• Reconstruction with Patient’s own tissue


    There are several breast reconstruction methods that use skin, fat, or muscle to form a “tissue flap” that helps recreate the breast.
    TRAM flap ( Use of muscle and fat from the tummy) was a very popular reconstructive option some years back. This is now mostly replaced by advanced microvascular techniques ( DIEP Flap) which do not disturb the muscle in the tummy and uses only the fat and the skin.



    • Most women have enough extra tissue in their tummy area to create a new breast.The DIEP flap (deep inferior epigastric perforator) is a tissue flap procedure that uses fat and skin with its own blood supply from the tummy to create a new breast mound after a mastectomy. The removal of skin and fat from your tummy is similar to the procedure for a tummy tuck (abdominoplasty). Abdominal muscle will not be cut or removed for this procedure. Additional minor procedures like tattooing and nipple reconstruction will be required.


      'Pros'

      • Since it is patients own tissue , it ages naturally with the patient and therefore the long term results are better.
      • Does not require multiple revisions as with implants.
      • Muscle is not moved and so there is almost no risk of developing an abdominal hernia as a result of this procedure.
      • Removal of abdominal skin and fat results in a tummy tuck
      • DIEP flap procedure has a less than 1% failure rate

      'Cons'

      • DIEP requires more time in surgery than implants.
      • Additional scar in the donor area( tummy)
      • If a DIEP procedure fails, the tissue flap may die and have to be completely removed and another option of reconstruction will be have to be done at a latter date.
      • Secondary procedures to create nipple areola have to be done as a separate procedure.


      Facts at a glance



      • Surgery time: 5-6 hours
      • Hospital stay: 6-7 days
      • Anaesthetic assessment: Yes, you will meet the anesthetist prior to surgery
      • Bladder Catheter: Yes
      • Confined to bed : 2 days
      • Up and walking : 3rd or 4th day
      • Reasonably mobile : 1 week
      • Full recovery : 6-8 weeks
      • Time off work : 6 weeks
      • Bras and garments: Abdominal binder and bra worn for 2 weeks
      • Possible reconstruction issues: Failure rate of less than 0.5% i.e. 1 in 200
      • Long term issues: Very few
      • Secondary surgery: Nipple reconstruction. Possible liposuction and/or auto fat injections. Possible surgery to opposite side to achieve symmetry.
    • Some women who request autologous breast reconstruction (using their own tissue), are too slim and do not have enough fat tissue in the lower abdomen to perform a DIEP flap. Others may have had a surgical procedure in the past to the abdomen, which has led to scarring. These women may be able to have a Transverse Myocutaneous Gracilis flap, known as well as the TMG or TUG flap.



      TUG Flap Method



      TUG flap microvascular breast reconstruction is an excellent option for patients who desire autologous reconstruction and who do not have adequate abdominal donor tissue or who do not desire abdominal scars .In this procedure, excess skin and fat from the inner portion of the upper thigh is used to create the new breast. Microsurgical techniques are used to reconnect the blood supply. The flap is constructed with a semilunar skin paddle centered over the long axis of the gracilis muscle in the inner thigh . This flap can then be shaped to mimic a breast and provide excellent contour and projection with a consistent blood supply. TUG flap allows for immediate nipple-areola reconstruction in both immediate reconstruction following skin-sparing mastectomy and in delayed breast reconstruction alike. This form of reconstruction usually improves over time.



      'Pros'

      • This type of procedure can be used for delayed or immediate reconstruction successfully.
      • A TUG flap reconstruction gives good projection and volume for the new breast as it contains muscle from the inner thigh.
      • The effect of the gracilis muscle being taken from the inner thigh is unlikely to be noticed by the patient.
      • The reconstructed breast will change with the opposite breast – it will age naturally as the patient as it is living flesh.
      • This is an option for those women who are unable to use tissue from the abdomen either because they do not have enough fat or they have previous scarring.
      • One operation, generally with no further maintenance.
      • Nipple reconstruction is done at the time of reconstruction.

      'Cons'

      • Generally more suitable for a smaller breasted patients.
      • It is a major operation, usually 4-5 hours of surgery and a 7 night hospital stay.
      • There is a small risk of failure of the flap at this stage and this could result in emergency surgery.
      • Sitting down can be uncomfortable for up to a month.
      • The failure rate is increased by factors such as obesity, smoking, diabetes, radiotherapy and other medical conditions.

      Facts



      • Surgery time : 4 hours
      • Hospital stay : 6-7 days
      • Anaesthetic assessment : Yes
      • Bladder Catheter : Yes
      • Confined to bed : 2 days
      • Up and walking : 3rd day
      • Reasonably mobile : 5th day
      • Full recovery : 6-8 weeks
      • Time off work : 4 weeks
      • Bras and garments : Yes
      • Possible reconstruction issues : Tenderness on sitting down
      • Long term issues : Subtle change in thigh contour, usually tighter inner thigh
      • Secondary surgery : Rarely

Quick Links

 

  • BIIP COURSE 2016

    BIIP 2014 3rd Breast Imaging & Interventions Program 2014 Multimodality Approach to Detection and Diagnosis of Breast Diseases

    Read more
  • Target BREAST BIIP 2017


    Multimodality approach to Detection and Diagnosis of Breast Disease September 30 2017 - October 01 2017 IIT , Chennai...

    Read more