Muscle flaps in breast reconstruction surgery after breast cancer
December 29, 2008 by Marijke Durning, RN
Filed under Diseases & Conditions
This article is the second of a 3-part series on breast reconstruction surgery introducing the reconstructive options available to women facing mastectomy for breast cancer.
Dr Minas Chrysopoulo has offered to write some information on various breast reconstruction
issues. What he writes is from his point of view and knowledge. I hope that the series is of interest and help to those who live through breast cancer and helps those who love them understand the issues more clearly.
Breast Reconstruction Surgery: What Every Woman Needs To Know – Part II – Muscle Flaps
By Minas Chrysopoulo, MD
Women interested in breast reconstruction after mastectomy have several reconstruction options to choose from. In Part I of this series we discussed tissue expanders, breast implants and Alloderm.
Though implant reconstruction remains the most common method of breast reconstruction in the US, many women are now steering away from this option, opting instead to use their own tissue for more “natural” results. Muscle flaps have, until fairly recently, been the only choice available for these tissue reconstructions. The most commonly offered muscle flaps are the latissimus and TRAM flap procedures.
The latissimus procedure uses muscle from the back of the shoulder blade which is brought around to the breast mound to help create a new breast. During the procedure a section of skin, fat and muscle is detached from the back and brought to the breast area.
Image credit: Dr. Chrysopoulo
Many women also need a tissue expander placed under the muscle flap in order to obtain a satisfactory result. The expander is replaced by a permanent implant at a second procedure down the line. Women will have a scar on their back shoulder region that can sometimes be seen through a tank top, swimsuit or sundress. The upper back can be numb or sore for a few following this procedure until the nerves grow back and the incisions are completely healed.
Women who are very active in sports should know that this procedure can reduce ability to participate in activities like golf, climbing, swimming, or tennis.
TRAM (Transverse Rectus Abdominis Myocutaneous) Flap: This was the first procedure to describe use of one of the rectus abdominis muscles (sit-up muscles) for breast reconstruction. This procedure begins with an incision from hip to hip rather like a “tummy-tuck”. A “flap” of skin, fat and one of the woman’s abdominal muscles is typically tunneled under the skin to the chest to create a new breast. This is known as a pedicled TRAM flap.
Recovery from the TRAM flap procedure can be difficult and painful and there is a risk of abdominal bulging (or pooching) and even hernia. Long-term, the woman has to adapt to the loss of some abdominal strength (up to 20%) which most active patients will notice.
In cases where both breasts are being reconstructed, both abdominal muscles are sacrificed and transferred to the chest (one for each breast). The loss of abdominal strength in these situations is far greater and very significant. Over the years and with the introduction of microsurgery, the procedure has evolved several times with each modification preserving more and more abdominal muscle. This has made postoperative recovery a little easier and has decreased the potential for abdominal complications somewhat.
The latest evolution in breast reconstruction surgery is the perforator flap. These techniques use skin and fat from various parts of the body. Since no muscle is sacrificed recovery is much easier and muscle strength and function are preserved long-term. These techniques will be discussed in Part III of this series.
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Part I: Every woman has a right to breast reconstruction
Dr Chrysopoulo is a board certified plastic surgeon specializing in breast reconstruction surgery including the Alloderm one-step and DIEP flap procedures. In-network for most US insurance plans. Toll Free (800) 692-5565. Latest breast reconstruction news available at The Breast Cancer Reconstruction Blog.
Note from Marijke: I don’t have any personal experience with breast cancer and reconstruction issues. The information is provided by the doctor’s knowledge and experience.
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Tags: breast reconstruction surgery, cancer blog, breast cancer. mastecomy, mastectomies, muscle flaps breast surgery, latissimus dorsi flap. transverse rectus abdominis myocutaneous flap
I am looking for women that have had Latissimus dorsi flap breast reconstruction. I had this procedure done in 2007. Wish I had never done it. I have so much back pain now, it is very uncomfortable. I’d like to communicate with you.
I feel like my breast is in a vise and there is a tourniquet from my back to my breast