Nathalie Krügel von Praxis Binzallee

Flap surgery with autologous tissue from the back

In the event of a delayed or so-called secondary reconstruction and the absence of excess skin, the breast reconstruction not only requires volume, but skin as well. In what is known as pedicled flap surgery we use skin, subcutaneous tissue and muscles from the back to form the new breast. As the muscle does not usually provide enough volume for the entire breast, we insert a silicone implant as well. The existing breast can be adjusted during the same operation, if necessary or desired.

 

Operation

The operation is performed in an inpatient setting, under a general anaesthetic.

The vascular pedicle of the latissimus dorsal flap is elevated to the apex of the axilla and rotated to the breast area. A new breast is then formed with the tissue, and a silicone implant is inserted if required. The drainage tube, which we insert on the back and under the tissue flap, can be removed after 2 to 3 days. The scar on the back is a diagonal line up to 20 cm long. Absorbable sutures are used so there is no need to have any stitches removed.

The existing breast can be adapted to the new breast and the nipple can also be reconstructed in a further operation.

 

Postoperative events

Unlike free tissue flaps, pedicled tissue flaps, in the manner in which we use them, rarely result in impaired blood circulation and partial or total loss of the flap. The implant that is inserted in the body is surrounded by a fine sheath of connective tissue. Thickening of this sheath may very occasionally result in capsular fibrosis.  The excess fluid that may collect in the wound on the back can easily be punctured. Secondary bleeding, infections and unsightly scars may occur, but are easily treatable.

 

 

 

Flap surgery with autologous tissue from the abdomen

A pedicled TRAM flap involves removing skin, fat and muscle from the abdomen to fashion a new breast. Since sufficient tissue is available here we do not need to use a silicone implant. As a result, we can usually give the breast a very natural shape, it is frequently unnecessary to adjust the healthy breast. The operation is, however, more complex than a reconstruction using an implant and causes additional scarring on the abdomen.

 

Operation

The operation is performed in an inpatient setting, under a general anaesthetic.

After making a spindle-shaped incision on the abdomen, the skin, adipose tissue and muscle on a vascular pedicle are then rotated to the breast that is to be reconstructed. This myocutaneous flap is then formed into a new breast and sutured. The abdominal wound is closed with stitches, similarly to a tummy tuck. The drainage tubes, which are inserted under the flap and on the stomach, are removed after 2 to 4 days. No stitches need to be removed as absorbable sutures are used.

The nipple can be reconstructed in a further operation.

 

Postoperative events

Unlike free tissue flaps, pedicled tissue flaps, in the manner in which we use them, rarely lead to impaired blood circulation and partial or total loss of the flap as a result of pressure on the vascular pedicle. A slight weakness in the abdominal muscles usually occurs. If a lot of volume is required, removing muscles from the abdomen can weaken the abdominal wall to such an extent that a nylon mesh has to be inserted to strengthen it. Secondary bleeding, infections and unsightly scars may occur but are easily treatable.