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Nowadays, microsurgical techniques are available to transfer tissue from one region in the body to another region. The surgeon removes skin and subcutaneous fat tissue without the underlying muscle and transfers this tissue flap (perforator flap) to the chest wall to reconstruct the breast. Microsurgery is used to restore the blood flow and we anastomose the small blood vessels (artery and vein) of the perforator flap to the blood vessels in the chest region. Microsurgical tissue transfer is the ideal approach to reconstruct a natural looking breast.
The first step in the breast reconstructive process is to reconstruct the breast itself. This is the longest surgical procedure. After this first procedure, we wait for 6 months to allow wounds to heal and settle down. The breast will become softer during this time period. After 6 months the second step is the remodeling phase. We will now look at symmetry between both breasts. The other non operated breast can be lifted or reduced in volume according to the clinical presentation. Often we perform scar revisions on the reconstructed breast or in the abdominal region. This procedure is usually performed in a one day clinic admission. The third step is the nipple reconstruction and is done approximately 3 months after the second step. It can be performed under local anesthesia. Finally, nipple and areola tattoo are done after the nipple reconstruction.
The DIEP flap is the standard approach in microsurgical breast reconstruction. The DIEP flap is taken from the abdomen (tissue below the belly button) and usually an ample amount of tissue can be removed to reconstruct the breast. Clinical examination before surgery is of upmost importance to assess whether the abdomen can be closed tension free.
The LUMBAR flap is a valuable alternative to the DIEP flap. The LUMBAR flap is chosen whenever the DIEP flap is not available due to previous surgery or insufficient abdominal tissue. The advantage of the LUMBAR flap is the nice shape of this flap and the possibility to restore breast sensation.