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Breast Reconstruction - The Flap Procedure

For women, our breasts are a very personal thing indeed. Not only do they define us as women in ways that cannot be easily articulated, breasts by their very nature are sensitive to touch, and surgery of any kind can be devastating physically, emotionally and psychologically. Taking time to research your options for breast reconstruction will give you insight that will lesson your fears, and guarantee at least a few things in your future. With that in mind, I have of late become very intrigued by the FLAP procedure.

The bottom line is that with these procedures it appears candidates for them would end up with more natural skin still intact, less scarring, and should still have sensation. This is due to the nature of the way the procedure is accomplished, which is through transferring live blood vessels to the affected area, which keeps the breast "alive", thus allowing it to retain its natural softness, warmth and sensitivity, which are the hallmarks of a woman’s breasts.

WHO INVENTED THIS PROCEDURE?
Robert J. Allen, M.D. pioneered this procedure in 1992, and is founder of The Center for Microsurgical Breast Reconstruction and the Group for the Advancement of Breast Reconstruction. He is a plastic surgeon and seems dedicated to making it possible for many women to keep their muscles and still have natural breasts after breast cancer.

He calls it autogenous breast reconstruction – auto (self) genous (specific class), and uses microsurgery, which is less invasive. All survivors know the side-effects of scar tissue after surgery, so less invasive surgery is a great thing. A woman’s future quality of life is enhanced by it. Depending on how you are built, there are several options available. In other words, if you have a large backside, you might be a candidate for one flap. If you have extra tummy tissue, you could possibly end up with a new breast and a tummy tuck to boot! See what I mean? The doctors take from where you have extra fat and tissue, and use that to remake your breast.

Below are different types of muscle sparing perforator flaps:

DIEP FLAP
Deep Inferior Epigastric Perforator Flap (inferior=lower than; according to Webster’s dictionary)

Perforator flaps represent the state of the art in breast reconstruction. Replacing the skin and soft tissue removed at mastectomy with soft, warm, living tissue is accomplished by borrowing skin and fatty tissue from the abdomen.

SGAP FLAP
Gluteal Artery Perforator Flap

For the thin woman or those with otherwise inadequate tummy tissue, the breast may be reconstructed with tissue borrowed from the gluteal area. Skin, fat, and the tiny feeding blood vessels are taken using a fine incision along the panty line.

IGAP FLAP (bilateral simultaneous)
Inferior Gluteal Artery Perforator Flap

Their newest development, it is called In-The-Crease IGAP. In this procedure, excess skin and fat are borrowed from the inferior buttock, leaving an improvement in buttock shape, and a scar that is completely hidden.

SIEA FLAP
Superficial Inferior Epigastric Artery Flap

In this procedure, blood vessels just under the skin in the lower abdomen may be chosen as the feeding vessels for the required tissue. Otherwise, the procedure is the same as the DIEP flap.

TUG FLAP
Transverse Upper Gracilis Flap

The TUG flap is used to reconstruct a breast that has been removed by mastectomy. It is an advanced microsurgical procedure that uses tissue from the inner thigh, namely skin and fat, that is transferred to the chest wall for the reconstruction.

Skin-Sparing Mastectomy with Reconstruction
This procedure leaves no scars on the breast. For some patients, all breast skin, including the nipple and areola can be preserved. The mastectomy is performed via an incision under the arm. The reconstruction is done using a selected flap through the very same incision. This results in a natural and normal appearance with no scars. (Note: This new technique is offered in select cases, including patients with invasive cancer.)

Ask Questions/Be Informed
Even though these sound like great options, do keep in mind that any surgery has side-effects, and even if you are a candidate and were to have one of them, there is always the risk of the onset of lymphatic compromise leading to lymphedema. Be sure you talk to your doctor about the known risks and all side-effects. Write down questions, and don’t leave out anything. You are going to alter your body permanently by surgery, so always make sure that you have a made up mind before having it done!

Dr. Robert J. Allen has offices in New York, South Carolina and New Orleans, LA. Two other physicians work with him and specialize in these procedures as well. They are Dr. Joshua L. Levine (DIEP, S-GAP,I-GAP, SIEA), and Dr. Christina Ahn who specializes in Nipple Sparing Mastectomies, as well as the DIEP, S-GAP, I-GAP, and SIEA procedures.

They are all members of the American Society of Plastic Surgeons. To learn more about Dr. Allen, visit the website at DIEP FLAP.



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