The method of breast reconstruction own tissues has gained popularity because it provides a more lasting results, while using the implants, they need to be replaced every 10 - 15 years, to the same consistency of the stomach tissue is almost the same as the mammary glands. However, its sensitivity is much less (as opposed to the blood vessels to restore the tiny nerve fibers that have not yet).
The technique of plastic breast tissue proper is that this part of the flap contains only skin, fat tissue and blood vessels - namely, the deep inferior epigastric artery (hence the acronym DIEP). The muscles in the flap does not. This is the main difference between the methods of DIEP and TRAM.
Due to the fact that the DIEP procedure is not carried out excision of muscle, the recovery period takes place at the same time easier and faster. In addition, this technique has a smaller risk of weakening the muscle layer of the abdominal wall, and less discomfort.
Another important difference from the technique DIEP TRAM technique is a method used by the flap of tissue blood flow. In DIEP flap technique is called free because it is completely separated from the underlying tissues. To restore the blood supply to the free flap microsurgical technique is applied. Therefore, patch plasty technique of DIEP Flap lasts longer (about 5:00 in the reconstruction of one breast, and 8 - for both). TRAM flap procedure when all of the tissues of the stomach is not separated, so it retains its blood supply.
As is the case with the method TRAM Flap, DIEP procedure ends holding abdominoplasty («tummy tuck») - Plastic surgery in the anterior abdominal wall.
DIEP technique is used in plastic surgery since 1990. Due to its complexity and potential complications, it is not shown for all patients. Involved in this procedure by specially trained surgeons, experienced in microsurgical techniques. As mentioned, the technique of DIEP Flap is shown not all women. This is a good choice if the woman has enough tissue for transplantation of free flaps. It is said that this technique is applicable even if you have had in the past, surgery in the abdomen (hysterectomy, appendectomy, bowel resection, liposuction).
The technique is contraindicated in DIEP Flap: Thin patient with a very small margin of adipose tissue Women who smoke, because they have the deterioration of microcirculation, which adversely affects the engraftment of the transplanted graft.
Techniques DIEP Flap procedure
Horizontal incision in the abdomen excised flap containing skin with subcutaneous fatty tissue and blood vessels. The flap is created in a manner reminiscent of the mammary gland, and filed in the appropriate place. The blood vessels are restored under the operating microscope. This operation takes about 5 hours.
Compared with patients undergoing surgery by the method of TRAM Flap, DIEP Flap technique differs less severe postoperative pain. However, this type of plastic surgery is difficult and requires about 4 weeks recovery period.
Methods of latissimus dorsi flap
Latissimus dorsi muscle - one of the largest, for which he speaks her name. It is located under the shoulder blade behind the axillary region, its base being attached to the spines. When this operation is carried out oval section of skin, fat, and latissimus dorsi flap is removed and carried through by a tunnel under the skin to a remote area of the breast. If possible, the blood vessels remain intact. Flap attached to the type of breast cancer and it is filed. In the event of damage to blood vessels, they are restored with the help of a microscopic technique. This procedure takes about two - three hours. The technique using latissimus dorsi flap - the only good option for patients with small and medium size of the breast, as in this part of the back is very little fat. Therefore, almost always have to be used during the implant surgery to give the desired shape of the breast.
Pros and cons of techniques using the latissimus dorsi muscle flap: Plus: this method is preferred by many surgeons for its ease of implementation and low risk of complications.
Minus: the color and texture of the skin of the back are different from those qualities of the skin of the breast.
Less: use of the latissimus dorsi flap also leads to distortions in the back. However, it is usually a function of the back muscles is not affected.
Using the breech of the flap
Field of the buttocks - another excellent source of tissue in plastic surgery, including the reconstruction of the breast. Although transplantation of tissue from the buttocks - the first thing that may come to mind is a woman, this technique is very complicated and is accompanied by complications, which is why it is rarely used.
With this operation, with an oval cut is carried out excision of the flap with the skin, fatty tissue and muscle, which is then stitched in breast cancer. Flap attached to the form of breast cancer. Depending on the desired size of breast implants can be used additionally.
Technique of this method is rather complicated operation, since the transplant with a gluteal flap on the breast has completely crossed all the blood vessels, which then should be restored under a microscope. The duration of this operation can be up to 12 hours! If the reunion vessels are damaged, it can lead to the fact that the flap does not take root.
Patch plasty technique TRAM Flap
The acronym TRAM mean transverse and rectus abdominis. TRAM Flap technique is by far the most popular method of breast reconstruction after mastectomy in patients, especially those who have excess fat in the abdominal wall. With this operation, you can spend, and tummy tuck («tummy tuck»).
However, this method of breast reconstruction is shown not all women: Thin women who do not have enough tissue in the abdomen, Smoking women, since in this case the deterioration of the microcirculation in the tissues, Women with multiple post-operative scars in the abdominal wall.
How is the plastic flap TRAM Flap
From the lower abdominal flap excised oval, consisting of skin, fascia, adipose tissue and muscle. This flap is carried out through a tunnel in the area of breast cancer. Blood vessels, thus, remain attached to the flap. Next, the surgeon attaches the appropriate tissue type of the breast and captures the seams in place. If a blood vessel had to cut a flap when it is moved by means of microsurgical techniques to the flap sutured blood vessel. This technique can be combined with reconstruction using an implant. The whole operation takes about three hours.
Plastic flap TRAM Flap after double mastectomy
In breast reconstruction after a double mastectomy used a single flap of the abdominal wall, and taking into account in order to restore the shape of the breast on both sides. The resulting flap is divided into two parts, each of which serves to restore the shape of each breast. This operation takes twice the time - six hours. It is noted more severe recovery period.
What you need to know about the method of TRAM Flap
Many patients are satisfied with the fact that when this technique is taken from the abdominal adipose tissue. Here are some points that need to be aware of this procedure: A long scar: as of the abdominal flap is taken long after that remains a postoperative scar in the abdomen.
Offset belly button: Due to the fact that after excision of the flap in the abdominal area are shifting and stretching the navel, the physician can re-create a new belly button.
The loss of sensitivity due to the fact that when you move the flap is a destruction of nerve fibers, reconstituted mammary gland has a much lower sensitivity.