Abdominal Muscle - Why Save It?

Most women that have looked into breast reconstruction know about the TRAM flap. The TRAM uses lower abdominal skin, fat, and varying amounts of abdominal muscle to reconstruct a "natural", warm, soft breast after mastectomy. The TRAM used to be the gold standard in breast reconstruction, but not anymore.

Over the years, the TRAM flap procedure has evolved into two more advanced procedures that decrease the risk of abdominal complications: the DIEP flap and the SIEA flap. Both use the same lower tummy skin and fat but unlike the TRAM, both SAVE all the abdominal muscle and leave it in place.

The SIEA flap differs from the DIEP flap only in terms of the blood vessels that supply the tissue. While the surgical preparation is slightly different, both procedures spare the abdominal muscle completely and only use the patient's skin and fat to reconstruct the breast. 

All three procedures provide the added benefit of a flatter abdomen with results that mimic a “tummy tuck”. However, because the TRAM flap sacrifices abdominal muscle, the risk of a hernia or abdominal bulging is signifantly higher than with the DIEP or SIEA procedures.

Since the DIEP and SIEA flaps preserve all the abdominal muscles, patients experience less pain than after TRAM flap surgery, enjoy a faster recovery and also maintain their abdominal strength long-term.

I hope this info helps.

Dr C

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PRMA Plastic Surgery specializes in advanced breast reconstruction including DIEP flap, SIEA flap, GAP flap, TUG flap, Alloderm One-Step and fat grafting. In-Network for most US insurance plans. Patients routinely welcomed from across the USA. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer reconstruction patients at www.facebook.com/PRMAplasticsurgery.

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Fat Grafting in Breast Reconstruction - What's the Scoop?

Fat grafting has been in the news a fair amount so I thought I'd give you a brief run-down of what's involved....

Fat grafting is a fairly new technique in breast surgery. Fat is liposuctioned from one part of the patient's body, purified and then injected into the breast.

Fat grafting can be used to fill-in partial breast defects after lumpectomy. It is also frequently used after mastectomy, usually in conjunction with other reconstructive techniques, to optimize the breast contour and improve overall cosmetic results.

There are several fat grafting techniques that are used by plastic surgeons. There is no "set way" that has been shown to be the best in terms of long-term results. However, studies have shown that regardless of the technique used, the collection, storage, and transplantation of the fat cells (and fat stem cells they contain) must be optimized to obtain the best long-lasting results.

Studies have also shown that once the injected fat "takes", it can also help improve the thickness and quality of radiation-damaged tissue and skin.

Regardless of technique, some of the injected fat will be reabsorbed over time but this can vary depending on the exact clinical situation. Patients must therefore be prepared to require more than one procedure for the best results.

As for the risks.... For women still undergoing regular mammograms, it is also important to know that fat grafting can also cause calcifications known as "MACRO-calcifications". As many of you have already unfortunately experienced, breast cancer can also cause calcifications, known as "MICRO-calcifications". According to the American Society of Radiology, these different types of calcifications are easily distinguishable. Having said that, I still tell my patients that fat grafting can lead to the recommendation for further tests in the future because of this calcification issue.

Injected fat can also become firm or create "oil cysts". Fortunately these are becoming much less frequent as techniques are refined but again, both of these can cause "unnecessary" stress.

Several independent studies that have evaluated patients over a few years after the procedure have shown that fat grafting is safe. However, because the technique is fairly new, no long-term safety data is currently available.

Unfortunately not all insurance companies cover the cost of fat grafting so the procedure can involve out of pocket expenses for some patients.

I hope this info helps.

Dr C

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PRMA Plastic Surgery specializes in advanced breast reconstruction including DIEP flap, SIEA flap, GAP flap, TUG flap, Alloderm One-Step and fat grafting. In-Network for most US insurance plans. Patients routinely welcomed from across the USA. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer reconstruction patients at www.facebook.com/PRMAplasticsurgery.

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Reconstructing Breasts with Sensation

Most women facing mastectomy and breast reconstruction want to know what kind of feeling their new breast(s) will have.

Unfortunately mastectomy leaves many women with very little feeling long term (if any), regardless of whether they have breast reconstruction or not.

There is some good news though.... Most women undergoing DIEP or SIEA flap breast reconstruction are also candidates for reconstruction of the sensory nerves in the breasts that provide feeling. The feeling in the new breast won't be as good as what Mother Nature provided but it's certainly a lot better than the alternative. A nice bonus at the very least.

Once the tummy tissue (flap) is moved up to the breast, a sensory nerve in the flap is connected microsurgically to a breast nerve in the chest that was cut by the mastectomy. New nerve cells grow from the chest nerve into the flap nerve over time allowing the reconstructed breast to develop feeling.

If you're feeling brave, here's a short video clip of how the two nerves are connected. You can also see the pulse in the blood vessel connections to the new breast:

I hope this info helps.

Dr C

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PRMA Plastic Surgery specializes in advanced breast reconstruction including DIEP flap, SIEA flap, GAP flap, TUG flap and Alloderm One-Step. In-Network for most US insurance plans. Patients routinely welcomed from across the USA. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer reconstruction patients at www.facebook.com/PRMAplasticsurgery.

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DIEP Flap Breast Reconstruction

Here's a short video about DIEP flap breast reconstruction after mastectomy.... details about the procedure and why it has become the gold standard in breast reconstruction.

Hope you find it useful.

Dr C

*****

PRMA Plastic Surgery specializes in advanced breast reconstruction including DIEP flap, SIEA flap, GAP flap, TUG flap and Alloderm One-Step. In-Network for most US insurance plans. Patients routinely welcomed from across the USA. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer reconstruction patients at www.facebook.com/PRMAplasticsurgery.

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Alloderm Breast Reconstruction

Alloderm is now being used routinely in breast reconstruction. Here's what you need to know...

First off, what is it? AlloDerm is derived from donated (cadaveric) human skin. It is FDA approved and is used in many different types of reconstructive surgery including breast reconstruction. Before being packaged for use, the Alloderm undergoes a multi-step process that removes all the cells that can lead to tissue rejection: even though it comes from another person, your body does not reject Alloderm because the immune cells are removed. Alloderm essentially acts as a scaffold and over time, the patient's own cells grow into it.

Since it is a human (cadaveric) product, the U.S. Tissue Bank rigorously screens all tissue donors' medical records. All donors must be negative for Syphilis, Hepatitis B and C, and HIV 1 and 2. AlloDerm grafts are also examined under the microscope before and after processing to rule out contamination.

Alloderm is frequently used in implant-based breast reconstruction (and has been for years). The tissue expander or implant is placed under the pectoralis (chest) muscle. The more tissue coverage over the implant, the better the results. Unfortunately, the pec muscle cannot cover the entire implant. The Alloderm is used to cover the lower part of the implant that is not covered by muscle.

Advantages:
- Stabilizes the implant in position.
- Allows for complete implant coverage.
- Can allow the creation of a full-sized breast when the tissue expander/implant reconstruction is performed at the same time as the mastectomy.
- No risk of rejection.
- Once incorporated by the body, resists infection as well as the patient's "natural" tissue.

Disadvantages:
- Like anything that is implanted in the body, there is an initial (low) risk of infection (until it becomes incorporated).
- Can cause temporary redness in the skin over the Alloderm.
- Costly but usually covered by insurance.

Many plastic surgeons, including myself, use Alloderm routinely when performing breast reconstruction with tissue expanders and implants.

Dr C

*****

PRMA Plastic Surgery specializes in advanced breast reconstruction including DIEP flap, SIEA flap, GAP flap, TUG flap and Alloderm One-Step. In-Network for most US insurance plans. Patients routinely welcomed from across the USA. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer reconstruction patients at www.facebook.com/PRMAplasticsurgery.

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