19364 Breast reconstruction; with free flap (eg, fTRAM, DIEP, SIEA, GAP flap)

Name of the Procedure:

Breast Reconstruction with Free Flap (e.g., fTRAM, DIEP, SIEA, GAP Flap)

Summary

Breast reconstruction with a free flap involves using tissue from other parts of your body, such as the abdomen or buttocks, to rebuild the breast after a mastectomy. Types of free flap procedures include free Transverse Rectus Abdominis Myocutaneous (fTRAM), Deep Inferior Epigastric Perforator (DIEP), Superficial Inferior Epigastric Artery (SIEA), and Gluteal Artery Perforator (GAP) flap.

Purpose

This procedure addresses the absence of breast tissue typically following mastectomy (breast removal surgery) due to cancer or other conditions. The goal is to reconstruct a natural-looking breast, improving psychological and aesthetic outcomes for the patient.

Indications

• Patients who have undergone a mastectomy or lumpectomy.
• Desire for breast reconstruction using the patient’s own tissue rather than implants.
• Adequate donor tissue available, typically from the abdomen or buttocks.

Preparation

• Preoperative consultations with the surgical team.
• Diagnostic imaging and medical evaluations.
• Fasting from midnight before the surgery.
• Adjustment of current medications as directed by the healthcare provider.

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision and Tissue Harvesting: An incision is made at the donor site (abdomen or buttocks). Tissue, including skin, fat, and possibly muscle, is detached along with its blood vessels.
3. Transplantation: The harvested tissue is then transplanted to the chest area. Microsurgery is used to connect blood vessels from the flap to those in the chest.
4. Shaping and Closing: The reconstructed breast is shaped to match the desired contour, and incisions are closed with sutures.

Duration

The procedure typically takes 6 to 12 hours, depending on the complexity and specific type of flap used.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Plastic Surgeon
• Surgical Team (including nurses and surgical assistants)
• Anesthesiologist

Risks and Complications

• Common risks: bleeding, infection, scarring.
• Rare risks: flap failure (loss of transplanted tissue), blood clots, complications from anesthesia.
• Management of complications involves medications, additional procedures, or interventions as required.

Benefits

• Natural-looking breast reconstruction.
• Use of own tissue reduces risk of rejection.
• Improved psychological and aesthetic satisfaction.
• Benefits can be seen shortly after recovery, with final results visible in a few months.

Recovery

• Hospital stay of 4 to 7 days.
• Instructions on wound care, pain management, and activity restrictions.
• Return to non-strenuous activities in about 4 to 6 weeks.
• Follow-up appointments to monitor healing and progress.

Alternatives

• Breast reconstruction with implants.
• No reconstruction.
• Pros and cons: Implants involve shorter surgery but may require future replacements; no reconstruction avoids surgery but may impact body image.

Patient Experience

• During surgery: Under general anesthesia, so there is no pain or awareness.
• After surgery: Expect soreness and swelling at both the donor and reconstruction sites. Pain management includes prescribed medications. Regular follow-up visits assist with managing discomfort and ensuring proper healing.