Microsurgical Expertise in Breast Reconstruction at Penn
Breast
restoration following mastectomy has
become an integral part of the holistic treatment
of breast
cancer. Free flap breast reconstruction
is the most complex and sophisticated breast
reconstruction technique available, offering
functional and cosmetic benefits that were
previously unavailable to patients.
Penn plastic
surgeons trained in reconstructive microsurgery
are performing this procedure on a daily basis,
making breast reconstruction available to more
women than ever before.
The Procedure
In free flap breast reconstruction, a variable amount of muscle, skin and fat are taken from one part of the body and moved to the breast area to create a breast mound.One of the most common free flap procedures is free “TRAM” flap breast reconstruction, during which the surgeon removes a small piece of the transverse rectus abdominus muscle (TRAM), skin and fat from the lower abdomen and moves it to the breast area.
Using microsurgical techniques (rejoining arteries
and veins using an operating microscope), the
surgeon reattaches blood vessels of the skin
and fat with existing blood vessels at the side
of the breastbone or in the underarm. When the
connections are complete and the flap is receiving
a good blood supply through the new channels,
the flap is shaped to form the new breast mound.
The surgeon can also perform a variation of the free TRAM flap procedure, called the deep inferior epigastric artery perforator flap, or “DIEP” flap, procedure. This procedure is similar to the free TRAM flap procedure, but skin and fat are the only tissues removed, and no muscle is sacrificed in taking tissue to build a breast.
Benefits
Free TRAM or DIEP flap reconstruction uses the patient's own skin and fat to create the breast mound, resulting in the most natural texture and best symmetry of any breast reconstruction technique. Also, because vascular tissue is cut and rejoined at the breast rather then stretched and tunneled into the breast, the new breast mound receives a better blood supply, resulting in an improved cosmetic appearance and better chances for long-term success of the reconstruction.
“The use of microsurgical techniques has revolutionized the way we approach breast reconstruction.Compared to more traditional methods of breast reconstruction, the free flap technique results in better blood flow, greater freedom in shaping the breast, less abdominal pain and minimal loss of abdominal function. As a result, candidates for this type of breast reconstruction have excellent results, both aesthetically and functionally,” says Liza C. Wu, MD, assistant professor of plastic surgery at the University of Pennsylvania.
Other Benefits Include:
- No prosthetic material used in the breast
- Can be performed at time of mastectomy and patient wakes with breast mound in place
- Better blood supply to new breast allows tissue to tolerate radiotherapy
- Provides skin to replace the nipple area in immediate reconstruction
- Removing skin and fat from abdomen results in “tummy tuck” effect
Who is a Candidate?
The free flap technique has opened the door for many women who previously were not candidates for breast reconstruction. Narrowed blood vessels resulting from smoking, obesity or other medical issues prevented many women from undergoing breast reconstruction because the breast mound would not receive an adequate blood supply. Microsurgical techniques used to rejoin vascular tissue improve blood supplied to the breast and increase the chances of success for previously at-risk patients.
Our Team
Because breast reconstruction is often performed
at the time of mastectomy, a cohesive team
approach to patient care is critical for optimum
results. Penn plastic surgeons work closely
with medical, surgical and radiation oncologists,
operating room and nursing staff, psychologists
and counselors to ensure continuity of care
through diagnosis and treatment of breast cancer,
as well as options for reconstruction following
treatment.
Patients interested in breast reconstruction
also have the opportunity to speak with past
patients who chose Penn for breast reconstruction.
The University of Pennsylvania Health System
offers patients all necessary resources for
comprehensive care.
For more information on free flap breast reconstruction,
visit the Plastic
Surgery at Penn web site or call 1-800-789-PENN
(7366).
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