Flap Breast Reconstruction in Houston

DIEP Flap vs TRAM Flap Breast Reconstruction

In the past, the most common breast reconstruction option available to patients after breast cancer surgery was breast implants. While still a popularly relied upon method for restoring aesthetic symmetry and shape to a woman’s bust, this technique is quickly becoming an outdated technique as newer, more advanced procedures emerge.  These superior techniques are commonly referred to as Flap breast reconstruction, and include a variation of different methods.

You may be wondering what the term “Flap breast reconstruction” means exactly. Flap procedures are defined as surgical techniques in which the patient’s own skin, muscle and fat is harvested and used to rebuild or cover up the breast(s). This technique is also commonly referred to as autologous tissue reconstruction. The term “Autologous” indicates that the tissue being used for the surgery comes from the patient’s own body.

Tissue Flap breast reconstruction is further broken down into two separate categories.

Pedicle Flap – In pedicle flap procedures, tissue detached from the back or abdominal region is transferred (or tunneled) to the intended site of attachment under the skin, so as not to be disconnected from its original blood supply.

Free Flap – In this more advanced method, tissue is actually separated from its blood source and blood vessels are cut. The tissue is then repositioned in the chest region and the breast reconstruction surgeon carefully sews and reconnects the donor tissue’s blood vessels to the blood supply in the mastectomy pocket with the aid of a microscope.

This latter method is the latest advancement in the field of Flap breast reconstruction, and due to its complex nature, requires the hands of a skilled breast reconstruction surgeon who is extensively trained in microsurgical techniques. Older tissue Flap breast reconstruction techniques that employed the pedicle flap, like the pedicled TRAM Flap, while achieving a more natural-looking breast mound than implants, can have negative effects on the abdominal wall donor site. These disadvantages include weakening of the abdominal muscle, possibility of bulging and increased risk for hernia. This is due to the partial removal of abdominal muscle in addition to skin and fat.

The newest free-flap microsurgical procedure, known as the DIEP Flap technique, involves the use of what is known as perforator flaps, meaning only skin, fat and blood vessels are removed from the donor site, no muscle. The DIEP Flap method is referred to as a “free” flap breast reconstruction procedure because the tissue is completely removed from the stomach area and then reattached in the breast region. This is in opposition to the TRAM Flap procedure, which as discussed previously, does not detach the abdominal tissue from the blood vessels in the belly, and is instead tunneled beneath the skin from the stomach to the chest.

Flap procedures that use the patient’s own tissue are popular because not only does the patient receive a fringe benefit of a tummy tuck procedure, but also because they tend to offer a longer-lasting solution, as opposed to implants that usually have to be replaced after about 10-15 years. Furthermore, because the patient’s own tissue is used, the new breast looks and feels much more natural than an implant.

The Controversy of Autologous Fat Transfer for Cosmetic Breast Augmentation

The use of fat transfer in breast reconstruction has proven to be a safe and effective technique with optimal aesthetic results. Its use in solely elective cosmetic procedures however is still controversial. There are a number of physicians who are beginning to offer autologous breast augmentation at their practice as an alternative to breast implants. Yet, many medical professionals still debate the reliability and long-term efficacy of fat transfer alone for cosmetic purposes.