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Microvascular surgery for breast reconstruction

The DIEP flap, SIEA flap, and the microsurgical TRAM flap procedures are unique services offered at the University of Florida. Only a handful of surgeons throughout Florida are trained to perform these procedures. UF Health Shands Hospital has the capacity to perform these types of uncommon procedures.

Women who are planning to have a mastectomy or have already had breast surgery may choose to have breast reconstruction surgery to restore a natural looking breast. Plastic and reconstructive surgeons have traditionally used prosthetic implants, or alloplastic methods, to reconstruct a female breast after a mastectomy.

More recently reconstructive surgeons have been using microvascular surgery and one's own body tissue, or autologous methods, to reconstruct a breast. By using autologous tissue, a patient can avoid many of the complications associated with a prosthetic implant.

Candidacy

Although the TRAM flap, DIEP flap, and SIEA flap procedures are common forms of breast reconstruction, indications for each procedure must be individualized during the consultation with your reconstructive surgeon.

Procedure

Microvascular procedures can be performed on patients who are not candidates for traditional methods of breast reconstruction or patients who desire the use of autologous tissue for breast reconstruction.

Microvascular surgery can be used to perform the transverse rectus abdominus myocutaneous (TRAM) flap procedure, one popular method of autologous breast reconstruction. The TRAM flap consists of abdominal skin, fat and muscle. The flap is transferred from the abdomen to the chest to form a new, natural-looking and feeling breast mound. Microsurgical transfer of the TRAM flap results in an augmented blood supply and increased survival of the flap. The TRAM flap surgery typically takes about six hours to complete.

Another breast reconstruction procedure is the deep inferior epigastric (DIEP) flap procedure. This flap is comprised of abdominal skin and fat but spares the rectus abdominus muscle, which the TRAM flap uses. The benefits of using the DIEP flap over the TRAM flap for breast reconstruction include less morbidity to the abdominal wall and often times less post-operative pain.

The superficial inferior epigastric artery (SIEA) flap can eliminate the use of the rectus abdominus muscle completely. Although only possible in 20 to 30 percent of patients due to anatomic variations, this flap offers patients another possibility in autologous tissue reconstruction.

Recovery

A patient is usually hospitalized for three to five days after surgery and can usually resume full activities in six weeks.

Symmetry procedures for the contralateral breast and nipple areolar reconstruction are performed in subsequent operations.