Tissue Reconstruction is another option available to women seeking breast reconstruction after mastectomy in Houston, The Woodlands, and Conroe, Texas. There are several options available to the patient in terms of autologous tissue reconstruction:
Deep Inferior Epigastric Perforator flap is a state-of-the-art breast reconstruction that has become the gold standard for autologous/tissue reconstruction in Houston, The Woodlands, and Conroe, Texas area. It involves utilizing one skin and fat from the abdomen to reconstructive the breast. Abdominal tissue is the most natural and closest tissue match to breast tissue. The technique preserves the abdominal musculature by identifying the blood supply to the overlying skin and fat and then dissecting this blood supply carefully through the six pack/rectus muscle. This leads to a main trunk or blood supply that can be harvested and connected to the chest wall. The advantage of this technique is that it preserves the rectus muscle since the muscle is simply open like a book, the blood supply removed, and then closed like a book. The old way of doing this, known as the TRAM flap, used to involve taking the whole six pack/rectus muscle to maintain blood supply to the overlying tissues. In this TRAM flap technique over 11% of patients developed hernias or abdominal wall weakness. Utilizing the state-of-the-art DIEP Flap technique, we are able to reduce the risk of hernia or bulge to less than 0.6%. Hence it allows us to utilize one’s own tissue without the risk and morbidity of the older TRAM techniques in terms of morbidity to the abdominal wall.
With this method of reconstruction, Dr. Gill usually monitor the patient in the hospital for a period of four days. This is because we have to be certain that the blood supply going into the tissue and going out of the tissue is healthy and safe. In addition it typically takes 3 to 4 hours to reconstruct one breast with this technique and 5 to 7 hours for both breast to be reconstructed utilizing the DIEP flap. Therefore, utilizing one’s own tissue does add to anesthesia time and hospital stay. We do find the patients require a longer recovery compared the implant reconstruction. Generally, most patients are off the pain medication and the drains are out by two weeks. Therefore, utilizing these techniques patients have a higher short-term risk in terms of longer surgery and longer healing, but we find that patients have much less long-term risk with the tissue flaps in comparison to implants. In fact many national plastic surgery surveys demonstrated a much higher level of patient satisfaction with tissue flaps in terms of their body self image.
After the initial reconstruction is complete, we typically will wait a period of 3 months to allow swelling/bruising to decrease and the breast tissue to settle. We will then perform a 2nd stage procedure as an outpatient, a shaping and symmetry procedure. This is the time where we further fine-tune the reconstructed breast and then perform any symmetry procedure, such as a lift/reduction or augmentation, to the contralateral breast. There are several options to reshape the tissue flaps. This can involve removal of flat tissue removal or mastectomy skin. We also use fat grafting to add volume to the flap itself or into areas around the flap to help further shape or contour the overall result. This can allow for a more natural reconstructed breast.
Tissue Reconstruction has a very high patient satisfaction rating in the long-term surveys. Once a patient heals, there is very little risk of problems such as scar tissue or infection. Many patients commend that the tissue looks and feels similar to their pre-existing breast tissue.
There is more short term risk with tissue reconstruction. There is a longer anesthesia time and longer hospital stay. We do find that the recovery typically takes 1-2 more weeks than an implant reconstruction. In addition, there are added risks of wound healing and infection associated with the donor site incision.