Advanced Breast Cancer Reconstruction

Breast reconstruction restores something that nature has provided but cancer has taken away.

Breast reconstruction not only allows patients to feel whole and restored, but also provides a renewed sense of hope after battling breast cancer. Thanks to a federal mandate in 1998, breast reconstruction is also covered by insurance.

There are many different ways to reconstruct a breast, ranging from breast implants to the patient’s own tissue (autologous reconstruction). Most patients prefer autologous reconstruction for several reasons. Unlike implant reconstruction, the reconstructed breast remains soft, warm and “natural” both in feel and appearance. It will also literally last a lifetime and will age appropriately as the patient ages. The nipple reconstruction and tattooing of the areola are preformed secondarily to complete the reconstruction.

The deep inferior epigastric perforator (DIEP) flap is the most advanced form of autologous breast reconstruction available today and is the latest evolution of the previous “gold standard” procedure, the transverse rectus abdominis myocutaneous (TRAM) flap. Like the TRAM flap, the DIEP flap uses the patient’s lower abdominal tissue to reconstruct the new breast. However, unlike the TRAM flap, the DIEP flap preserves all the patient’s abdominal muscle. Only abdominal skin and fat are removed, similar to a “tummy tuck.” This tissue is disconnected from the abdomen, transplanted to the chest and reattached microsurgically to reconstruct the breast.

Since all the muscle is saved, DIEP flap patients experience less pain after surgery, enjoy a faster recovery, maintain their abdominal strength long-term and are able to return to their prebreast cancer activity levels. The risk of abdominal complications, such as bulging and hernia is also very small, much smaller than with the TRAM flap. Most women also welcome the body contouring benefits of the simultaneous “tummy tuck.”

While there are many plastic surgeons in the United States performing breast reconstruction, only about 40 routinely perform DIEP flap surgery due to the technical difficulty of the procedure. Plastic Reconstructive & Microsurgical Associates is the only center in San Antonio, TX, and one of only a handful of centers worldwide, to provide DIEP flap reconstruction on such a large scale. Unfortunately, this means many patients are forced to travel, often out of state, to gain access to these advanced procedures.

“For me, arriving at the decision to do a DIEP flap reconstruction was simple. The key was finding the perfect surgeon for the task. Being from New York, I was concentrating at first on the surgeons in my area, until I learned that it was PRMA that performed the majority of this type of reconstruction in the U.S. I knew that this was the group I wanted to perform my reconstruction; someone who sees this and does this every day,” says Sue M. of New York, NY.

Dr. Chrysopoulo is a board-certified plastic surgeon specializing in advanced breast reconstruction. He and his partners have performed over 3,000 DIEP flap procedures and are In-Network providers for most U.S. insurance plans. For more information call PRMA at 1-800-692-5565 or visit www. or PRMAplasticsurgery.

MD News October 2010, San Antonio



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