Perforator flaps for breast reconstruction

There are many options for women contemplating breast reconstruction after mastectomy, including implants. Using a woman's own tissue requires cutting another part of the body--often including muscle--producing scars and possibly weakness or hernias there. Some surgeons have evolved techniques to lessen (not eliminate!) the damage to normal muscle by dissecting the blood vessels needed to supply the overlying fat and skin from the muscle below. These are called "perforator flaps". Their names will depend on the area and specific blood vessels used: lower abdomen = DIEP or SIEA, buttock = SGAP or IGAP, back = TDAP, etc. Different bodies have different sites available for use. Scars, weight, shape, and patient preference will influence this decision. Not everyone has blood vesels suitable for use as a perforator flap. In that case, more muscle may need to be cut, or the procedure may not be possible at all. Furthermore, these blood vessels must be sewn to others under a rib or in the armpit. If these "recipient vessels" are too small, the procedure may not be possible. If the ateries or veins clot after being sewn, the tissue may die. This happens approximately 5% of the time. These operations are difficult, tedious, and time-consuming, which is why they are not offered everywhere. Less complicated TRAM or latissimus flaps may be as good an option for some women. The only way to avoid muscle injury alltogether is to forego reconstruction. These operations last several hours, which may increase the risk of anesthetic complications, nerve compression, hair loss, and pneumonia. Blood loss may be enough to require transfusion. For this reason, some patients choose to bank their own blood 2-3 weeks before the operation. The hospital stay is usually 4 nights. Full recovery takes 2 months. If all goes well, the flap will be evaluted after a few months of healing to determine if any contouring of either breast is necessary to improve symmetry. Then a "nipple" may be made by rearranging skin to make a bump. Color is later tattooed around this. The reconstructed breast will gain or lose weight as you do. Should radiation ever by administered to the chest, the reconstructed breast may suffer shrinkage, hardening, or shape change.

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