Breast Reconstruction at Froedtert & the Medical College of Wisconsin

The deep inferior epigastric perforator (DIEP) flap operation has distinct advantages over previous methods of autologous (using one’s own tissue) reconstruction, primarily because it does not require muscle to be taken, only fat. The same tissue that would be harvested for a 'tummy tuck' is used to form the new breast. The blood vessels that normally feed the abdominal tissue are carefully preserved when removing the tissue, and are then reattached to blood vessels in the chest using a microscope. The end result is a more natural looking and feeling breast, and little-to-no abdominal weakness or herniation. 

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The superficial inferior epigastric artery (SIEA) flap is similar to a DIEP flap in that it is a muscle-sparing perforator flap option for reconstruction. The SIEA flap uses a different, more superficial blood supply than the DIEP flap. However, only about 20 percent of women have this superficial system, and the blood vessels must be of adequate size and character to perform the microsurgery successfully. All of the blood supply is carefully examined and evaluated in the operating room, and the most appropriate vessels are chosen at that time. 

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The transverse rectus abdominis myocutaneous (TRAM) flap, both free and pedicle, has been used by plastic surgeons for more than 20 years for breast reconstruction. During this procedure, abdominal tissue - including part of, or all of, the rectus abdominis muscle - is transferred to the chest. During a pedicle TRAM, the tissue remains attached to the body and is tunneled under the skin to the chest. During a free TRAM, the tissue is removed from the body and then reattached at the chest. In both instances, a large amount of abdominal muscle is removed, leading to core muscle weakness, hernias, and bulges.

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Occasionally, the flap can reconstruct a complete breast mound, but often provides the muscle and tissue necessary to cover and support a breast implant. This procedure is often used to add or replace skin to a mastectomy site that has been radiated. 

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Breast reconstruction with tissue expansion allows an easier recovery than flap procedures, but it is a more lengthy reconstruction process. During the initial procedure, a tissue expander device is placed under the skin and muscle in the chest. Over the next 4-6 months, several office visits are required to slowly fill the expander through a valve under the skin. The device expands the skin so that eventually a permanent, softer implant can be placed as a final reconstruction. This second surgery is a short, outpatient procedure with little discomfort or down time. 

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Learn more about implant reconstruction