Question: What is an “autogenous” tissue breast reconstruction?

Answer: Autogenous means that the tissues used for breast reconstruction are your own. As a result that your breast reconstruction will be your own soft, warm, natural tissue, rather than consist largely of a breast implant. These reconstructions are carried – out using a variety of flap options which may be available to you.



Question: Aren’t breast implants simpler and easier?

Answer: Initially, it may seem simple because a pocket is created, and then an implant is placed. But that’s not always the case. Often the amount of skin and muscle remaining after a mastectomy may be limited and a pocket therefore may be small or if the skin is very limited, even impossible to develop. In these cases an expander must be placed, and inflated gradually over several weeks in order to create a pocket for the implant by stretching the tissues.



Question: Are there cases where an expander / implant can’t be used?

Answer: Yes, sometimes, if there is a skin graft, or poor quality skin (following radiation therapy), a flap must be used. Some flaps such as latissimus dorsi often require an implant to be placed under them to achieve the desired breast size. While other flaps such as TRAM, Free TRAM or DIEP flap don’t need any breast implants.




Question: Are Breast Implants safe?

Answer: Yes, the best information currently available indicates that breast implants are safe.




Question: What is a capsule contracture?

Answer: Breast Implants are made of foreign materials that the body does react to by surrounding it with a scar. Sometimes the scar can become thick, contract and tighten, so that the breasts may look deformed, feel hard, and even be painful.



Question: Why not reconstruct all breasts with implants?

Answer: In Some patients, who have sufficient amount of good quality skin and muscle, reconstruction with an implant may be a good option. However, more commonly, conditions are not satisfactory for implant or implant expander reconstruction. In these cases a flap reconstruction.




Question: What are some of the Breast Implant disadvantages / complications?

Answer: Breast Implant contracture. Implant foreign bodies and so your body forms a scar around them. Some scars become thick, tight and painful.



Question: What are some of Breast Implant disadvantages / complications?

Answer: Implant infection may occur even after a long time. Implants usually need to be removed, and then replaced once the infection has cleared. Sometimes and autogenous reconstruction with a TRAM or DIEP flap is done instead of replacing the implants.



Question: What are some of Breast Implant disadvantages / complications?

Answer: Implants can leak or rupture. The breast becomes distorted, flat and lumpy.



Question: What are some of Breast Implant disadvantages / complication?

Answer: Implants can become displaced and mal-positioned resulting in significant breast asymmetry. The implant will need to be replaced, or a TRAM or DIEP flap reconstruction can be done.



Question: What are the advantages of autogenous flap breast reconstruction?

Answer: Flap reconstruction adds your own tissue to the area of tissue (breast) loss. Flap tissues reconstruction result in soft natural breasts. Flap tissue reconstruction can be done at the same time as the mastectomy, or at a later time.



Question: What is a perforator flap?

Answer: A perforator flap is the latest type of flap for breast reconstruction. These flaps consist of skin, subcutaneous fatty tissues and its vascular (artery & vein) pedicle, and importantly spare the muscle.



Question: What is DIEP flap?

Answer: A DIEP flap is a type of perforator flap which is based on the Deep Inferior Epigastric Perforator (artery) of groin and includes the skin, subcutaneous tissues of the lower abdomen.



Question: What is an SIEP Flap?

Answer: The SIEP Flap uses the same tissue but is based on the superficial inferior Epigastric perforator (artery) of the groin and includes the skin and subcutaneous tissues of the lower abdomen.



Question: What are GAP flaps?

Answer: GAP stands for Gluteal Artery Perforator Flap. There are two types. The first is the S-Gap or Superior Gluteal Artery Flap which includes an ellipse of skin and subcutaneous tissues from the upper lip and buttocks area. The second is the I-GAP or inferior Gluteal Artery Perforator Flap which include an ellipse of skin and subcutaneous tissues from the lower hip and buttock area.



Question: When might you use a GAP flaps?

Answer: GAP flaps are used when there is insufficient fat of the lower abdomen to use a DIEP flap. Also, GAP flaps are used when a patient has had an abdominoplasty that would preclude the use of a DIEP flap.



Question: What is a S-GAP Flap?

Answer: S-GAP (Superior Gluteal Artery Perforator) Flap is used for women who have very thin abdominal tissues that are inadequate to create a breast mound. This flap is similar to the Superior Gluteal Myocutaneous Flap but without a muscle component. It is based on the superior gluteal artery and consists of the skin and fat from the upper hip and buttocks area, but spares the muscle, and therefore has a longer vascular pedicle. The incision line is designed to be hidden by your undergarments.



Question: What is an I-GAP Flap?

Answer: I-GAP (Inferior Gluteal Artery Perforator) Flap that spares the gluteal muscle, but includes an ellipse of skin and subcutaneous tissues from the lower hip and buttock area aerved by the inferior gluteal artery perforator.



Question: What is a free flap?

Answer: A free flap is a type of autogenous breast reconstruction where the skin, fat and sometimes muscle are dissected along with the blood vessels that serve these tissues. The vessels are then cut, then using a microscope and very fine sutures, these vessels are reconnected to vessels as the mastectomy site to immediately restore circulation. It’s called a “free flap” because the vessels are cut and the entire flap is free of all attachments to the body until the circulation is reconnected.




Question: What is a TRAM flap?

Answer: TRAM stands for Transverse Rectus Abdominis Myocutaneous A TRAM flap is a myocutaneous flap consisting of the rectus abdominis muscle and an overlying paddle of muscle and an overlaying paddle of muscle fascia (sheath), fat and skin with preservation of the deep superior epigastric blood vessel (pedicle) that provides circulation to these tissues. The rectus muscle is divided from its attachment to the pelvic bone and rotated onto the chest.



Question: What is a TRAM Free Flap?

Answer: This is similar to a TRAM Flap but its circulation is based on the deep inferior epigastric artery pedicle. These vessels are divided and then using microvascular surgery are reconnected to vessels at the mastectomy site, immediately restoring circulation.



Question: Can Mastectomy and Breast Reconstruction be done during the same operation?

Answer: Yes. This is commonly done. Usually, dissection of the breast reconstruction flap can begin while the mastectomy is being done, thus shortening the total OR time.



Question: If I’m having chemotherapy or radiation can I still have breast reconstruction?

Answer: Yes. But you need to recover from these treatments first. For chemotherapy that’s usually 3-6 months, and for radiation it is at least 6 months.



Question: Will insurance cover my breast reconstruction?

Answer: Yes, by law they must cover the breast reconstruction surgery of you choice. In fact, for highly specialized procedures such as the DIEP flap there are often no participating surgeons in your plan. Importantly, therefore, the insurance carrier is usually obligated to pay the fees for an out-of-network surgeon.




For more information on Insurance and the Law Click Here to read “Know your Rights“

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