Immediate Reconstruction with your Own Tissue

Flap from your Back (Latissimus Dorsi or LD flap)

This is a flap of muscle and surrounding fat with an overlying patch of skin. This muscle remains connected to its blood vessels coming through armpit which makes it extremely useful for breast reconstruction.

In this procedure, the muscle is transferred to the breast area by swinging it around the ribcage so that it lies at the front of the body. The ellipse of skin brought with it replaces the skin removed at the time of mastectomy. Most women will also need an implant to further supplement the volume of the breast, but sometimes it is possible to remove enough fat from the back along with the flap of skin and muscle to replace the missing breast volume without the need for an implant. This procedure is a larger operation than using an implant alone, but it will usually give a more natural result, particularly if an implant is not needed.

It does result in quite a large scar on your back, but this can usually be positioned to be concealed by most clothing and underwear. It takes 3-4 hrs long operation and you are likely to be in hospital for 3-4 days. Healing takes 3-4 week and complete recovery takes 3-4 months. Losing the muscle from the back does not seem to cause any restriction of shoulder movement or strength in most patients but does affect strength involving climbing and rowing sports. It is more suitable for relatively heavily built women who have small to medium sized breasts.

Complications: Bleeding, Flap loss (less than 1%), fluid build-up at the back (seroma) sometimes need aspiration in clinic and tightness of the back.

 

Flap from your Abdomen (DIEP flap)

The skin and fat of the lower tummy is often the ideal tissue for breast reconstruction because a large amount of skin and volume can be replaced to achieve a very natural look and feel. Removal of excess skin and fat can often be a welcome bonus, resulting in a “tummy tuck”. Whole fold of fat from lower tummy (abdomen) is removed along with its blood vessels and re-plumbed up in the chest/breast area. You would normally need a scan before the surgery to check your suitability for this flap.

Whilst abdominal flap reconstruction can give the best results, this comes at a cost of a major operation and long recovery. It takes 6-7 hours of operation time and you stay in hospital for a week out of which 1-2 day in intensive care unit. Healing takes 6-7 weeks and full recovery about 6 months. There will be scars on the breast and a large scar across the whole lower tummy as well as around the belly button (umbilicus). However, in the long term, most women notice no real problems in day-to-day activities. Once the breast reconstruction process is complete then the shape and appearance are usually stable and permanent.

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