Robert J. Allen M.D.

Understanding Perforators and Flaps

February 16th, 2012 admin

I realize that for those of you outside the medical community, all this talk of perforators and flaps may be somewhat confusing. So, I’d like to take this time to define and provide explanations for the commonly used vocabulary and terminology in field of perforator flap breast reconstruction. This will help you better understand the concept of perforator flap breast reconstruction itself, as well as much of the upcoming blog discussions on flaps.
So, let’s break down the name perforator flap. A flap is a specific area of tissue, meaning skin and fat, that can be harvested and relocated to another part of the body in order to restore form or function. However, in order for that living tissue to remain alive, it must have a viable blood supply. A perforator is a set of main blood vessels, meaning an artery and a vein, that perforate through or around the muscle to a specific area of tissue, or in this case a flap, and supply it with blood. Therefore, a perforator flap is a specific tissue site that can be harvested and relocated because it contains a main set of perforating vessels that provide it with a blood supply. How does it work? When specific tissue sites have adequate perforating vessels, this tissue can be detached and its perforating vessels can be dissected down through the muscle, leaving the muscle in place and preserving its function. These vessels can then be cut and reattached to arteries and veins elsewhere, allowing the tissue to be perfused with blood and live as part of your body in another location.

So, what does this mean for breast reconstruction? It means that natural, living tissue can be used to replace the natural, living tissue removed during a mastectomy. Breasts can be reconstructed by using your own tissue, creating warm, supple, natural feeling breasts. No need for implants, painful tissue expanders or the sacrifice of essential abdominal muscle, as in the traditional TRAM flap. And when it comes to the field of breast reconstruction, this is truly considered state of the art.

Natural Breasts, Even After Breast Cancer

February 10th, 2012 admin

23 years ago, my mother was diagnosed with breast cancer.  Faced with a possible mastectomy, she would require breast reconstruction in order to maintain her active lifestyle, including various water sports.  Put in charge of her reconstruction, I initially planned the traditional pedicle TRAM procedure, which would force her to sacrifice the complete function of her rectus abdominus muscle and therefore, her active lifestyle as well.  Fortunately for my mother, when re-excising the cancer, she was found to have clear margins, and did not require a mastectomy with reconstruction.  She instead underwent a lumpectomy with radiation.  However, it was this experience that challenged and inspired me to develop better, less quality of life sacrificing options for women and breast reconstruction.  After studying the blood supply to the skin and fat above the muscle in the lower abdomen, I discovered how to use a microsurgical technique to reliably transfer only the skin and fat from the abdomen to recreate the breast, while completely avoiding the use of abdominal muscle altogether.  This was called a perforator flap.  This discovery, called the deep inferior epigastric perforator or DIEP flap, was the first ever developed perforator flap for breast reconstruction, as well as the birth of the entire field of perforator flap breast reconstruction known today.


Unfortunately, not all women are as lucky as my mother.  Every year, thousands of women around the world must undergo the traumatic experience of mastectomies and reconstruction, the majority of which still undergoing traditional techniques that often sacrifice function or lead to painful persistent problems.   For that reason, I have dedicated my entire career to the development and continuous refinement of perforator flap breast reconstruction – the only form of breast reconstruction that I believe gives women the most optimal quality of life post mastectomy.  And therefore, I have chosen to write this blog in attempt to reach out, better inform and provide education about this truly wonderful form of breast reconstruction that I believe all women need to know about.