Breast Reconstruction

Learn more about Atlanta breast reconstruction performed by Dr. Franklyn Elliott with Atlanta Plastic Surgery, P.C. who has offices at Northside & Alpharetta, GA.

January 6, 2012

How Long Does Breast Reconstruction Take?

After breast cancer surgery like a mastectomy, many women find it difficult to consider breast reconstruction surgery. However, studies done across the country including one published in Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS) says that breast reconstruction is beneficial both physically and emotionally for breast cancer patients and survivors.
The process of having a breast removed is mentally trying, and having additional invasive procedures to replace what was lost often gets put to the wayside in favor of emotional healing. However, new advances in breast reconstruction technology and techniques make undergoing breast reconstruction surgery safer and more beneficial than ever.

One common question from many of Dr. Franklyn Elliott’s breast reconstruction patients is how long the breast reconstruction process takes. While the answer to this varies depending on the type of procedure performed and each patient’s individual situation, the average breast reconstruction procedure can take anywhere from 1 to 3 hours.

A tissue expander procedure can take about an hour to complete, while pedicled TRAM, free TRAM, and DIEP flap reconstruction techniques take 2 to 3 hours depending on the patient and the surgeon. During a pedicled TRAM, muscle and other tissue is removed from the abdomen and relocated to the breast area, while remaining attached to a blood supply. With the free TRAM technique, muscle and fat tissue is removed from a section of the abdomen and reattached to a blood supply in the breast area. In a DIEP flap procedure, tissue is removed from the donor area with no muscle attached to help recreate the breast.
For some women, procedures are spread out in which tissue is removed and relocated to the breast and then tissue expanders are used to help stretch the skin to make room for an implant. In these cases, multiple procedures are necessary to achieve the patient’s desired result.

As the developer of one of the original breast reconstruction techniques first used by breast surgeons, Dr. Elliott will be showcasing the latest in breast reconstruction technology at the Annual Breast Surgery Symposium in Atlanta on January 13th- 15th, 2012.

Contact our office for more information on the different breast reconstruction techniques or to schedule a consultation for a reconstructive or cosmetic surgery procedure. You can also find Dr. Elliott on Facebook and Twitter with the latest in breast cancer and breast reconstruction news as well as cosmetic surgery updates!

October 20, 2011

Why Perform a Pedicled TRAM, free TRAM, or DIEP flap for Breast Reconstruction?

Blog, Breast Cancer, Breast Reconstruction, Educational breast cancer, breast reconstruction, breast reconstruction surgery, diep flap, dr franklyn elliott, franklyn elliott, franklyn elliott md, free tram flap, mastectomy, pedicled tram, plastic and reconstructive surgeon, reconstructive surgery, tram flap techniques

Dr. Franklyn Elliott performs many types of cosmetic and reconstructive procedures including those of the body, face, and breast. After a woman undergoes a mastectomy, breast reconstruction surgery is often desired to restore a more natural looking silhouette. While there are multiple methods used to recreate the breast, Dr. Elliott explains below why he chooses to avoid the DIEP flap procedure in favor of the free TRAM flap breast reconstruction procedure.

I have been performing TRAM flaps since 1983. Initially the TRAM flap technique was introduced as a pedicled TRAM flap in which a strip of muscle was taken from the stomach and placed onto the recently removed breast to insure blood supply to the flap, which becomes the new breast. In approximately 1989, the free TRAM flap method was introduced wherein a smaller segment of muscle was harvested than in the pedicled TRAM procedure. The free TRAM flap requires the use of microsurgical techniques, which are technically more difficult than those used during a pedicled TRAM flap. Because less muscle is harvested, and because of increased blood flow to the TRAM flap, the free TRAM technique has become increasingly popular. Around 1994 the DIEP flap was introduced. This surgery had the attraction of removing no muscle from the abdominal wall. Furthermore, it used only one blood vessel branch, called a perforator, to the tissue to be transferred for the new breast.

Since 1994, I have studied the DIEP technique in detail and have discussed it with many colleagues around the world. I’ve even employed the perforator technique during a breast reconstruction surgery in which buttock tissue was used to make a new breast. Though I am very familiar with the perforator technique and understand why many surgeons may be attracted to the procedure, I do not prefer the DIEP technique for breast reconstruction using transfer of abdominal tissuebecause of the following:

The DIEP flap takes significantly more time to perform than the free TRAM flap. The free TRAM flap can be done in approximately three hours, whereas the DIEP flap (link to PDF) generally takes five hours. While this time difference would not matter if the procedure were my preferred method, this factor combined with those listed below
There is less reliable blood flow to the tissues with a DIEP flap than with the free TRAM technique. This is because the DIEP technique for breast reconstruction employs only one branch of arteries and veins, whereas the TRAM flap contains numerous arterial and venous branches to the overlying fatty tissue. Thus, the transferred tissue is generally more likely to survive with the free TRAM technique because there is a more reliable source of blood.
The alleged advantage of the DIEP is that it does not harvest any abdominal wall muscle. However, while no abdominal muscle is removed during this operation, an incision is still made through the fascia and muscle. In numerous studies around the world comparing the DIEP and free TRAM, there is no statistical, scientific difference in the abdominal wall function or abdominal wall weakness with either flap. This is contrary to claims from some websites, blogs, and articles regarding the DIEP flap. However, it has been proven in multiple comparative DIEP and Tram flap studies.

In summary, because the DIEP operation takes a lot longer, has less reliable blood flow to the transferred fat, and does not result in an improved abdominal wall, I prefer the free TRAM operation.

If you would like a more scientific analysis about my decision to avoid the DEIP flap method of breast reconstruction please refer to the article published in Plastic and Reconstructive Surgery, entitled “The Three Hour Free TRAM Flap.”

Elliott, L.F., Seify, H. and Bergey, P. The 3-Hour Muscle-Sparing Free TRAM: Safe and Effective Treatment Review of 111 Consecutive Free TRAM Flaps in a Private Practice Setting. Plastic and Reconstructive Surgery.120:27, 2007.

I will be more than happy to discuss this subject in detail. I can be contacted on my breast surgery website or through Suzanne Campbell, 404-250-3889.