Perforator Flap Microsurgical Breast Reconstruction

Autologous (Using Your Own Fat) Breast Reconstruction

Autologous reconstruction is the gold standard in all types of reconstruction because replacing the same type of tissue as the type of tissue missing results in a reconstruction that has the same characteristics as the original part.

In terms of breast reconstruction, an autologous breast reconstruction results in a breast composed of skin and fat without the breast ducts that can develop into cancer. Gravity acts upon the skin and fat of the reconstructed breast in the same way as your original breast, shaping it into a natural looking breast. Nerves and blood vessels continue to grow into the reconstructed breast, resulting in a warm breast that develops sensation over time. The quality and degree of sensation is not the same as before the mastectomy.

The perforator flap microsurgical technique of using your tissue is a way of removing extra skin and fat from an area on your body without removing the underlying muscle. This technique can be applied to many areas of the body for breast reconstruction.

Abdomen As The Donor Site Of Fat

The abdomen remains the ideal source of tissue to reconstruct a breast because of the stretching of the skin with weight changes, pregnancies, and movement, the natural predisposition of most women to deposit fat on the abdomen, and the anatomy of the blood vessels. The abdominal contour can be improved like in an abdominoplasty (tummy tuck) procedure. Most women have enough fat on their abdomen to make breasts that are proportional for their body.

Types of Abdominal Flaps:

TRAM (Transverse Rectus Abdominis Musculocutaneous) Flap

DIEP (Deep Inferior Epigastric Artery Perforator) Flap

SIEA (Superficial Inferior Epigastric Artery) Flap

Other Donor Sites Of Fat

Although the abdomen is usually the best source of tissue to make a breast, sometimes patients are not a candidate for using the abdomen. The most common reasons that a patient cannot have an abdominal perforator flap breast reconstruction are the patient has already had an abdominoplasty or extensive liposuction to the abdomen.

Types of Buttock Flaps:

SGAP (Superior Gluteal Artery Perforator) Flap

IGAP (Inferior Gluteal Artery Perforator) Flap

Types of Inner Thigh Flaps:

TUG (Transverse Upper Gracilis) Flap

PAP (Profunda Artery Perforator) Flap

LTP (Lateral Thigh Perforator) Flap

Types of Lateral Chest/Back Flaps:

Latissimus Dorsi Musculocutaneous Flap

Lateral Thoracic (TDAP and ICAP) Flaps

Partial Mastectomy (Lumpectomy) Breast Reconstruction 

Skin and volume can be added to a breast after lumpectomy for improved shape and symmetry with the nonoperated breast. Frequently, the tissue from the lateral chest and back (lateral thoracic) are used.

MRA (Magnetic Resonance Angiography)

Dr. Vasile worked with Dr. Martin Prince and Dr. Tiffany Newman to develop a MRA imaging protocol that helps surgeons identify which vessels are the best ones to use for each donor site (abdomen, buttock, thigh, and lateral thoracic). Advance knowledge of the best vessel to use can help the surgeon identify suitable patients for perforator flap breast reconstruction and can shorten the operating time. The advantage of MRA compared to other imaging modalities is that there is no exposure to radiation, which is a frequent concern in patients with cancer or a high risk of cancer. This research has been published in the Journal of Reconstructive Microsurgery and radiology journals, as well as presented by Dr. Vasile at the American Society of Plastic Surgeons annual meeting.

Lymph Node Transfer

Some women develop swelling of the arm (lymphedema) after axillary node dissection. An inguinal lymph node can be transferred to the axilla (armpit) with an abdominal perforator flap microsurgical breast reconstruction. Microsurgical lymph node transfer can result in a great improvement in lymphedema symptoms, but the improvement is variable with each patient.

Nipple Areola Reconstruction

The nipple areola reconstruction is usually done during a separate procedure after the microsurgical transfer of tissue procedure as an outpatient (ambulatory) procedure. The advantage of waiting is improved blood flow for the nipple reconstruction and possibly improved cosmesis as the breast reconstruction has more time to settle and swelling has subsided.

Implant Breast Reconstruction

Saline and silicone implants are another option for breast reconstruction. Implant reconstruction is the oldest and still the most common form of breast reconstruction.

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