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Breast Reconstruction Surgery
When is Breast Reconstructive Surgery Necessary? What are the different types of Breast Reconstruction Surgery?
Breast reconstruction is done in an effort to restore a sense of normalcy and balance for women who have undergone mastectomies. Technology has made great strides in the field of reconstruction, giving women several options from which to choose. While most people are familiar with breast implants when used for purposes of breast enlargement, they may not be aware that implants are also used in breast reconstruction. The first stage of breast reconstruction typically uses a tissue expander to stretch the skin of the breast sufficiently to accommodate the final implant that is inserted at a later time. A salt-water solution is injected into a tissue expander in regular intervals to stretch the skin of the breast area. Once breast expansion is complete, the tissue expanders are removed and final breast implants are placed. Breast implants are available in silicone or saline. Both types are FDA approved and they also come in various textures, sizes and shapes. Surgery is done to place these implants under the skin or chest muscle to form a breast reconstruction mound. The goal is to create a reconstructed breast that resembles the other breast in shape and size, or if both breasts have undergone a mastectomy, then the reconstruction is used to create balance and stability for the patient.
One inconvenience of breast implants is they don’t last forever. With implants, problems can develop such as leaking, shifting of position, or they may not look or feel right. If any of these problems occur, it would have to be surgically corrected.
Flap Breast Reconstruction
Flap reconstruction is another type of breast reconstruction that removes tissue from the patient’s back, abdomen, thigh or buttocks and moves it to the chest area, where the tissue is then reshaped or rebuilt into a breast. With this type of breast reconstruction, patients may not only have to deal with the healing process of the breast but there could also be problems at the sites from which the tissue is extracted. The potential problems are abdominal hernias and weakened or damaged muscles. On the plus side, tissue used in flap reconstruction retains its ability to function normally meaning it shrinks or enlarges according to the patient’s weight loss or gain. Also, there’s no concern for rupture or future need of replacement. Following are types of flap surgical procedures commonly used in breast reconstruction.
TRAM (transverse rectus abdominis muscle) Flap
TRAM flap surgery uses muscle and tissue from the lower abdominal wall for breast reconstruction. Tissue from this area can often be sufficient enough to form the new breast without having to use an implant. At least one muscle along with the blood vessels, fat and skin are removed from the abdomen and moved to the chest. While this procedure can weaken the stomach area, it also produces the same effect as a tummy tuck which could be a welcome result. Two types of flap surgeries are:
Pedicle flap: leaves the flap attached to its original blood source and channels it under the skin up to the chest area.
Free flap: the flap, along with its surrounding muscles, blood vessels and fat, is completely excised from its primary location and reconnected microsurgically to the blood vessels in the chest.
Latissimus Dorsi Flap Reconstruction
The latissimus dorsi flap uses skin and muscle from the upper back to create a breast mount or to cover an implant during the breast reconstruction process. This tissue is also channeled under the skin to the chest area and it’s used to produce a more rounded, plump reconstructed breast.
Gluteal Free Flap
A type of flap surgery that has only recently arrived on the breast reconstruction scene is the superior gluteal artery perforator (SGAP) or the gluteal free flap. This surgical procedure uses tissue and muscle from the buttocks and it’s an alternate choice for women when removal of tissue from the abdomen isn’t an option. Like the free TRAM flap surgery, the flap and its surrounding tissue are completely cut from the buttocks and reconnected through microsurgery to the tiny vessels of the chest.
It should be noted that some of the drawbacks of all breast reconstruction procedures are rupturing, bleeding, infection, poor incision healing, and anesthesia risks. Also, reconstructive surgery is an ongoing process that’s completed in several stages so patients must be prepared to deal with several months of discomfort.
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