Robert J. Allen M.D.

Understanding Perforators and Flaps

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.

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