Breast Reconstruction with Autologous Tissues

What is Autologous Breast Reconstruction?

Nowadays, breast reconstruction with autologous tissues following mastectomy is considered the “gold standard” for patients with specific indications. With this type of reconstruction, we use patient’s own tissue in order to reshape the breast. These tissues are called flaps and have an important and necessary role in modern Reconstructive Plastic Surgery.

Advantages and Disadvantages

In general terms, tissues (flaps) which can be used are the following:

• flap from the back
• flap from the abdomen
• flap from inner thighs or buttocks

The advantages of this type of reconstruction are the following:

• the reshaped breast has a more natural look and texture
• breasts are reconstructed with almost natural breast droop and therefore, it is easier to achieve symmetry on the unilateral breast
• reconstruction is permanent (if we do not use implant), consequently there is no need for revision in the future
• it is the method of choice in irradiated breast or to a breast to be irradiated due to poor quality of irradiated skin.

Of course, autologous flap reconstruction has also disadvantages such as:

• longer operating time and consequently longer recovery time
• additional incision and increased donour area morbidity
• However, certain conditions should be met. For example, a flap from the abdomen cannot be used in very low weight patients.

Dr Karmiris has been trained for 4 years in this type of operations in the United Kingdom on specialized departments of Plastic Surgery. He will analyze you in detail all the possible options, he will answer your questions and he will recommend the ideal solution for the best result.

Who is a good candidate for autologous flap reconstruction?

Candidates for autologous reconstruction are the following:

• patients that prefer the particular reconstruction
• overweight patients, especially in the abdominal area
• patients who have undergone unsuccessful reconstruction surgery with implants (capsular contraction or bottoming out)
• patients with defects that cannot be reconstructed with breast reduction methods.
• non smoking patients and without vascular diseases (relative contraindication)

What to expect at your first appointment:

At your first appointment, you will discuss:

• your past medical history regarding breast cancer, data about the histological classification of the tumour, if you had lymphadenectomy as part of your treatment, as well as any further therapy you had in case of mastectomy.
• the remaining medical history, if you are on any medication, vitamins or other herbal supplements, if you have any allergies or any other operations in the past
• if you smoke (if the answer is yes, how many cigarettes per day).

Afterwards, Dr Karmiris:

• will evaluate your general health condition and any other risk factors

• will examine you and will take all the detailed measurements from your breast and your chest and he will evaluate your skin quality as well as your scar, if you already had mastectomy.
• will take preoperative photographs

• will discuss with you all the possible surgical options, depending on your case

• will discuss with you all the possible risks or potential complications, as described in the international literature

• will discuss with you about the anaesthetic plan.

Preoperative check:

Preoperative check includes mainly blood tests, chest X-ray, electrocardiogram (ECG) and any other specialized tests, depending on the case.

Also, it will be necessary to stop smoking preoperatively, and immediately post-operatively as well as avoid taking aspirin and any anti-inflammatory medicine, since they increase the risk of bleeding.

The surgical procedure:

Depending on the flap which will be used, reconstruction can be made as follows:

• Reconstruction with tissue from the back:

In this surgical procedure, we a muscle from the back together with overlying skin in order to create a reshaped breast. This flap is called Latissimus Dorsi (LD) flap. It provides very good quality of tissue (skin and muscle) which is very important especially when it comes to irradiated breast area. Although it is a very reliable flap, it has been blamed for providing inadequate volume when it is used on its own and consequently, the use of a silicone implant is necessary in order to obtain the desired volume.

• Reconstruction with tissue from the abdomen:

In this surgical procedure, we reconstruct the breast by using tissue from the abdomen, either solely, or in combination with rectus abdominis muscle.

In the first case, the flap is called DIEP (Deep Inferior Epigastric Perforator Flap), a name that derives from the blood vessel feeding the flap. In the second case, the flap is called TRAM (Transverse Rectus Abdominis Myocutaneous Flap) due to the use of rectus abdominis muscle with a transverse orientated skin island. It is about surgical procedures which are more demanding regarding the expertise of the Plastic Surgeon not only to perform them, but also to understand which method is the most appropriate, depending on the case.

• Reconstruction with tissue from buttocks or inner thighs:

These are reconstruction surgeries performed with tissue from thighs or buttocks. However, they have disadvantages such as being technically difficult, they create visible scars (especially in the case of buttocks) and have relatively small volume results. They have indications in certain patients such as the patients who do not meet the requirements in order to use the abdomen or back.

The most important decision in this type of surgeries is the proper selection of the reconstruction which will be used. For example, a very low weight patient is not an ideal patient for reconstruction with flap from the abdomen, while an athlete (eg. tennis player) is not an ideal patient for reconstruction with flap from the back (latissimus dorsi) due to donor area morbidity.

Dr Karmiris has been trained for 4 years in this type of surgeries on the United Kingdom on specialized departments of Plastic Surgery. He will analyze you in detail all the possible options, he will answer your questions and he will recommend the ideal solution for the best result.

Post operatively:

Immediately after the surgical procedure, you will have medical gauze or bandages on the incisions which will be reduced, gradually. Drains will be removed in a few days. You will need to wear a surgical bra in order to minimize oedema and to ensure breast support, during recovery.

Depending on the case, patients are discharged after 5-7 days. Dr Karmiris will give you particular instructions on how to take care of your incisions immediately post-op, what medication you should take and when you will be seen for a follow up.

Risks and safety information:

In general, autologous tissue reconstruction is a safe surgical procedure which is performed with great success. However, like any other surgical procedure, autologous tissue reconstruction has some risks, as well as potential complications that every patient should be aware of and should fully understand, before entering the operating room.

The most important potential complications are the following:

• bleeding or haematoma in about 1% of patients
• wound infection
• risk of poor scarring
• asymmetry
• loss of the flap (partial or total)
• hernia in the donor area (if it is about flap from the abdomen)
• umbilical necrosis (in abdominal flaps)
• donor area morbidity
• general risks from anaesthesia, such as deep vein thrombosis, cardiac or pulmonary complications.

Dr Karmiris will explain you in detail all the potential risks and he will answer any questions related to that.