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Because of the anatomy of this blood supply, many women who undergo reconstruction with a SIEA flap experience less post-operative pain than with a DIEP flap, without any risk of muscle weakness. Tissue flaps look and feel more natural and act more like natural breast tissue than breast implants. "Looking for an experienced plastic surgeon can help prevent flap failure from occurring, " Chu says. Nahabedian M. Options for autologous flap-based breast reconstruction. Long answer, keep reading. Depending on a women's body build and preferences, there are good free flap options from tissues of the inner and outer thighs. Breast Cancer Res Treat. DIEP flap revision is a second surgery performed to achieve the final breast contour. The major drawback of this flap is the possible change in the buttock contour, such as skin dimpling. Second Stage Surgeries.
SECOND STAGE BREAST RECONSTRUCTION | LIPOFILLING. The TRAM flap can be transferred as a free flap or a pedicled flap. However, the surgeon may not recommend immediate reconstruction for a number of reasons, such as when the patient is using nicotine products, has an advanced tumor or is morbidly obese. Most of the time, free flaps don't need to take the muscle from the donor site, so there is less risk of losing muscle strength, and the donor site often looks better than if the muscle had been removed. Breast reconstruction may be performed at the same time as a mastectomy, or it may be delayed for some time. The gluteal free flap might be an option for women who cannot or do not wish to use the tummy site because they are thin, have previous incisions, have had a previous tummy tuck, or for other reasons, but it's not offered at all surgical centers. You might want to read, Dear Plastic Surgeons, 14 things we want you to understand.
The process of total breast reconstruction depends heavily on the type of mastectomy performed, as well as the additional therapies used to treat the cancer, such as chemotherapy and/or radiation therapy. If your breast cancer surgeon recommends mastectomy, talk to a board-certified cosmetic surgeon about DIEP flap reconstruction. Plast Reconstr Surg Glob Open. Are there any new developments or ongoing research in breast reconstruction? This type of reconstruction can sometimes be used without an implant depending on the amount of tissue and the desired breast size. Partially erase the physical reminders of your disease. You might want to read, Preparing for surgery during a pandemic. Sometimes, the initial scarring can be smoothed out a bit or fine tuned to minimize appearance and roughness as much as possible. To be clear, significant scars will remain. Refinements and finishing touches are generalized terms.
The DIEP flap procedure has become the standard of care for autologous breast reconstruction using abdominal tissue, compared to the outdated TRAM flap procedure, which involves completely removing a muscle from the abdomen and inserting mesh. Instead wear a bra that has a more cupping shape, such as a foam bra with or without an underwire that has, I guess, a more normal breast shape. When thinking about the advantages of a DIEP flap, the conversation is shaped by comparing it to an implant-based reconstruction or other autologous reconstructive donor sites. Not all women are candidates for breast reconstructive surgery, and some choose not to pursue this option. If uncertainty remains, several options are available, including delaying reconstruction, resecting the questionable skin with immediate reconstruction, and closing the questionable skin over a non–de-epithelialized skin paddle, which allows full demarcation of the questionable skin and definitive surgical repair 2-3 days later. Not gonna lie, it was startling. Phase 2 is also the time when scar revision is done. When it is necessary to reduce the reconstructed breast, the surgeon has several options. Textured saline expandable implant with built-in port. Latissimus Dorsi Myocutaneous Flap. The technique is not a free flap procedure and is usually used to reconstruct defects caused by a partial mastectomy. The diameter of the implant should not exceed the diameter of the breast pocket. No, breasts do not define us, but they sure as heck are (or were) part of us and for many years too. However, once the flap is removed, it will have to be replaced.
In addition, with the onset of menopause (ie, decrease in estrogen levels), the relative amount of fatty tissue increases as the glandular tissue diminishes. This procedure has been found to be safe as far as cancer recurrence in patients who have had mastectomies. What are the benefits and risks of delayed or immediate breast reconstruction for me? Appointments in as little as 24 hrs. How Is Second Stage Surgery Performed? Once home, you can relax and start healing.
14] Key measurements include nipple-to-sternal notch distance and the nipple-to-IMF distance. For instance, they may get bigger or smaller as you gain or lose weight. If I think of any, I'll add them, so you might want to stop by again if DIEP phase 2 is in your future. Will it be implant-based or a DIEP flap or a tissue flap, which relies on the patient's own tissue? Delayed reconstruction. Options and considerations in the timing of breast reconstruction after mastectomy.
These vessels may be more reliable in delayed reconstructions. No muscle is removed. If performing reconstruction with a prosthesis, select the projection of the implant accordingly. What should patients preparing for DIEP flap or tissue flap reconstruction anticipate? Tunneling the tissue beneath your skin to your chest area, the surgeon then creates the new breast mound or pocket for the implant. Wondering how many times you can have your breasts injected after the surgery with the Lipo if your still not happy with the outcome? 120, Chandler, AZ 85225. How Long Until I Can Exercise After Surgery? Reconstruction with autogenous tissue also requires careful preoperative planning.
Phase 2 discomfort was completely handled with Tylenol. The purpose of the second stage of DIEP surgery is to fine-tune the reconstructed breast and improve the overall cosmetic results. The blood vessels will also be reattached. Everyone's situation is different, so there's no one-size fits all here either. The blood vessels (arteries and veins) must then be reattached with microsurgery. Both my phase 1 and phase 2 surgeries were done at Mayo Clinic in Rochester, MN, so it involved a two-three hour drive.
Patel K, Bloom J, Nardello S, Cohen S, Reiland J, Chatterjee A. Preserves Core Muscle Function. These ligaments run throughout the breast tissue parenchyma from the deep fascia beneath the breast and attach to the dermis of the skin. Nipple reconstruction.
The abdominal wall (tummy) is the most popular and common donor site for free flap breast reconstruction. The techniques used will depend on which surgery is performed. If the inferior skin flap remains tight, it can be split vertically to allow the skin paddle of the flap to reach down to the IMF; this often corrects the problem. This may be achieved by means of lifting (mastopexy) and/or reducing the native breast. During this stage of the reconstruction, we can address any issues you have with your new breast and improve the aesthetic appearance compared to your initial operation. Final thoughts about things you should know. As you continue to heal, the nerves can start connecting again, which will restore sensation. Again, this is my experience. I did my appointments out of their red bank office with Dr Pierce. Because no fascia is harvested, it is believed that function returns more quickly, hernias and bulges are less frequent, and postoperative pain is less severe. From my consolation up to my post ops I was very comfortable.
Because of reattaching blood vessels, free flap surgery typically takes longer than does pedicled flap surgery. They aren't mind readers! Breast cancer strikes one in every eight American women. Close cooperation with the oncologic surgeon can alleviate problems, since technically no breast tissue lies inferior to this plane. If the dead flap tissue is removed in time, your surgeon might be able to use that tissue. In this flap procedure, the surgeon takes tissue from the latissimus dorsi muscle in your back, tunnels it underneath your skin to its new location and uses it to form a new breast mound. To learn more, check out our website where you can upload your photos and concerns for a virtual consult. While other donor sites may leave areas of irregular contour or visible scars, using the abdomen as a donor site results in favorable body contour and scars that are usually able to be concealed by regular clothing and bathing suits. When you undergo a mastectomy to remove breast cancer, you may receive either a nipple-sparing mastectomy or a non-nipple-sparing mastectomy. Your surgeon determines which method is best for you based on your body type and your medical and surgical history. Fat grafting is usually used for breast revisions or "touch up" surgeries. Implant-based breast reconstruction is the most common and is often the most convenient when it comes to recovery and downtime. What about follow-ups and photo shoots? Sometimes, it's hard for plastic surgeons to fully understand our perspectives, what's bugging us about surgery outcomes or what we really want.
You should also not lift anything above your head during your recovery period, as it could damage the rebuilt breast and cause complications.