JOHN M. TAYLOR MD, FACS
LONG BRANCH, NEW JERSEY
732.483.1800
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DIEP FLAP BREAST RECONSTRUCTION
And
TRAM & LATISSIMUS DORSI FLAPS
Dr. John Taylor performs the most advanced microsurgical reconstruction of the breast after a mastectomy, the Deep Inferior Epigastric Perforator flap (DIEP flap) procedure. He helped initiate one of the first DIEP teams in New Jersey, bringing together surgeons, anesthesiologists, physician assistants and nurses, and they now have the most surgical experience with DIEP flap reconstruction in the region. This ground-breaking surgery allows a woman to use her own tissue from her abdomen to reconstruct natural looking and feeling breasts.
The DIEP flap uses microsurgical techniques to remove abdominal skin, fat and blood vessels (the perforators) without removing any core abdominal muscle (as is done in the TRAM flap-see below). The abdominal flap is then transferred to the chest wall where the blood vessels are connected with microsurgery to the blood vessels at the mastectomy site. A breast form is created that looks and feels much like a woman’s natural breast. This procedure can be done at the time of mastectomy, or it may be performed as delayed reconstruction, at a later date. In addition, the abdominal flap removed can be used to create two breasts in patients undergoing a double mastectomy, or only one breast in unilateral mastectomy patients. And since the tissue taken to create the new breast/s is virtually the same as that taken for a cosmetic abdominoplasty, these patients get a tummy tuck in the process.
A hospital stay of 4-7 days is required, and Dr. Taylor will closely monitor the condition of the flap and its circulation. It is important for patients to discuss their complete medical, surgical and social history, especially if they smoke cigarettes, to determine the risks associated with this surgery. Poor candidates are those who smoke, have diabetes or are obese. Delayed reconstruction may be recommended in some cases where radiation therapy may be required post-mastectomy. Good candidates are women who have enough fat and skin of the abdomen to create the breast forms desired. Other good candidates include women who have undergone failed tissue expander/implant reconstruction in the past. In addition, the vessels that will provide the flap must be of adequate size and function. The integrity of these vessels is evaluated during a pre-operative CT angiogram of the chest, abdomen and pelvis. Other pre-op testing will be performed to determine candidacy, including an EKG and blood work.
After the surgery, patients will be given prescription oral medication for pain as well as antibiotics to prevent infection. Patients may resume light activity in about 2 weeks but are to avoid strenuous activity for 6 weeks. Patients usually return to work in 6-8 weeks. Numbness and a firm feeling over the skin’s surface will resolve in a few months and the final results are complete several months after the surgery. If you are considering breast reconstruction at the time of mastectomy or even many years after a mastectomy, the DIEP flap procedure should definitely be a consideration. Patients regain very natural looking and feeling breasts as well as the benefit of a tummy tuck without the necessity of a prosthetic breast implant. Call the office today to schedule your personalized consultation with Dr. John Taylor to determine if the DIEP flap is good for you.
As with the DIEP flap, the Transverse Rectus Abdominus Muscle flap (TRAM flap) uses skin and fat from the lower abdomen to re-create the breast. However, the underlying abdominal muscle is used for blood supply to the tissue in the TRAM as the flap is tunneled under the skin to the chest. This flap, which is never fully disconnected, is brought up and out through the mastectomy site and the tissue is sculpted to look as much like the other breast as possible. The lower abdominal site is closed to achieve cosmetic results similar to a tummy tuck. The TRAM flap can be used to create one or two breasts, as is desired. The recovery time includes a 3-5 day hospital stay and 6-8 weeks for a full recovery.
Another option for breast flap reconstruction utilizes the latissimus dorsi muscle. This muscle flap is taken from the back of the body (next to the shoulder blade) and is tunneled to the front mastectomy site. Because there may not be enough “filler” tissue in this area of the back to match the size of the other breast or to achieve the desired size of the breast, this procedure may also require the placement of an implant. Generally, the latissimus dorsi donor site is used in cases where the abdominal tissue is not suitable for reconstruction.
In order to determine the best breast reconstruction option for you call Dr. John Taylor today. All of your questions will be answered during your personalized consultation.
