Reconstruction of the breast after mastectomy using abdominal tissue
Reconstruction of the breast after mastectomy using abdominal tissue (known as DIEP or MS-TRAM) is the ‘Gold Standard’ in breast reconstruction.
The surgery uses the patients’ own tummy tissue and transplants it to the breast to restore breast volume and shape, with some of the benefits of a tummy tuck. The breasts will move, feel and age in a more natural way than an implant reconstruction and will withstand radiotherapy better. The below diagrams outline the surgical procedure…
Patient has had previous mastectomy, which involves removal all breast tissue, +/- armpit nodes and some breast skin to go ‘flat’.
Extra (adjuvant) treatment with chemotherapy and radiotherapy should be completed first.
6 months need to splash after the latter to allow the tissues to settle down.
A special CT scan is done to look at the blood vessels under the skin in the area below the bellybutton
Here the tummy tissue is mobilised similar to a tummy tuck. However, unlike that operation the underlying muscles are split in order to dissect out the blood vessels that apply the overlying skin and fatty tissue by a microsurgeon using optical magnification.
The abdominal wall and muscles are repaired as in a hernia operation and then the skin closed like a tummy tuck. (Note the belly button stays still and is brought out through a new hole).
Then the breast scar is removed and a pocket created in order to fit in the tummy tissue and restore the breast contour.
This allows access the ‘recipient’ vessels behind the ribs. The tummy tissues are moulded, trimmed and shaped.
Then using an operating microscope the arteries and veins are joined together. The arteries are stitched by hand and the vein is joined using a device known as ‘the coupler’.
The wounds are all closed, cleaned and dressed with an abdominal binder and a Doppler point marked on the reconstructed skin. Typically the operation takes 5 hours, with 6 days in hospital and a 7 week recovery.
For smaller breasts symmetry may be achieved immediately, for others a later breast reduction or uplift may be needed along with a nipple reconstruction and adjustment of any scars. This is done in 1-2 hours and as a day case.