The DIEP flap physical care for has apace buy the farm the "gold standard" inwards pectus reconstruction today. While non every adult woman is a candidate for DIEP flap surgery, many are turned away when inwards fact they needn't be. The most mutual areas of confusion include:
1) Previous Abdominal Surgery
While to a greater extent than or less types of previous abdominal surgical physical care for tin brand the DIEP flap physical care for impossible to perform, most of the fourth dimension previous abdominal surgical physical care for actually isn't an issue.
Many women these days bring had a previous c-section or hysterectomy. It is possible for these procedures to drive impairment to the blood vessels needed for DIEP flap surgery, simply this is rare. Influenza A virus subtype H5N1 previous c-section, hysterectomy, or tubal ligation is non a contra-indication to having the procedure.
If your surgeon is worried well-nigh potential impairment from previous surgical physical care for in addition to thence for sure tests tin live performed to examine the anatomy to a greater extent than closely. This tin include a elementary doppler ultrasound assay inwards the component subdivision or a to a greater extent than involved assay similar a CT angiogram.
So which previous surgeries DO drive a problem? Women that bring had a previous TRAM flap, tummy tuck or really extensive abdominal wall surgeries (like complex repairs of huge hernias) cannot bring a DIEP or SIEA flap reconstruction because the lower stomach tissue that is needed has already been removed, disconnected or moved around.
While previous abdominal surgeries may non forbid DIEP flap reconstruction, women that bring had multiple previous abdominal procedures are at increased guide chances of abdominal complications similar bulging in addition to fifty-fifty hernia afterwards DIEP flap surgical physical care for when compared to women that bring never had prior abdominal surgery.
2) An Umbilical Hernia
It is really unlikely that an umbilical hernia would forbid DIEP flap surgery. Most umbilical hernias are small. Influenza A virus subtype H5N1 really large umbilical hernia tin brand the surgical physical care for harder simply fifty-fifty this is non commonly a contra-indication to having the procedure.
3) Previous Chest Radiation
One of the most of import things for the reconstructive surgeon to arrive at is to supervene upon the damaged, theatre irradiated tissue alongside normal, healthy, soft tissue. If the irradiated tissue is non good for yous plenty to live used equally component subdivision of the reconstruction (as is the instance inwards many instances), it volition live removed in addition to replaced yesteryear the good for yous (DIEP) tissue.
I bring visited alongside a fair number of patients who bring previously been told they are non candidates for DIEP flap reconstruction because they received pectus radiations afterwards their mastectomy. I do not portion this opinion.
Most of the fourth dimension this advice seems to stalk from fearfulness that the radiations may bring caused impairment to the internal mammary vessels inwards the chest. These are the blood vessels that are commonly used to connect the DIEP flap to the chest. In reality it is exceptionally rare for us to uncovering these blood vessels are damaged in addition to cannot live used.
4) Not the Right Amount of Tissue
You don't quest to live overweight to live a candidate for a DIEP flap. What matters is the distribution of the fat. We bring performed DIEP flaps on smaller breast, sparse women alongside a BMI (body volume index) of twenty (and fifty-fifty less) because the fatty that they did bring was "in all the correct places". Having said that, in that location is an upper boundary beyond which the risks of surgical physical care for outweigh the benefits - At PRMA nosotros laid an upper BMI boundary of twoscore equally nosotros bring institute that performing the physical care for on women alongside BMIs greater than this significantly increases the rates of complications (especially injure healing problems).
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Dr Chrysopoulo is a board certified plastic surgeon specializing inwards the latest pectus reconstruction techniques . He in addition to his partners are in-network for most the U.S. of A. insurance plans. Learn to a greater extent than well-nigh your breast reconstruction options in addition to connect alongside other pectus reconstruction patients here. You tin likewise follow Dr C on Twitter!
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Showing posts with label bulging. Show all posts
Showing posts with label bulging. Show all posts
Healty | Breast Reconstruction With Tummy Tissue (Abdominal Flaps)
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:
*****
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.
*****
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
*****
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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Healty | Abdominal Muscle - Why Save It?
Most women that accept looked into thorax reconstruction know almost the TRAM flap. The TRAM uses lower abdominal skin, fat, as well as varying amounts of abdominal musculus to reconstruct a "natural", warm, soft thorax subsequently mastectomy. The TRAM used to live the gilded criterion inwards thorax reconstruction, but non anymore.
Over the years, the TRAM flap physical care for has evolved into ii to a greater extent than advanced procedures that decrease the direct chances of abdominal complications: the DIEP flap as well as the SIEA flap. Both role the same lower stomach peel as well as fatty but different the TRAM, both SAVE all the abdominal musculus as well as acquire out it inwards place.
The SIEA flap differs from the DIEP flap exclusively inwards price of the blood vessels that render the tissue. While the surgical training is slightly different, both procedures spare the abdominal musculus completely as well as exclusively role the patient's peel as well as fatty to reconstruct the breast.
The SIEA flap differs from the DIEP flap exclusively inwards price of the blood vessels that render the tissue. While the surgical training is slightly different, both procedures spare the abdominal musculus completely as well as exclusively role the patient's peel as well as fatty to reconstruct the breast.
All 3 procedures provide the added produce goodness of a flatter abdomen amongst results that mimic a “tummy tuck”. However, because the TRAM flap sacrifices abdominal muscle, the direct chances of a hernia or abdominal bulging is signifantly higher than amongst the DIEP or SIEA procedures.
Since the DIEP as well as SIEA flaps save all the abdominal muscles, patients sense less hurting than subsequently TRAM flap surgery, relish a faster recovery as well as likewise keep their abdominal pull long-term.
I promise this information helps.
Dr C
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PRMA Plastic Surgery specializes inwards advanced thorax reconstruction including DIEP flap, SIEA flap, GAP flap, TUG flap, Alloderm One-Step as well as fat grafting. In-Network for most the States insurance plans. Patients routinely welcomed from across the USA. Please telephone telephone (800) 692-5565 or e-mail patientadvocate@PRMAplasticsurgery.com to acquire to a greater extent than almost your thorax reconstruction options. Connect amongst other thorax cancer reconstruction patients at www.facebook.com/PRMAplasticsurgery.
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Healty | Who is NOT a DIEP flap candidate?
With to a greater extent than women becoming aware of DIEP flap thorax reconstruction every bit an option, the inquiry of who is in addition to who isn't a skilful DIEP flap candidate is coming upwards to a greater extent than often.
As a full general rule, women that accept had extensive abdominal surgical physical care for like a previous TRAM flap, stomach tuck or a complex hernia repair cannot accept a DIEP or SIEA flap thorax reconstruction. This is because the lower stomach tissue that is needed has ordinarily been removed or moved around, in addition to the necessary blood render has been disrupted.
Having said that, most of the fourth dimension previous abdominal surgical physical care for isn't an number inwards experienced hands.
Many women these days accept had at to the lowest degree ane previous c-section or roughly other gynecologic physical care for similar a hysterectomy. It is possible for these procedures to campaign harm to the blood vessels needed for DIEP flap surgical physical care for but fortunately this is unusual. H5N1 previous c-section, hysterectomy, or tubal ligation is non a contra-indication to having a DIEP or SIEA flap. Previous liposuction is non ordinarily a occupation either unless this was extensive.
If your surgeon is worried close potential harm from previous surgical physical care for in addition to thus for certain tests tin live performed to evaluate your anatomy to a greater extent than closely. This tin include a unproblematic doppler ultrasound seek out inwards the purpose or a to a greater extent than involved seek out similar a CT angiogram. Unfortunately, the CT scan does involve radiation.
While previous abdominal surgeries may non forbid yous having DIEP flap reconstruction, women that accept had multiple previous abdominal procedures are at increased adventure of abdominal complications similar bulging in addition to hernia later DIEP flap surgical physical care for when compared to women that accept never had prior abdominal surgery, fifty-fifty though the abdominal muscles are preserved. This is because the fascia (the strong layer of tissue over the muscles) has already been weakened past times the previous surgeries.
Some medical issues tin brand whatever bird of microsurgical thorax reconstruction (like the DIEP flap) to a greater extent than hard in addition to they tin every bit good increment the adventure of complications similar flap loss. These include disorders that brand the blood clot to a greater extent than easily (eg Factor V Leiden).
I promise this information helps.
Dr C
*****
As a full general rule, women that accept had extensive abdominal surgical physical care for like a previous TRAM flap, stomach tuck or a complex hernia repair cannot accept a DIEP or SIEA flap thorax reconstruction. This is because the lower stomach tissue that is needed has ordinarily been removed or moved around, in addition to the necessary blood render has been disrupted.
Having said that, most of the fourth dimension previous abdominal surgical physical care for isn't an number inwards experienced hands.
Many women these days accept had at to the lowest degree ane previous c-section or roughly other gynecologic physical care for similar a hysterectomy. It is possible for these procedures to campaign harm to the blood vessels needed for DIEP flap surgical physical care for but fortunately this is unusual. H5N1 previous c-section, hysterectomy, or tubal ligation is non a contra-indication to having a DIEP or SIEA flap. Previous liposuction is non ordinarily a occupation either unless this was extensive.
If your surgeon is worried close potential harm from previous surgical physical care for in addition to thus for certain tests tin live performed to evaluate your anatomy to a greater extent than closely. This tin include a unproblematic doppler ultrasound seek out inwards the purpose or a to a greater extent than involved seek out similar a CT angiogram. Unfortunately, the CT scan does involve radiation.
While previous abdominal surgeries may non forbid yous having DIEP flap reconstruction, women that accept had multiple previous abdominal procedures are at increased adventure of abdominal complications similar bulging in addition to hernia later DIEP flap surgical physical care for when compared to women that accept never had prior abdominal surgery, fifty-fifty though the abdominal muscles are preserved. This is because the fascia (the strong layer of tissue over the muscles) has already been weakened past times the previous surgeries.
Some medical issues tin brand whatever bird of microsurgical thorax reconstruction (like the DIEP flap) to a greater extent than hard in addition to they tin every bit good increment the adventure of complications similar flap loss. These include disorders that brand the blood clot to a greater extent than easily (eg Factor V Leiden).
I promise this information helps.
Dr C
*****
Dr Chrysopoulo is a board certified plastic surgeon inwards San Antonio, Texas specializing inwards state-of-the-art reconstructive thorax surgery. He in addition to his partners at PRMA are In-Network for most major U.S.A. insurance plans. Patients are welcomed from across in addition to exterior the US. Please telephone phone (800) 692-5565 or electronic mail patientadvocate@PRMAplasticsurgery.com to acquire to a greater extent than close your thorax reconstruction options. Connect amongst other breast cancer patients on Facebook.
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