surgery...
Breast Reconstruction...
Surgery to make a new breast is an important part of the treatment following a diagnosis of breast cancer or DCIS. The exact technique can vary depending on the wishes of the woman concerned and the advice of the plastic surgeon. Mr Uppal will discuss the best option for you having taken into consideration your thoughts and aspirations.
The choices and information that you are given can at first be confusing and even frightening. However, you will get a lot of support from the nurses and doctors in the clinic. Please ask as many questions as you need. Sometimes we forget things we are told, so don't be scared to ask again.
Breast reconstruction can be an important step to getting back to a truly normal life and can signal the end of cancer treatment...
Breast reconstruction does not make a woman's body just as it was before the mastectomy. Even a reconstructed breast that looks completely natural will not have the original sensation and is not a real breast. It can, however, look and move naturally and feel to the touch like a soft, natural breast. Women who have had successful breast reconstruction are therefore much closer to their original physical state than are those who have not had breast reconstruction. Breast reconstruction can go a long way toward making patients feel better and most patients who undergo breast reconstruction are able to return to the lifestyles they enjoyed before being diagnosed with breast cancer.
The pictures above were taken before and after surgery to create a new breast with a DIEP operation using spare skin and fat from the tummy. This operation takes about 6 hours to perform and does not need a breast implant. The new breast does not change if radiotherapy is required afterwards. There is however a 5% chance that the new breast may not keep the blood supply that is connected using microsurgery with a microscope. If this happens a breast implant may be used to make a new breast.
You may also have surgery to the other breast, if you wish, to get a more even appearance. Nipple reconstruction is also performed. All this extra surgery can be performed at the same time or, as is more common, it is done a few months later to give the best results in the end.
You will be offered a chance to see photographs and meet a patient if you wish.
Special Considerations for the DIEP Flap Surgery
DIEP flap is Micro-Surgery which requires extensive training and experience, in addition to special facilities and surgical tools. The sutures used to reconnect the blood vessels are only about the same diameter as a strand of your hair. The surgical team will use a high-power microscope to perform the most critical part of this procedure (reconnecting blood vessels).
DIEP Flap Breast Reconstruction
Restore Breast Symmetry After a Mastectomy
When considering breast reconstruction, there are several surgical options to consider -- DIEP flap is one of them. Not everyone is a good candidate for the DIEP flap, but there are many advantages to this procedure.
What is DIEP Flap Reconstruction?
The DIEP flap (deep inferior epigastric perforator) is a tissue flap procedure that uses fat and skin from your tummy to create a new breast mound after a mastectomy. This procedure takes its name from the deep inferior epigastric perforator artery in your tummy area and is a form of autologous reconstruction...a surgery that uses your own tissue.
Your reconstructed breast won't be just the same as your natural breast, and you will need additional reconstructive surgery to create a nipple and areola.
DIEP Flap Method
The skin and fat from your tummy area will be moved to your chest. No abdominal muscle will be cut or moved during this process. Most women have enough extra tissue in their tummy area to create a new breast. If not, a small implant can be placed under your tissue flap to create the breast size that you want. The removal of skin and fat from your tummy is similar to the procedure for a tummy tuck (abdominoplasty). A DIEP flap, however, also includes the movement of an artery and vein from your tissue flap to the chest so that the transplanted tissue can be supplied with blood.
Advantages and Disadvantages
Pros:
• No muscle is moved (unlike a TRAM flap) or pediculed Tram Flap
• Almost no risk of developing an abdominal hernia as a result of this procedure
• Less pain, faster recovery time than a TRAM flap
• Removal of abdominal skin and fat results in a tummy tuck
• DIEP flap procedure has a less than 1% failure rate
Cons:
• DIEP requires more time in surgery than a TRAM flap
• Two scars result from a DIEP, as you will have two surgical sites
• If a DIEP procedure fails, the tissue flap may die and have to be completely removed
• If the tissue dies, new reconstruction may not be done for 6 to 12 months
You're Not a Good Candidate If:
• not enough tummy fat (you have already had abdominal skin and fat removed)
• you are very thin (you don't have ample skin and fatty tissue on your abdomen)
• you're an active smoker (your abdominal scar will heal slowly, and your fat tissue will more likely develop into scar tissue)
Getting Ready for DIEP Flap Breast Reconstruction
Mr Uppal will mark your skin to carefully plan for the tissue flap incision. Using a skin marker, he will draw a semi-elliptical section across your tummy, just below your navel and above your pubic area. This semi-ellipse will become the skin flap that closes the incision for your reconstructed breast. When the incision for the flap is shut, it will become a line that goes all the way across your tummy. This is the same procedure that precedes a tummy tuck.
Moving Fat, Skin and Blood Supply
An incision along the marked skin on your tummy, to raise a layer of skin and fat. Before disconnecting this tissue flap, the deep inferior epigastric perforator artery and vein that will bring a dependable blood supply to your new breast. These blood vessels will be carefully preserved along with your tissue flap. Your tummy incision will be closed, and drains may be placed to promote healing and prevent fluid build-up. Your navel will remain in position above the incision.
Your tissue flap, complete with blood vessels, will be moved up to your mastectomy area. In order to ensure that the tissue will survive in its new location, Mr Uppal will use microsurgery to reattach the blood vessels in the tissue flap to blood vessels in your chest. The skin and fat tissue are then carefully reshaped into a breast mound and sutured into place. He may use skin marking techniques over the blood vessels to help the nurses monitor healing as you recover. Expect to have surgical drains in this incision, too, to help with healing.
All operations carry risks as well as benefits which Mr Uppal will discuss with you in detail.
