Atlanta Breast Reconstruction

https://perimeterplasticsurgery.com/procedures/tummy-tuck/

The latissimus flap is a pedicle flap that utilizes the skin, fatty tissue, and latissimus muscle from the upper back to the chest to reconstruct the breast. The procedure can correct the defects left by partial breast removal, total mastectomies or from chest wall deformities such as Poland’s syndrome. Patients who desire autologous reconstruction but are not candidates for a TRAM or DIEP are ideal candidates. The flap may be combined with a tissue expander to allow for a larger volume of breast upon completion. The flap is released through a crescent-shaped skin paddle and rotated around to fill the defect. Hospitalization is 2-3 days. Patients are given a combination of pain relievers, muscle relaxants, antibiotics, and a detailed instruction sheet on discharge. Office visits take place one week following hospital discharge and again six weeks following surgery. Full recovery time is six weeks. Patients are to avoid heavy lifting and strenuous activity during this time. Scars continue to fade and improve up to a year after surgery. After the patient is well-healed, outpatient surgery is planned for revision (shaping) of the flap and nipple reconstruction. Tattooing is performed in the office under local anesthesia once the new nipple is healed. A delay in this timeline may occur with chemotherapy, radiation therapy, poor or delayed wound healing, or infection.

reconstruction allows the patient to use excess tissue from the abdomen to reconstruct the breast or breasts. The fat and skin overlying the rectus muscle are carried to correct the defect left following a mastectomy. Ideal candidates are healthy, have adequate abdominal tissue, and have realistic expectations of the outcomes. A hip-to-hip incision is made to elevate the flap like someone undergoing a tummy tuck; however, this tissue is utilized and not discarded. The remaining soft tissue above the harvested flap is released and the incision is reapproximated. The umbilicus or belly button is preserved and is brought back out to the surface and stabilized. In a Pedicle TRAM (Transverse Rectus Myocutaneous), the blood vessels supplying the tissue are left intact and the entire abdominal flap is tunneled into the pocket left by the mastectomy and reshaped to form a new breast. Pedicle flaps are an ideal option for patients who have had radiation damage or some other type of problem with the vessels used for reanastomosis for a Free TRAM. A Free TRAM requires microvascular reanastomosis (reattaching of blood vessels under the microscope) of the vessels from the abdominal flap to a blood supply in the chest (usually the internal mammary vessels along the sternum of the thoracodorsal vessels in the axilla).

The advantages of the free TRAM versus a pedicle TRAM are decreased risk of abdominal hernia or bulge and a lower incidence of fat necrosis. Success rates for the free TRAM are 97-98%. Complications related to TRAM flaps are low but include the following: total or partial flap loss, fat necrosis (hard areas in flap due to poor fat healing), inadequate abdominal wound healing, hernia, abdominal bulge, infection and hematoma (blood accumulation). Patients generally stay 3-5 days in the hospital after plastic surgery. Patients are given a combination of pain relievers, muscle relaxants, antibiotics, and a detailed instruction sheet on discharge. Office visits take place one week following hospital discharge and again six weeks following surgery. Full recovery is six weeks. Patients are to avoid heavy lifting and strenuous activity during this time. Scars continue to fade and improve up to a year after surgery. After the patient is well-healed, outpatient surgery is planned for revision (shaping) of the flap and nipple reconstruction. Tattooing is performed in the office under local anesthesia once the new nipple is healed. A delay in this timeline may occur with chemotherapy, radiation therapy, poor or delayed wound healing, or infection.

54 y/o female had Stage 1 left breast cancer. She wore a 36DD bra and wanted to use her abdominal tissue for breast reconstruction. She underwent left modified radical mastectomy and muscle sparing free TRAM flap reconstruction. Her postop picture is following nipple reconstruction and tattoo 1 year after surgery.

Breast reconstruction with a tissue expander which is later exchanged for an implant (saline or silicone), utilizes prosthetic materials to correct the mastectomy defect. The expander can be placed at the time of mastectomy or later. It is inserted under the pectoralis muscle and then slowly expanded in the office to stretch the overlying tissue and make room for a “permanent” implant. Expansion is done on a weekly basis until the desired size is achieved. The technique is tolerated relatively well, requires a short operating time and reduced recovery time, and provides good aesthetic results. It is an excellent option for patients who do not meet the protocol for autologous reconstruction. After the patient is well-healed, outpatient surgery is planned for revision (shaping) of the flap and nipple reconstruction. Tattooing is performed in the office under local anesthesia once the new nipple is healed. A delay in this timeline may occur with chemotherapy, radiation therapy, poor or delayed wound healing, or infection. Disadvantages include implant rupture, rippling (ability to see/feel edges of an implant), need for multiple procedures and prolonged reconstruction, and poor results in radiated patients.