TRAM & DIEP Flap Reconstruction Options - The Park Clinic for Plastic Surgery скачать в хорошем качестве

TRAM & DIEP Flap Reconstruction Options - The Park Clinic for Plastic Surgery

Dr. Christopher Park and Dr. Ryan Rebowe of The Park Clinic for Plastic Surgery are the only physicians on the Alabama or Mississippi Gulf Coast that offer the DIEP Flap reconstructive surgery to breast cancer patients. In this quick video, Dr. Rebowe discusses the two procedures with viewers. Not everyone is an ideal candidate for these procedures, however if you are considering one of these or are interested in discussing your options further please do not hesitate to give us a call at 251-340-6600! Breast reconstruction flaps create a breast by moving tissue from another part of one’s own body (autologous). The advantages are increased durability to radiation, more natural shape and feel, and the ability to add tissue where tissue is missing. In suitable patients, Dr. Park prefers flap reconstruction. Blood supply is critical for flap reconstruction and is impaired in patients who are smokers, diabetic, obese, or suffer from vascular disease, collagen vascular disease, and autoimmune diseases. The most common source for breast reconstruction flaps is the abdomen. The primary advantage of using abdominal tissue is that it provides the most cosmetic and natural breast reconstruction in women with the best skin and texture match to the breast. In addition, a modified version of an abdominoplasty or tummy tuck is performed at the same time, but this should not drive the decision. The potential complications of implants are also usually avoided. The skin and fat of the lower abdominal wall, normally discarded in a tummy tuck operation, are elevated and moved to the chest using either the rectus muscle as a pedicle or hinge with blood supply (Pedicled Transverse Rectus Abdominis Myocutaneous /TRAM flap), disconnecting the tissues blood supply to the muscle and skin and moving it to the chest (Free Transverse Rectus Abdominis Myocutaneous / Free TRAM flap), a free TRAM with limited muscle (Muscle sparing free TRAM), or moving the tissue based only on a blood vessel, skin, and fat (Deep Inferior Epigastric Perforator / DIEP flap). The last 3 options mentioned are much more complicated and time intensive, requiring division of vessels and reconnection to blood vessels in the chest or armpit using a microscope, similar to a transplant. Once completed, the amount of blood flow is greater than the pedicled TRAM, but there is a risk of thrombosis (clotting) of the anastamoses, creating the need for urgent reoperation and the risk of complete loss of the flap. The operation can take between 2-½ to 4 hours for a pedicled TRAM and 4 – 12 hours for a free TRAM/DIEP and usually requires a 3 to 5 day hospital stay. There will be tubes to drain fluid and blood from the breast as well as the abdomen for 1 to 2 weeks. This operation does require a prolonged convalescence. The removal of abdominal skin will leave the belly tight and the patient will not be able to stand or lay straight for at least a week in order to minimize pain and prevent tension on the abdominal closure. It will take at least 3 weeks before resuming light activity and 3 months to resume strenuous levels of activity. There will be a scar across the length of the lower abdomen as well as on the breast. The abdominal wall may be weakened and prone to bulge, which can be prevented or corrected with mesh reinforcement. Skin transferred from the abdomen may develop some sensation, but it will be quite different than sensation prior to mastectomy.