What's New in Breast Reconstruction?

View from my balcony in Kauai

I recently attended a conference in Hawaii (yes, I actually attended the conference!) for the American Society of Reconstructive Microsurgeons.  I was there presenting a technical paper on breast reconstruction, but more importantly, I had the chance to hear about what’s new in the field.  It was exciting to see what other surgeons are doing around the country and around the world.

I attended a fascinating lecture by Bob Allen, who is widely regarded as one of the pioneers of advanced breast reconstruction.  His talk was entitled “25 Options for Breast Reconstruction when the Abdomen is not enough.”  With a procedure like breast reconstruction, it’s important that patients know about all the possibilities before they make a decision.  Believe it or not, there are dozens of ways to re-build a breast after mastectomy.  Here is just a sampling of the list compiled by Dr. Allen for his talk.

Using your belly:

1. SIEA: Superficial Inferior Epigastric Artery flap
2. DIEP: Deep Inferior Epigastric Artery Perforator flap
3. MS-TRAM: Muscle-sparing Transverse Rectus Abdominis Myocutaneous flap
4. TRAM: Transverse Rectus Myocutaneous flap

Using your butt:

1. SGAP: Superior Gluteal Artery Perforator flap
2. IGAP: Inferior Gluteal Artery Perforator flap

Using your thigh:

1. TUG: Transverse Upper Gracilis flap
2. ALT: Anterolateral Thigh flap
3. PAP: Profunda Artery Perforator flap
4. scTFL: Tensor Facia Lata (septocutaneous) flap

Using your thorax:

1. TDAP: Thoracodorsal Artery Perforator flap
2. ICAP: Intercostal Artery Perforator flap
3. LAP: Lumbar Artery Perforator flap

These are called “flaps,” because we take a flap of tissue attached to its blood vessel and disconnect it from the body.  We then move the flap up to the chest wall to make a new breast, and reconnect the blood vessels to the vessels in the chest or armpit.  The reconnection is done under a microscope because the vessels are tiny, usually only a couple of millimeters in diameter.

Most women are good candidates to use the belly, because most women have a little extra fat in the belly area.  That fat is nice and soft, mimicking a breast beautifully when it’s moved up to the chest.  However, some women are pear-shaped, or have large abdominal scars that prevent us from using the belly.  For those patients, it’s good to have all these options to choose from based on a woman’s body habitus and breast size.

All in all, a great meeting, and a great review of all the options available to our patients!