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PROCEDURES / BREAST RECONSTRUCTION
TISSUE-BASED BREAST RECONSTRUCTION
Tissue transfer from one part of the body to the breasts can be performed to restore the volume and shape of the breasts. Most commonly, excess lower abdominal tissue is transferred to the breasts. The technique of tissue transfer—relying on a maintained connection to underlying muscle (such as a TRAM flaps), relying on microsurgical transfer based on a more limited muscle harvest, or a muscle sparing approach (free TRAM flaps or DIEP flaps)—is planned preoperatively based on a shared decision-making process.
There are patient characteristics that can limit the utility of abdominal tissue transfer, such as a smoking history, previous abdominal wall surgery (such as abdominoplasty), or medical comorbidities.
Another source of donor tissue is the latissimus flap. This technique relies on the transfer of back skin and fat, usually carried on the underlying latissimus muscle, which is rotated into the breast under the lateral chest wall skin. In most cases of latissimus muscle flap transfer, an implant is required to provide sufficient volume to reproduce the desired breast volume. Autologous fat grafting or lipofilling is being done more often with the latissimus flap transfer to add to the tissue volume and limit the use of an accessory implant.
If a mastectomy is performed on one side only, procedures to improve symmetry of the remaining breast—such as breast lift or reduction, or placement of a breast implant to the remaining breast—can be done. Based on the Women’s Health and Cancer Reconstruction Act, a federal law enacted in 1998, these symmetrizing procedures are considered part of the reconstruction and these federal mandates ensure insurance coverage.
The advantages of tissue transfer procedures are related to the natural feel of the transferred tissue and the limited requirement for revision surgery once the desired breast shape is achieved. Hospital stays of 1–4 days can be expected in tissue-based reconstruction, as there is a donor surgical site as well as the mastectomy site. Return to normal activities can be expected in 6–8 weeks.