what is autologous reconstruction

This type of reconstruction can sometimes be used without an implant depending on the amount of tissue and the desired breast size. The internal mammary vessels are preferentially used for anastomosis given the relatively short pedicle length as well as facilitate central flap positioning. In: StatPearls [Internet]. Dr. Ramon Garza III, PRMA Plastic Surgery, 9635 Huebner Rd, San Antonio, TX 78240, E-mail: [emailprotected].

What is Autologous Breast Reconstruction? Grabinski VF, Myckatyn TM, Lee CN, et al. 2022 American Cancer Society, Inc. All rights reserved.

[Epub ahead of print].

Celebrity Chef Sandra Lee is recovering from a Double Mastectomy. Research. Another possible abdominal wall (tummy) flap is the SIEA (superficial inferior epigastricartery) free flap.

While creating the lower incision, care is taken to preserve the superficial inferior epigastric vein as a potential secondary venous outflow source. : UpToDate, 2021. https://www.uptodate.com.

And, of course, a patient needs enough extra skin and fat for us to transplant to the breast.

Patients should have adequate adiposity and skin laxity in the upper inner thigh region.

Comparison of donor-site complications and functional outcomes in free muscle-sparing TRAM flap and free DIEP flap breast reconstruction. 2008;75 Suppl 1:S30-33.

Also called the saddlebag flap. This is a major complication but the probability is extremely low. Autologous fat grafting in secondary breast reconstruction. The primary alternative to implant-based reconstruction is autologous tissue reconstruction or free flap reconstruction.

J Plast Reconstr Aesthet Surg. When fat grafting alone will not allow for patient goals to be met, implants placed under autologous tissue can provide abundant volume when needed.51 Small implants are usually selected and can be placed primarily at the time of autologous reconstruction or delayed during a revision surgery. Other possible donor site areas for breast free flap reconstruction are the thighs, buttocks, and lower back. Schoeller T, Wechselberger G. Breast reconstruction by the free transverse gracilis (TUG) flap. If you are experiencing a medical emergency, please call 911 or seek care at an emergency room. While it is by no means guaranteed, you are more likely to regain sensation in your breast with autologous reconstruction than with an implant.

Plast Reconstr Surg.

Chapter 79: Malignant Tumors of the Breast. 2008;60:562-567. We go over the possibilities with each of our patients, walking them through their options and learning the goals they hope to accomplish with their reconstruction. LTP Flap. When abdominal scars are present, the flap design can be adjusted to exclude the scar (ie, shifted cephalad or caudal). Plast Reconstr Surg. Tissue from the abdominal wall (tummy) can also be used as a pedicle flap (transverse rectus abdominis muscle or TRAM flap). The difference compared to a free TRAM flap is that no muscle is taken from the abdominal wall. The lateral edges can be shaped and positioned to cone the reconstructed breast, adding projection to the breast mound. 3 Surprising Facts About Delayed Breast Reconstruction. J Plast Reconstr Aesthet Surg. Once the bulk of the pedicle dissection is complete, the remaining flap dissection is completed over the lateral portion of the flap. 2019;143:373379. 2015;135:112. In this surgery, the lower part of your buttock is taken. The flap can include 13 perforators. 2019;7:e2163. Risks of lower extremity lymphedema or seroma formation are best avoided by limiting anterior limb dissection at the medial border of the great saphenous vein.39 Similarly, limiting the posterior limb boundary to not extend past midline of the posterior thigh minimizes the risk of distal flap skin necrosis and injury to the posterior femoral cutaneous nerve.40,41 Postoperatively, use of negative pressure dressings at the lower extremity donor site may reduce wound dehiscence, as reported by McKane.42, One frequent issue that arises in patients who desire autologous tissue reconstruction is the lack of volume from the donor site.

Plast Reconstr Surg Glob Open.

DIEP Flapstands for Deep Inferior Epigastric Perforator flap. This improves the blood supply to the new breast.

Version 5.2021. Although expedient and appropriate perforator selection is a crucial step in DIEP flap elevation, certain principles or maneuvers may facilitate a decision-making process. How Long is the Recovery from Breast Reconstruction? The bottom half of your abdominal skin is removed. The abdominal wall (tummy) is the most popular and common donor site for free flap breast reconstruction. The skin on the chest wall can feel numb (no feeling) or be more sensitive. Beveling at the perimeter of the flap dissection can maximize the volume obtained from any donor site. Health Equity. In Collins KA, ed. A 42-cm. Am I a Candidate for DIEP Flap Breast Reconstruction? 2017;140:229239. Breast Reinnervation: DIEP Neurotization Using the Third Anterior Intercostal Nerve. Br J Plast Surg. Breast Reconstruction. Breast reconstruction with SGAP and IGAP flaps.

Unlike implants, tissue flaps will change like any other tissue in your body. Patients have a 0.8 percent chance of getting a hernia from transplanting the tissue from the abdomen.

How Long After Breast Reconstruction Can I Exercise? If we cant take enough skin and fat from the tummy to rebuild a patients breast, we can take it from the thighs or buttocks if necessary. A conservative pinch test should be used to mark the width of the flap (preferably limited to 7cm), to minimize the risk of postoperative donor site dehiscence. 2010;126:393401. Aesthet Surg J. Wolters Kluwer Health, Inc. All rights reserved. The lateral thigh perforator flap for autologous breast reconstruction: a prospective analysis of 138 flaps. You must first want to use autologous (tissue) reconstruction after a mastectomy. Plast Reconstr Surg. Autologous breast reconstruction offers several advantages compared to implant reconstruction: There are several ways to perform autologous breast reconstruction, with different techniques to transfer skin and fat from different areas of your body. Plast Reconstr Surg Glob Open.

Prospective longitudinal patient-reported satisfaction and health-related quality of life following DIEP flap breast reconstruction: relationship with body mass index. Nipple reconstruction and matching mastopexy performed to contralateral breast 6 months after initial surgery.

2019;7:e2479. You may be trying to access this site from a secured browser on the server. Autologous reconstruction utilizes tissue, including skin, fat, and sometimes muscle, from someplace else on your body to rebuild your breast shape. Trends and variation in use of breast reconstruction in patients with breast cancer undergoing mastectomy in the United States. Autologous breast reconstruction after failed implant-based reconstruction: evaluation of surgical and patient-reported outcomes and quality of life.

The umbilical stalk edges should be trimmed to create a small round circular pattern.

Insetting is done with the caudal edge of the flap placed at the inframammary fold. Ann Plast Surg. 2018;71:15571562. Plast Reconstr Surg Glob Open. The information throughout this plastic surgery website is not intended to be taken as medical advice. This prevents inadvertent lateral migration of the flap and a potential traction injury to the pedicle during dissection.

Often, more then one session of fat grafting is needed to correct some contour deformities. The feeling might return after a few months or years or not at all. 2016;138:1068e1069e.

28. (See Video 2 [online].)

Received for publication July 1, 2020; accepted December 23, 2020. Deep inferior epigastric artery perforator flap donor-site closure with cannula-assisted, limited undermining, and progressive high-tension sutures versus standard abdominoplasty: complications, sensitivity, and cosmetic outcomes.

The blood vessels (arteries and veins) must then be reattached with microsurgery.

The American Cancer Society is a qualified 501(c)(3) tax-exempt organization. An enhanced recovery after surgery pathway for microvascular breast reconstruction is safe and effective. DIEP flap uses a free flap technique, meaning blood vessels from the lower belly are completely detached from their original location and reattached to blood vessels in the chest using microsurgery.

J Surg Oncol. 2013;131:693e701e. autologous fat grafting after breast reconstruction in postmastectomy patients: complications, biopsy rates, and locoregional cancer recurrence rates. Can I Sleep on My Side After Breast Reconstruction? Outcomes after oncoplastic breast-conserving surgery in breast cancer patients: A systematic literature review. Spiegel AJ, Menn ZK, Eldor L, et al. Breast reconstruction is an integral component of comprehensive breast cancer care. 2018;2:234238. Ochoa O, Chrysopoulo M, Nastala C, et al. 2013;1(8):e72. 16.

Tissue flaps are often used by themselves to reconstruct the breast, but some tissue flap procedures can be used with a breast implant if more volume is needed. 2008;122:2938.

So, for example, a 5-foot-5-inch woman whos 98 pounds with D-cup breasts likely wouldnt have enough tissue to borrow from.

Harvest techniques for the DIEP flap are well described in other published studies.14,15 As a high volume practice, however, some of the salient points and pearls we have learned are described below. The gracilis myocutaneous free flap for breast reconstruction is an essential alternative flap option in breast reconstruction.12,38 The elevation of the flap and anatomic descriptions are well known in the plastic surgery literature. The posterior septum incision is closed using 2-0 PDS suture. For information on cookies and how you can disable them visit our Privacy and Cookie Policy.

Evaluating outcomes after correction of the breast conservation therapy deformity. ]]>

The types of autologous breast reconstruction include: At The Breast Center Park Meadows Cosmetic Surgery, we prefer the DIEP flap method of autologous reconstruction and recommend it to our eligible patients.

Most of the time, the thighs only provide enough tissue to make a small or medium-sized breast. Haddock NT, Gassman A, Cho MJ, et al. Djohan R, Gage E, Bernard S. Breast reconstruction options following mastectomy.

A unilateral (one breast) surgery takes approximately 6-8 hours, and for bilateral (both breasts) surgery time is 10-12 hours. The gluteal free flap or gluteal artery perforator(GAP) flap uses tissue from the buttocks (bottom) to create the breast shape. We couldnt do what we do without our volunteers and donors. The fat is not removed with skin, muscle, or other tissues. Flap design is guided by tissue distribution and patient preference in terms of final scar placement. Her preoperative BMI was 23. 21.

Nearly everyone is a candidate for this procedure, and I think it should be the standard of care in breast reconstruction. But we have options available to rebuild patients breasts after the often painful and difficult process of being treated for the disease. 13. This creates a challenge when trying to reach the patients desired goals for reconstruction. You can help reduce your risk of cancer by making healthy choices like eating right, staying activeand not smoking. What will Breast Reconstruction look and feel like? A lenticular pattern is created from above the umbilicus down to the natural skin crease above the mons pubis. 2004;57:481482. Latissimus Dorsi Myocutaneous Flap. What Every Woman Should Know about Breast Cancer, Understanding the Stages of DIEP Flap Reconstruction, Your Guide to the Stages of Implant-Based Reconstruction. 2004;18:157173. 12.

Factors to consider in breast reconstruction.

31. Additional scarring. These factors lead many patients to choose autologous tissue over implant-based reconstruction. Breasts look and feel very much like natural breasts and will continue to look better over time. Ann Plast Surg. 1990;85:16978; discussion 179. Microsurgery. Imagine a world free from cancer.

Degree of flap beveling in the cranial direction is determined by flap volume requirements and abdominal wall thickness. How Long Before My Breast Implants Settle After Breast Reconstruction? Depending on a women's body build Theres much less risk of abulge because no muscle is taken. By David H. Song, MD, Washington Regional Chief, Plastic Surgery.

With this procedure, the surgeon removes a section of skin and fat from the lower abdominal roll and transfers it to the chest to rebuild your breast, while preserving all abdominal muscles.

Between us, weve done somewhere between 3,500 and 4,000 of these technically challenging surgeries. Breast sensibility in bilateral autologous breast reconstruction with unilateral sensory nerve coaptation. Plast Reconstr Surg Glob Open. The skin, fat, and blood vessels are removed from the lower back area (also sometimes called love handles) and moved to the chest and the blood vessels are reconnected.

Ann Plast Surg. Waltham, Mass. Abdominal muscles and the nerves leading to the muscles are preserved using this method, allowing for a faster recovery. The skin, fat, and other tissue is removed from the area in the upper outer thigh and upper buttock and moved to the chest. Plast Reconstr Surg.

Batista BN, Mandujano CC, Liu J, et al. 2005;116:753759. 17.

Until we do, well be funding and conducting research, sharing expert information, supporting patients, and spreading the word about prevention. Read our ADA compliance disclosure. Bodin F, Dissaux C, Dupret-Bories A, et al. You must also have sufficient fat tissue in the lower abdomen to meet your goals for breast size and shape. Plast Reconstr Surg. Maricevich MA, Bykowski MR, Schusterman MA II, et al. Plast Reconstr Surg. //-->
2019;7:e2341.

Breast reinnervation: DIEP neurotization using the third anterior intercostal nerve. Bajaj AK, Chevray PM, Chang DW. In: Hall-Findlay EJ, Evans GRD, eds.

Arch Plast Surg. Plast Reconstr Surg. 2019 Jul 24. doi: 10.1245/s10434-019-07592-5.

How to Find a Surgeon for Breast Reconstruction Revision, 5 Things To Know About Nipple Reconstruction. Photographs taken 9 weeks after revision surgery. 50. Examples of low BMI breast reconstruction patient. Breast reconstruction in private practice. If theres a silver lining to breast cancer and its treatment, its that. Vegas MR, Martin-Hervas C. The superolateral thigh flap: cadaver and computed tomographic angiography studies with a clinical series. Cleve Clin J Med. Post Mastectomy: Tips for Your At-Home Recovery, Tissue Flap vs Implants: Making the Breast Reconstruction Decision.