What is a free flap breast reconstruction?
Breast mastectomy is the surgical removal of the breast, usually due to breast cancer. Breast reconstruction involves rebuilding the shape of the breast. Breast reconstruction is often performed after breast mastectomy. Breast reconstruction with the complete removal of a piece of tissue (flap) from a healthy site to the site of mastectomy is known as free flap breast reconstruction.
The advantages of free flap breast reconstruction are:
- Flap reconstruction provides a more desirable look and feel
- Flap reconstruction can be performed immediately after a mastectomy
- Flap reconstruction has fewer chances of infection
- Breast sensitivity is not lost
The advantages of immediate reconstruction after a mastectomy are:
- Remarkable improvement in the shape and projection of the reconstructed breast
- Secondary wounds and scar formation can be prevented
What are the different free flaps used?
Free flaps are usually named after the area of the body that the flaps are harvested from. Three different types of free flaps used in breast reconstruction are:
- Gluteal free flap uses the flap from the hips (around the buttocks) for the reconstruction of breasts. Gluteal free flaps are of two types:
- Superior gluteal free flap: Flap is taken from the upper hip to reconstruct the breast.
- Inferior gluteal free flap: Flap is taken from the lower hip to reconstruct the breast.
It is usually used in patients who had previously failed breast reconstruction or who are lean and have less abdominal fat.
- Latissimus dorsi flap: Latissimus dorsi is a muscle present between your shoulder and the armpit at the back. An oval flap is taken from the upper back to reconstruct the breast. Latissimus dorsal flap is considered as a muscle-transfer type of flap because it involves a considerable amount of muscle. This flap type is advised in patients:
- Who had failed breast reconstruction
- Who are lean and have less abdominal fat
- Lateral transverse thigh free flap: Flap is taken from the upper thigh to reconstruct the breast. This flap type is advised in patients:
- Who had failed breast reconstruction
- Who have deformity following a lump removal or a radiation therapy
How is free flap breast reconstruction done?
The technique varies in different free flap reconstruction:
Gluteal free flap:
- A surgical cut is made in the hip/buttock area, to expose the buttock muscle (gluteus maximus)
- The two buttock muscles (gluteus maximus and gluteus medius) are retracted from each other, exposing the underlying blood vessels
- The flap is then harvested by including one-third of the muscle
- The flap is placed on the site of mastectomy
Latissimus dorsi flap:
- A surgical cut is made in the upper back along the brassiere line
- The flap is raised and moved under the skin of the chest
Lateral transverse thigh free flap:
- A surgical cut is made from the pelvis to the inferior buttocks to reveal the hip muscle
- The flap, which is of 6-7 cm wide and 20-25 cm long, is raised and placed at the site of mastectomy
The surgical cut at the reconstruction site and donor site are closed using sutures.
Post-surgery monitoring is important for a successful free flap breast reconstruction.
What are the complications of free flap breast reconstruction?
The complications of free flap breast reconstruction are as follows
- Partial or complete tissue breakdown or death of flap (5-15%)
- Seroma (fluid collection, usually in abdominal donor site)
- Hematoma (bleeding at chest or abdomen)
- Hernia (noticeable bulge in the abdomen)
- Abdominal bulge without hernia (5-15%)
- Deep venous thrombosis (clots in the deep vein of the leg) and/or pulmonary embolus (diffused clots in the lungs) (< 1%)
- Death (< 1%)
- Breast sensitivity may be affected
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