BREAST RECONSTRUCTION WITH AUTOLOGOUS TISSUE
Informative material about breast reconstruction procedures after breast cancer
There are many options for breast reconstruction which use the patient’s own tissues. Such reconstructive options are however limited by specific clinical situations; in fact, they require long surgical operations. In some cases, it is possible to avoid the use of a prosthetic implant, while in others the operation is aimed at just integrating the lost breast volume after a radical mastectomy or after the damages of radiation treatments. These complex plastic and reconstructive surgery techniques are based on transferring to the breast site portions of skin and fat, sometimes together with some muscular tissue, from another body district. These are techniques that require a certain availability of tissue from the donor site, which sometimes requires a previous expansion, and a particularly good health state which allows for a more extensive and demanding surgical operation respect to an implant-based reconstruction. The flap of tissue can be harvested resecting its blood vessels and reconnecting it then to the circulation (anastomosis) also in a different body part to keep it alive, otherwise it can be sutured in another position while remaining connected to its own blood vessels.
Some complications typical of this kind of operations can be related to the healing process of the donor site, involve scars or other aesthetic features due to a different appearance of the skin between the donor site and the breast.
The most common flaps
Latissimus dorsi muscle flap
The latissimus dorsi muscle flap is an eye-shaped portion of skin and muscle harvested from the lateral part of the back, at about the same height as the breast, which is then repositioned on the chest. This technique is used to provide more tissue to the breast or substitute damaged tissue because of radiation therapy, but usually, it does not exclude the need for a prosthetic implant.
TRAM Flap
The TRAM flap (transverse rectum abdominis muscle flap) requires the transposition of a portion of skin and subcutaneous tissue keeping it connected to the abdominal blood vessels that feed it but performing an incision on the rectus abdominis muscle in order to untether them and perform the transposition. Another flap from the abdomen is the DIEP flap (deep inferior epigastric artery perforator flap): skin and subcutaneous tissues are harvested, the abdominal muscles are only incised to reach the deepest part of the blood vessels that will feed the flap once grafted on the chest and connected to the local blood vessels.
The possibility of using a flap is determined through the evaluation of the surgeon, who also considers the preferences and the expectations of the patient. However, the surgeon’s decision cannot disregard the general state of the patient, the possible conditions she suffers and the quality of the subcutaneous tissue in the possible donor sites. Beyond the techniques described here, which are the most common, many other flaps exist and can be used in breast reconstruction. However, they are very delicate procedures, and few centres have personnel able to perform such surgeries.