeking a moderate-sized implant (B- or C-cup). It’s also best if you are physically fit, with a moderate body mass index (BMI). For more information or to find out if pre-pectoral reconstruction is right for you, call 443-481-5300.