It is of import for women considering these reconstructive options to realize that non all tum tissue options are created equal. For example, a DIEP flap is non the same every bit a TRAM flap only because both provide the exercise goodness of a tum tuck.
Many women are similar a shot rejecting pectus implants preferring to role their ain abdominal tissue for reconstruction subsequently mastectomy. Influenza A virus subtype H5N1 pectus that has been reconstructed alongside the patient's ain tissue typically looks in addition to feels to a greater extent than natural than an implant reconstruction, volition final longer without the long-term complications that tin give the sack live associated alongside implants, in addition to volition every bit good historic menses similar a natural breast. Women wanting to role their abdominal tissue convey iii reconstructive options: TRAM flap, DIEP flap, or SIEA flap.
The TRAM flap is a real mutual pectus reconstruction technique that requires the sacrifice of at to the lowest degree a constituent of the rectus abdominus (sit-up) muscle. There are iii dissimilar types of TRAM flap ("pedicle", "free", in addition to "muscle-sparing free"): the exact type is defined past times the sum of abdominal musculus removed. Unfortunately, TRAM surgical operation tin give the sack live associated alongside meaning post-operative pain, prolonged recovery in addition to a host of abdominal complications such every bit loss of abdominal musculus describe (up to 20% or more), bulging (or "pooching"), in addition to fifty-fifty abdominal hernia.
The DIEP flap physical care for is similar to the TRAM flap except that it spares the rectus abdominus musculus completely. Only pare in addition to obese are removed from the abdomen. This tissue is disconnected from the trunk completely, transplanted to the pectus in addition to re-connected using microsurgery to exercise the novel breast. As the sit-up musculus is saved completely in addition to left behind inwards its natural place, the jeopardy of abdominal complications is much less than alongside a TRAM. There every bit good tends to live less hurting in addition to a quicker recovery fourth dimension because the abdominal muscles are preserved in addition to left inwards place.
Like the DIEP flap, the SIEA (Superficial Inferior Epigastric Artery) flap completely preserves the abdominal muscles. The primary divergence betwixt these 2 procedures is the artery used to provide blood current to the newly reconstructed breast. The “SIEA” blood vessels are to a greater extent than often than non works life inwards the obese tissue only below pare whereas the “DIEP” blood vessels run below in addition to inside the abdominal musculus (making the DIEP to a greater extent than technically challenging). Recovery from the SIEA flap is fifty-fifty easier than the DIEP since the abdominal muscles are non disturbed at all during the surgery.
Despite the similarities betwixt these 2 surgeries the SIEA flap is used much less ofttimes than the DIEP flap because less than 20% of patients convey the appropriate anatomy. Unfortunately, at that topographic point are no pre-operative tests to reliably exhibit which patients convey the appropriate anatomy in addition to the conclusion every bit to which physical care for to perform is made intra-operatively past times the plastic surgeon based on the anatomy works life at the fourth dimension of surgery.
Since the TRAM, DIEP in addition to SIEA procedures all role the patient's lower abdominal pare in addition to fat, all these abdominal flap options provide the added exercise goodness of a tum tuck at the same fourth dimension every bit the pectus reconstruction.
There are many plastic surgeons inwards the US offering TRAM flap reconstruction. Unfortunately, real few centers inwards the US routinely perform the advanced microsurgical procedures similar the DIEP in addition to SIEA flap. Many patients volition hence convey to move for these procedures.
When considering a reconstructive surgeon, ensure he/she is a plastic surgeon certified past times the American Board of Plastic Surgery that has extensive experience alongside this specific type of surgery. Also inquire close the success charge per unit of measurement inwards their hands - most specialists boast a flap survival charge per unit of measurement of 97% to 99%+.
The 2 websites below listing surgeons that offering DIEP in addition to SIEA flap reconstruction in addition to serve every bit a adept starting indicate when researching surgeons:
www.diepbreastreconstruction.org in addition to www.breastrecon.com
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Dr Chrysopoulo is a board certified plastic surgeon at PRMA Plastic Surgery. PRMA specializes inwards microsurgical pectus reconstruction including the DIEP flap procedure. PRMA has performed thousands of DIEP flaps in addition to is In-Network for most US insurance plans. On Facebook?.... Connect alongside other pectus cancer patients inwards our FB Breast Cancer Reconstruction Community.
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