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Breast reconstruction plastic surgery
To get answers to the most frequent questions about breast reconstruction
plastic surgery, the latissimus dorsi flap, the PEG procedure,
and nipple/areolar reconstruction, please select one of the links
below:
Are there any other uses for the latissimus
dorsi flap?
Because of the low risk of fat necrosis, latissimus dorsi flaps
are favored for reconstruction of smaller defects from breast
conservation surgery, for example following lumpectomy or quadrantectomy.
In these instances an implant is often not needed. The latissimus
flap can be used in reconstruction following "skin-sparing"
mastectomies and is an integral part of the PEG
procedure.
In a rare condition known as Poland's Syndrome where there is
a partial absence of the breast and its underlying pectoral musculature,
the latissimus flap is used to reconstruct the fold in the front
of the axilla.
Like the TRAM flap the latissimus flap has many uses in plastic
surgery in addition to breast reconstruction.
What about scarring with the latissimus flap?
In order to harvest the flap, an incision must be made overlying
the latissimus dorsi muscle. Recently the techniques of endoscopic
surgery have been used to harvest latissimus dorsi flaps although
the advantage of this method is largely limited to instances where
only the muscle is transferred without the overlying skin (muscle
flap).
When skin is transferred as part of the flap, a skin paddle (or
ellipse) must be designed overlying the muscle that results in
a scar at least as long as the ellipse. There is some variability
in the location and orientation of the ultimate scar that can
be designed to fall along a brassiere strap or more obliquely
along the line of a low cut dress.
The location and length of the scar following latissimus dorsi
myocutaneous (muscle and skin) flap transfer is perhaps the greatest
limitation of the technique.
Will drains be needed after a latissimus flap?
In most cases one or more drains are placed at the site of the
newly reconstructed breast. In addition, the latissimus donor
site will also require the placement of surgical drains to heal
properly.
These drains are usually required for about 10 - 14 days because
the tissue in this area has a tendency to accumulate fluids.
I'm having a "skin-sparing" mastectomy
-- what does this involve and can I have reconstruction?
Skin-sparing mastectomy procedures are designed
to preserve the envelope of breast skin and the inframammary fold,
resulting in a significant reduction in the amount of scarring
produced during the mastectomy.
There are several different incisions that are used for skin-sparing
mastectomies, but most involve an incision that circles the areola.
Sometimes an additional incision is performed in the axillary
area.
Skin-sparing mastectomies can greatly facilitate subsequent reconstruction
that is usually performed on an immediate basis. Two recent articles
illustrated outstanding results with reconstruction following
skin-sparing mastectomies -- one using the latissimus dorsi flap
and one using solely autologous techniques.
Reconstruction with autologous techniques following skin-sparing
mastectomy requires only a very small amount of donor skin, (limited
to the area of the areola in a complete skin-sparing mastectomy),
thus minimizing color and contour matching problems. (References:
Slavin, S.A., et. al. Skin-Sparing Mastetomy and Immediate Reconstruction:
Oncologic Risks and Aesthetic Results in Patients with Early-Stage
Breast Cancer Plast. Reconstr. Surg. 102: 49, 1998. Hidalgo, D.A.,
Aesthetic Refinement in Breast Reconstruction: Complete Skin-Sparing
Mastectomy with Autogenous Tissue Transfer Plast. Reconstr. Surg.
102: 63, 1998).
What is the "PEG Procedure?"
The PEG Procedure is a type of skin-sparing
mastectomy combined with immediate reconstruction utilizing a
latissimus dorsi flap.
What are the goals of nipple/areolar reconstruction?
The creation of the nipple/areolar complex is regarded as the
final step in modern breast reconstruction following modified
radical mastectomy.
The goals are similar to the overall goals of reconstruction
-- symmetry in size, shape, color and projection (protrusion)
of the nipple and symmetry in size, color and placement of the
areola.
How is the nipple reconstructed?
While there have been many different techniques used over the
years, the most common method of nipple reconstruction today is
by means of a local flap. Many flaps have been devised but most
use a rotation and folding of the skin adjacent to the nipple's
final location.
One of the most popular techniques is known as the "skate
flap." Some other flaps include the fishtail flap, tab flap,
omega flap, star flap and Bell flap.
Plastic surgeons have used the other nipple and even the earlobe
as donor sites for nipple reconstruction. Some surgeons have even
used composite tissue transfer or prosthetic material for nipple
reconstruction.
Appearance shortly after
nipple reconstruction in breast
reconstructed with the
expander-implant method
(J. O'Connell, M.D.)
Do I need to go to the hospital for nipple
reconstruction?
Nipple reconstruction can be performed without the need for general
anesthesia. Depending on your plastic surgeon's preference and
the technique chosen, the procedure can be performed either in
the office or as an outpatient hospital or surgicenter procedure.
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Reconstruction Index
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454-0044.
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