tram flap surgery Atlanta

As a board-certified plastic surgeon, I have always felt strongly that every breast surgery patient should be thoroughly educated on all of the available options for treatment before committing to one. When it comes to breast reconstruction, a surgery that too frequently comes on the heels of a medically necessary mastectomy or lumpectomy, patients may be feeling particularly overwhelmed and unsure. It’s crucial that these patients are able to make an informed decision after having weighed each option against their needs and preferences.

Breast Reconstruction Awareness (BRA) Day on October 15 is an excellent opportunity to review the options available to patients preparing to undergo breast reconstruction surgery. I have performed all of the available options on many patients over three-plus decades as a board-certified plastic surgeon and believe that while there is no “best” reconstruction procedure, some are more appropriate than others for certain patients. Below is a brief explanation of some of the most common breast reconstruction techniques. It is best and most understandable to divide them into two basic choices – using the patient’s own tissue to build a new breast or using an implant to build the breast. We will first discuss using the patient’s own tissue.

• TRAM flap: The TRAM stands for transverse rectus abdominis, a lower abdominal muscle above the pubic bone. In this procedure, I use a ‘flap’ – the skin, fat, and occasionally a portion of the muscle – to reconstruct the breasts. The muscle is not removed, but instead “rerouted” to the chest wall as it is the blood supply to the transferred lower abdominal fat. This fat is then shaped into a new breast. The result is replacement of breast tissue with the patient’s own fat and a tightening of the lower tummy like a tummy tuck.
• Free TRAM: This is a variation on the TRAM flap procedure; instead of being rerouted, the flap is actually detached and reconnected to the chest.
• DIEP flap: Different from other flap techniques, a DIEP flap does not require the use of abdominal muscles and instead utilizes blood vessels called deep inferior epigastric perforators (DIEP) and the connecting fat and skin to reconstruct a breast. However, this operation takes significantly more operating time and has more risk for blood transfusions and flap loss.
• Breast implants: Unlike flap procedures, which make use of a patient’s own tissue, breast implants are made from either silicone or saline and placed directly into the chest following a mastectomy.
• Latissimus dorsi flap: I use skin, muscle, fat, and blood vessels from the upper back to help create a new breast. This procedure is usually combined with breast implants in order an appropriate shape and size to the new breast. The implant provided the volume to the new breast and the latissimus Doris muscle provides the coverage. The latissimus dorsi muscle flap can also be performed without leaving a scar on the back.
• Supplemental fat transfer: Fat transfer during breast reconstruction is used to add volume to the new breasts and give them a more natural look and feel. Fat transfer is not necessarily part of reconstruction, however.

Each of these breast reconstruction options comes with its own set of advantages, disadvantages, potential risks, and possible benefits. I always encourage my patients to ask as many questions as necessary to help them feel confident and prepared to undergo surgery.

If you’ve recently undergone a mastectomy and are considering breast reconstruction, please contact our office today to schedule a consultation. Don’t forget to connect with me, Dr. Franklyn Elliott, on Facebook, Twitter, and Google+ for the latest breast surgery news and information.