The female breast consists out of skin, subcutaneous fat tissue and glandular tissue. Women who have had a mastectomy or breast amputation lack skin as well as breast volume (previously determined by the breast glandular tissue). The natural skin envelope around the breast has been discarded (except when a subcutaneous mastectomy has been performed) and needs to be replaced in addition to restoring the volume and natural breast projection.
Their are two main approaches using cosmetic surgery in breast reconstruction: either with prosthetic materials (such as breast implants) or by using the patient’s own tissue (“autologous” reconstruction). The disadvantage of using prosthetic materials is that there is a risk of infection, migration of the implant, and scar tissue formation over time with deformation of the newly created breast. As well as this, prosthetic materials are not long lasting and will need to be changed after a certain period. The advantage of using the patient’s own tissue is that the body “recognizes” the tissue as part of the patient and the result will be permanent. The reconstructed breast will have a very natural appearance and touch with preservation or restoration of the natural body contour.
Plastic surgeon Van Canneyt’s preferred technique is to use a “perforator flap”, or more specifically DIEP-flap or DIEAP-flap technique. DIEP stands for “Deep Inferior Epigastric Perforator” and DIEAP for Deep Inferior Epigastric Artery Perforator. This is the name of the vessel that nourishes the flap.
The DIEP-flap means that a bulk of tissue (“flap”) is harvested from the belly together with that specific vessel. The tissue bulk comes from skin and fat tissue without muscle. The advantage of the technique of the DIEP-flap is that the muscles in the abdominal wall are preserved thus reducing the risk of abdominal weakness after the operation. In other words, the innervation and function of the muscles are completely preserved. This in contrary to another established technique, namely the TRAM-flap, where the muscle (or part of it) is taken to reconstruct the breast. The vessels of the abdominal flap (DIEP flap) are anastomosed (or sutured together) to the vessels in the chest next to the sternum (internal mammary vessels) with microsurgical techniques (using a microscope). The final scar on the belly will lie in the bikini-line and the umbilicus (belly button) is preserved. Three to six months after the initial breast reconstruction the new nipple will be reconstructed and any adjustments necessary can be performed to obtain a perfect symmetry between both breasts.
The total hospital stay varies from 5 to 7 days and we advice the patients to consider a recovery period of 6 weeks. The failure rate of this kind of operation is about 0.5 – 1% and is mainly determined by the patient’s own condition (vessel disease, bleeding disorders with formation of blood clots, smoking, …).