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Direct Implant Reconstruction

 

In certain cases patients may be candidates for direct implant reconstruction. Post mastectomy reconstruction with a direct to implant, or “one-step” approach, allows for a single-stage reconstruction of the breast in the same operation as the mastectomy. This option is best for patients with good preservation of the breast skin following mastectomy, good skin tone, and moderate sized breasts. A permanent implant is inserted immediately following the mastectomy, forgoing the placement of a tissue expander and subsequent expansion process.

A second stage procedure may still be considered in some cases for minor refinements in contour and symmetry without exchanging the implant.  This usually occurs several months after the first primary procedure, allowing time for swelling and healing to occur.

 

Choosing Your Implant

 

Together with your surgeon, you will decide which implant best suits your individual needs. There are two general categories for implants: saline-filled, and the new generation of silicone cohesive gel-filled implants (“gummy bear implants”). The advantages of gel implants are that they tend to be softer; with a feel that is more like natural breast tissue. Also, gel implants can have less rippling and visibility as compared to saline implants. Both types of implants come in numerous shapes, sizes, and profiles.

 

In two to three months, the next stage of surgery will be performed to reconstruct the nipple and areola. If desired, additional contouring procedures, such as fat injections, can be performed to adjust breast shape at this third stage.

A PRACTICE DEDICATED TO BREAST RECONSTRUCTION

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DIEP . SIEA . Stacked DIEP . PAP . DIEP-DCIA . TUG . S-GAP

 

 

ATL DIEP

 

Dr. Theresa Wang and Dr. Samuel Shih are amongst only a handful of surgeons in Georgia that routinely utilize the DIEP and SIEA flaps in breast reconstruction. These techniques utilize the patients’ own abdominal skin and fat to recreate the breasts while sparing the abdominal muscles.

 

DIEP FLAP

 

The DIEP flap is the latest modification of the traditional pedicled TRAM procedure. The TRAM was pioneered by Dr. Carl Hartrampf in 1981 and actually originated in Atlanta, Georgia. Since then, there have been several modifications such as free TRAM and muscle sparing TRAM. These modifications have resulted in a flap with a more robust blood supply and less abdominal wall morbidity.

 

The DIEP flap is a free flap where the abdominal muscles are preserved. Only the skin and fat is utilized in the breast reconstruction thus causing even less abdominal wall morbidity.

 

The skin and fat is removed from the abdomen via a tummy tuck incision while keeping the blood supply attached via the Deep Inferior Epigastric Vessels. The skin/fat flap is then transplanted to the chest where it is connected to blood vessels using a microscope. The skin and fat is then molded into the shape of a breast.

 

STACKED DIEP

 

The Stacked DIEP Flap is where both sides of the abdomen (two DIEP flaps) are used to reconstruct one breast. It is an option for unilateral breast reconstruction in woman who do not have sufficient fatty tissue for a single DIEP flap breast reconstruction.

 

This technique provides the opportunity for woman, who usually are not candidates for abdominally based breast reconstruction, to receive DIEP flap reconstruction.

 

Dr. Theresa Wang and Dr. Samuel Shih are amongst the most experienced in Georgia in Stacked DIEP Flap breast reconstruction. This allows women with insufficient fatty tissue, who need reconstruction of only one breast, the option of DIEP flap reconstruction. 

 

SIEA FLAP

 

The SIEA flap does not violate the abdominal fascia or muscle at all. It is essentially a tummy tuck, with preservation of the blood supply to the abdominal skin and fat. The blood supply, Superficial Inferior Epigastric Artery, does not run through the abdominal musculature like the DIEP flap and therefore no violation of the abdominal fascia and muscle is needed at all. While this would make this the ideal flap, the SIEA is frequently too small to provide robust bloody supply to the flap. Given the potential benefits, the SIEA and SIEV is dissected out and examined in every patient undergoing abdominally based free flap reconstruction of the breasts. The SIEA flap will be offered to our patients based on our intra-operative findings.

 

EXTENSION FLAPS – DIEP-DCIA

 

There are women who require a little more fatty tissue, that cannot be provided by DIEP flaps alone, to achieve their desired size.  These women may have the option of a DIEP flap with DCIA extension. This is where the DIEP flap is extended to another zone supplied by the Deep Circumflex Iliac Artery. This adds an additional microvascular connection thus allowing for more blood flow to the larger flap.

 

 

Abdominally based free flap breast reconstruction is dependent on the availability of skin and fat from the abdomen.  Some woman are not candidates given their prior surgical history such previous abdominoplasty “tummy tuck” or major abdominal surgery. Others, simply do not have enough fatty tissue to reconstruct the breast.

There are other donor sites that can be considered for some patients:

 

 

BRCA Reconstruction

 

What do we know about heredity and breast cancer?

 

Each year, approximately 200,000 women in the United States are diagnosed with breast cancer, and one in nine American women will develop breast cancer in her lifetime. However, hereditary breast cancer — caused by a mutant gene passed from parents to their children — is rare. Estimates of the incidence of hereditary breast cancer range from between 5 to 10 percent to as many as 27 percent of all breast cancers.

 

In 1994, the first gene associated with breast cancer — BRCA1 (for BReast CAncer1) was identified on chromosome 17. A year later, a second gene associated with breast cancer — BRCA2 — was discovered on chromosome 13. When individuals carry a mutated form of either BRCA1 or BRCA2, they have an increased risk of developing breast or ovarian cancer at some point in their lives. Children of parents with a BRCA1 or BRCA2 mutation have a 50 percent chance of inheriting the gene mutation.  If a patient carries BRCA gene, they can have a lifetime risk of 50-70% of developing breast cancer.

 

BRCA Reconstruction

 

In the event you are diagnosed with a BRCA1 or BRCA2 mutation and have been referred for prophylactic, or risk-reducing  mastectomies, you have several options in breast reconstruction:

-DIEP flap reconstruction

-Direct to implant reconstruction

-Implant-based reconstruction with tissue expanders

 

© 2014 ATL DIEP

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