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 The goal of
reconstructive breast surgery is to
restore the removed breast tissue with an
alternate that resembles as closely as
possible the anatomic form and
characteristics of a normal
breast. Autologous tissue breast
reconstruction has been recognized as an
excellent and reliable method to
reconstruct the breast after
mastectomy. For more than ten
years it has become evident that
autologous tissue can offer results that
surpass implants for durability and
form. Free (microvascular) TRAM, DIEP and SIEA flap transplantation can
improve the outcome of autologous
reconstruction by improving the
aesthetics of the reconstructed breast and by reducing
complications such as fat necrosis and
flap loss. Although microvascular autologous reconstruction
can be surgically more complex and
requires an increased operating time,
the long term results have solidly
established it as a superb method of
reconstruction.
Autologous tissue from the abdomen
(anatomy) provides a large amount of skin and
subcutaneous tissue with an excellent
blood supply. The most common
technique for autologous reconstruction
is the TRAM (transverse rectus abdominus
myocutaneous flap). This flap
provides all the advantages of the use
of abdominal tissue, but requires
removal of the rectus muscles from the
abdomen and some of the fascia of the
abdominal wall. The DIEP (deep
inferior epigastric perforator) flap
provides the abdominal skin and
subcutaneous tissue the TRAM flap does
while sparing most or all of the rectus muscles and fascia. Patients are
believed to have decreased post-operative pain, less post-surgical abdominal
wall weakness and a decreased chance of abdominal wall hernia formation.
The SIEA flap provides the abdominal skin the DIEP flap does, but it relies on a
different blood supply and requires significantly less surgical dissection than
the DIEP flap.
The most common all natural techniques
for reconstruction of the breast after mastectomy are:
Less common, but superior in many
respects are are the muscle and abdominal wall sparing reconstructions:
PATIENT SELECTION IN AUTOLOGOUS SOFT
TISSUE BREAST RECONSTRUCTION
The unique circumstances of each
specific patient help define the choice of a reconstruction method. No
single technique is applicable to all patients. Consultation with an experienced microsurgeon
is required to determine if a patient is a
candidate for autologous reconstruction with a TRAM, DIEP or SIEA flap. Although
technically more complex, the potential benefits DIEP and SIEA flaps can be
significant
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