Breast Reconstruction
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Breast Reconstruction: Microsurgery Pioneered in the early 1990's, free TRAM and perforator flap breast reconstruction represents the state of the art in breast reconstruction surgery after mastectomy. The tissue removed at the time of mastectomy may be replaced with the patient's own warm, soft, living tissue to recreate a "natural" breast. In the case of a free TRAM, skin, fatty tissue, and a small portion of the abdominal muscle is taken from the abdomen and used to reconstruct the breast. In perforator flaps, skin, fatty tissue, and the tiny blood vessels that supply nutrients to the tissue ("perforators") can be taken from the patient's abdomen (SIEA flap and DIEP flap procedures) or buttocks (SGAP flap). Unlike conventional tissue reconstruction techniques (like the pedicled TRAM flap), these microsurgical perforator flap techniques carefully preserve most or all of the patient's underlying musculature. The tissue is then transplanted to the patient's chest and reconnected using microsurgery. Preserving underlying muscles lessens postoperative discomfort making the recovery easier and shorter, and also enables the patient to maintain muscle strength long-term. This is particularly important for active women. Sparing the abdominal muscle also decreases the chance of abdominal hernia in the future. As with all types of breast reconstruction, 2 or 3 procedures performed a few months apart are often required to complete the reconstruction process and to obtain the best cosmetic result. While muscle sparing free tram or perforator flap breast reconstruction offers many advantages to the patient, the surgeries are very complex and time-consuming and specialized training is required. Dr. Williams performs these reconstructions and has been a leader in microsurgical breast reconstruction. Insurance companies are federally mandated to pay for the cost of breast reconstruction - this includes microsurgical breast reconstruction. It is important to recognize that secondary to the complexity of these surgeries not everyone will be a candidate. Previous abdominal surgery, a history of smoking, other medical issues and many other factors can make other breast reconstruction options more appropriate. Dr. Williams will take the time to discuss each patient's options in detail. |
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