Cancer

DIEP flap? TRAM flap? SIEA flap? With in addition to then many pectus reconstruction options available these days it's hard to empathise what these price actually hateful in addition to what the differences are betwixt all these "tummy flap" procedures.

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:


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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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Implant pectus reconstruction is the most mutual method of pectus reconstruction currently performed inwards the US. There are 2 principal approaches: the "Alloderm one-step" (also referred to equally "single stage" or "direct to implant" reconstruction), as well as the two-stage reconstruction alongside tissue expanders. To easier explicate the ins-and-outs of the one-step procedure, I start ask to summarize the to a greater extent than traditional two-stage approach...

Tissue expanders essentially human activity equally "spacers". They tin either live placed at the same fourth dimension equally the mastectomy or some fourth dimension later. They are inflated alongside saline injections to recreate the desired pectus size. This expansion physical care for tin lead maintain several weeks depending on the amount of expansion required to accomplish the optimal loving cup size. Once the expansion physical care for is completed, the tissue expanders are removed as well as the concluding implants are placed. Reconstruction alongside pectus implants is thence unremarkably performed equally a multiple-step physical care for as well as tin lead maintain several months.

Alloderm One-Step / Single Stage / Direct to Implant Reconstruction

Some patients are candidates for a "One-Step" physical care for whereby the permanent implant is inserted at the fourth dimension of the mastectomy. Influenza A virus subtype H5N1 cadaveric implant known equally Alloderm is besides used to supply extra implant coverage as well as support. By going straight to the concluding implant inwards a unmarried stage, the patient has solely i physical care for as well as avoids the purpose of a tissue expander (and the whole expansion process) altogether. The scar tin besides live placed inwards the inframammary bend (at the pectus crease) which makes it much easier to hide. The One-Step physical care for is besides referred to equally "direct to implant" or "single stage" reconstruction.

This physical care for is apparently really appealing to many women, including those that may non live candidates for perforator flaps. The downwards fourth dimension inwards damage of recovery is besides much shorter than most of the alternatives (2-4 weeks).

There are some caveats though.... I used to offering this physical care for to most patients. Some One-Step surgeons even then do. Personally, I don't anymore - "the perfect candidate" for the physical care for has evolved inwards my eyes. Experience (and grayness hair) has a vogue of doing that.

So who is the "ideal candidate"?

1) Patients that practise non lead maintain a electrical flow pectus cancer diagnosis

2) Patients that are having rubber mastectomy only, e.g. for BRCA1 or BRCA2

3) Patients that are having nipple-sparing mastectomy

4) Patients that practise non ask a pregnant pectus lift

5) Patients that lead maintain non had previous breast/chest radiation


By limiting the physical care for to women who fulfill these strict criteria the surgical results are far to a greater extent than predictable as well as really cosmetic. The opportunity of farther revision or "touch up" procedures is besides really low.

PRMA patient Mrs Michelle Coben kindly shares her sense alongside the One-Step physical care for inwards the video below. You tin besides consider before as well as after pictures here.



I promise this information helps.

Dr C



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