Breast reconstruction with flap surgery

Breast reconstruction with flap is a complex surgical procedure where individuals own tissue is utilized to reconstruct the breast that has lost its shape following removal cancer or other medical complications. In flap surgery the patient’s body is considered as donor site.

Flap Surgery: A detailed overview:

In breast reconstruction using flaps tissue, one must note that it consists of skin, fat or adipose tissue and at times muscle mobilized from any part of the body, i.e., donor site to the chest to form a mound that looks like a breast. This flap has its own blood supply thus enabling it to heal perfectly Additionally, its appearance appears natural.

Types of Flap Reconstruction:

Different kinds of Flap Reconstruction include:

• DIEP Flap. Skin, fat and blood vessels are extracted from a woman’s low tummy so as; the most useful muscles of the lower abdomen are not damaged at all.
• TRAM Flap Surgery which is a lot like DIEP except it entails using this unique abdominal muscle that runs in front of our stomach all way to crotch line providing more fat for larger breasts.
• Latissimus Dorsi Flap: This procedure involves moving some muscle tissue together with fat and skin taken from someone’s back hence making it ideal for those who want reduced size breasts only.
• Free Flap: In this kind of surgery, the flap is taken completely away from its original blood supply source before being re-connected with other vessels situated within the chest area itself.
• Pedicled Flap: It refers to a situation where the tissues from part of the body are kept connected to the blood vessels but then transported underneath your skin ultimately reaching chest.

Significance of Flap Reconstruction:

• Flaps are less prone to infection, capsular contracture as compared to implants.
• In terms of texture, shape and movement flap tissue closely resembles natural breast tissue.
• Flap reconstruction can potentially restore sensation to some degree in the reconstructed breast.
• Eliminates concerns about long-term safety and potential complications by removing the need for implants.

Limitations

Flap surgery takes longer and requires more complex wound care: Compared to implant-based reconstruction, flap procedures involve extended surgery and recovery times.

Scarring at the donor site: There will be scarring at donor site, but it can often be hidden by clothing or strategically placed within natural skin folds.

Not applicable to the majority: Not all patients are suitable candidates for flap reconstruction due to factors like body composition and medical history.

Post Flap Surgery expectation:

Changes in breast sensation are common after flap breast reconstruction surgery and vary depending on the type of flap used and individual healing. Some common features include.

Initial Numbness: Immediately after surgery, you will likely experience numbness in the reconstructed breast and surrounding areas. This is due to nerve disruption during the surgery and is temporary. The numbness may extend to the donor site, depending on the flap type.

Gradual Improvement: Over time, some sensation may return to the reconstructed breast. This can take several months or even years.

The degree of sensation recovery varies significantly among individuals. Some women may regain near-normal sensation, while others may have persistent numbness or altered sensations.

Types of Sensation Changes:

• Numbness: The most common change is a lack of feeling or reduced sensitivity to touch, temperature, and pain.
• Tingling or Pins and Needles: Some women experience tingling or prickling sensations as nerves regenerate.
• Hypersensitivity: In rare cases, the reconstructed breast may become overly sensitive to touch, causing discomfort.

Factors Affecting Sensation:

Flap Type: The type of flap used can influence sensation recovery. DIEP flaps generally have better sensation outcomes compared to TRAM flaps.

Nerve-Sparing Techniques: Surgeons may use nerve-sparing techniques during surgery to preserve as many nerves as possible, potentially improving sensation.

Individual Healing: Each person's healing process is unique, and sensation recovery can vary significantly.

The exercises and therapies that can help improve sensation after flap surgery include:

• Massage and gentle stroking or tapping of the scars can help control strange sensations and pain.
• Exercises to improve shoulder mobility and reduce swelling in the arm can also help with sensation.
• Abdominal exercises can help strengthen the tummy muscles and minimize the chance of developing back pain.

Additional Therapies for Improved Sensation After Flap Surgery

Besides massage, gentle stroking, and exercises, several other therapies can potentially help improve sensation after flap surgery:

• Electrical stimulation: This technique uses small electrodes to stimulate nerves in the reconstructed breast and surrounding areas. It can help promote nerve regeneration and improve sensation over time.
• Mirror therapy: This involves looking at a reflection of your unaffected breast while simultaneously touching the reconstructed breast. The brain may interpret this as simultaneous stimulation of both breasts, potentially enhancing sensation.
• Acupuncture: Acupuncture is believed to stimulate nerve pathways and improve blood flow, potentially contributing to sensation recovery.
• Sensory retraining: This therapy involves focusing on different sensory experiences in the reconstructed breast, such as temperature, texture, and pressure. It can help retrain the brain to interpret and process sensory input more effectively.
• Neuromuscular electrical stimulation (NMES): This technique uses electrical currents to stimulate muscles in the reconstructed breast and surrounding areas. It can improve muscle control and potentially enhance sensation.

Potential risks associated with flap surgery:

Longer Surgery and Recovery: Flap surgery is more complex and requires a longer surgery time and recovery period compared to implant-based reconstruction.

Donor Site Complications: The donor site (area where tissue is taken) can experience complications like scarring, pain, numbness, and weakness, depending on the flap type.

Potential for Tissue Loss: In rare cases, the transferred tissue may not receive adequate blood supply and die, requiring additional surgery.

Abdominal Wall Weakness: Some flap procedures, like TRAM, may weaken the abdominal wall, increasing the risk of hernias.

General Risks:

Bleeding: Both types of reconstruction carry a risk of bleeding during or after surgery.

Infection: A potential risk to any surgery is infection.

Anesthesia complications: Anesthesia can cause complications in some patients.

Changes in Sensation: Both flap and implant reconstruction can affect breast sensation.

Remember:

This is not an exhaustive list of all potential risks.

The specific risks you face will depend on your individual health and the type of reconstruction you choose.

Discuss the risks and benefits of each option with your surgeon to make an informed decision