Robert J. Allen M.D.

Choosing Your Breast Reconstruction

Choosing Your Reconstruction:  What Is Right For You

When choosing a type of breast reconstruction, the very first thing one must decide upon is method – traditional reconstruction using implants or autologus tissue transfer.  While implants are the traditional, widely accepted method that accounts for nearly 80% of breast reconstruction today, the popularity of autologus tissue reconstruction is rapidly on the rise based on its natural and far more permanent qualities compared to the implant.   If autologus tissue transfer is the method of choice, then one must decide between 2 techniques – traditional methods called the pedicle flap that require the sacrifice and use of muscle, as in the TRAM flap that uses the rectus muscle of the abdomen, or the muscle sparing procedure known as the perforator flap, where only the skin and fat above the muscle is harvested and utilized for the reconstruction.  While perforator flap breast reconstruction is a far more complex procedure than its predecessor the pedicle flap, it is truly considered the state of the art method that leads to better, more natural results and less complications.

Once one has decided to pursue perforator flap reconstruction, determining the flap that is right for you is based upon several variables, the first being body type and fat distribution.  Generally speaking, female body type falls into 2 main categories : apple shaped, in which excess fat and skin are carried in the abdomen with a generally thinner bottom appearance, and pear shaped, in which a female is narrower in the midline and carries excess fat below the waist line in the buttock, hips and thighs.  Therefore, where one’s weight is carried will generally give you an idea of what location a flap can potentially be taken from.  That being said, however, despite body type, most women commonly have enough excess lower abdominal tissue, especially those who have carried children.   The second variable to consider is previous surgery in possible flap site locations.  If one has had a tummy tuck, unfortunately the use of the lower abdomen as in the DIEP flap, cannot be an option.  However, a common misconception is that the same pertains to cesarean sections, which is simply not true.  Both vertical and horizontal c-section incisions do not necessarily rule out the use of the abdomen for a DIEP flap.  Other types of abdominal surgery, depending on location and scarring, may or may not allow for the use of the abdomen but need to be assessed on a case by case basis.  Similarly, extensive liposuction may rule out the use of certain flap sites as well.  Lastly, the third variable that should always considered is personal preference.  This is your life and the body that you need to live in, so being satisfied, comfortable, and fully functional in your lifestyle is extremely important.  Choosing a flap that fulfills not only the medical and surgical criteria, but your own personal criteria should be a high priority as well.

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