Breast reconstruction involves re-creating a breast mound when part or whole of the breast is missing.
Who needs breast reconstruction?
Broadly speaking there are three main types of Breast reconstruction
A Hybrid technique involves combination of two or more of the above methods, usually the last two.
Additionally some patients will require a separate reconstruction of the nipple and areola if that is also missing/removed.
Breast Reconstruction with flaps
These flaps are taken from various parts of the patients own body, most commonly the back or abdomen. There are two main types of flaps which are differentiated on the basis of the blood supply.
- Pedicled flaps
- Free flaps
Pedicled flaps
These are tissues transferred from other parts of the body to the breast with their blood supply intact. They are named according to the part of the body they are taken from. Some commonly used pedicled flaps are explained below.
Latissimus dorsi flap or LD flap
This flap contains skin, fat and muscle taken from the back and swung around to the front and put in the place of the missing breast tissue.
TRAM Flap (Transverse Rectus Abdominis Flap)
This flap contains skin, fat and muscle tissue taken from the lower abdomen and swung upwards to put in the breast.
Both these surgeries have their own advantages and risk of complications which your surgeon will discuss with you in detail during the consultation. These flaps can also be combined with implants or fat transfer ( Hybrid Reconstruction) to increase the volume of the reconstructed breast.
Free Flaps
These flaps are so named as their blood supply is detached from the original site ie “free”, and re-attached to a new blood supply in the breast area. This procedure is called microvascular anastomosis and is a very delicate surgery which involves re-joining of the blood vessels. It requires a plastic surgeon with microvascular expertise to perform. Sometimes the area where the blood vessels are re-joined gets blocked with blood clots which will require an emergency return to the operation room to save the flap.
Free flaps are named for the blood vessel on which they are based. The most frequently used one is the DIEP flap. Other less commonly used flaps are SGAP flap and LAP flap.
DIEP Flap (Deep Inferior Epigastric artery Perforator Flap)
This contains skin and fatty tissue taken from the lower abdomen and based on the deep inferior epigastric artery and vein viz, DIEP.
SGAP Flap (Superior Gluteal Artery Perforator Flap)
This contains skin and fatty tissue taken from the upper half of the buttocks and based on the superior gluteal artery and vein viz, SGAP.