Free Deep Inferior Epigastric Perforator (DIEP)Flap
Rationale:
Advantages
of free Flap:
1. Improved blood supply to the flap
2. Low donor site morbidity
3. Better texture & consistency of the reconstructed
breast
4. Can be sculpted to required shape easily.
Difficulties
for free Flap:
Patient Selection
Correct Flap Selection
Longer operating hours
Microsurgical training
necessary
Postoperative monitoring critical
Goals
for Reconstruction:
Correct Deformity
Avoid the need of an external prosthesis
Promised goal is to make the patient look normal
in her clothing, not in the nude. Unrealistic expectations
discouraged.
Simpler technique preferable in obese patients.
Implant-based reconstruction preferable in the elderly.
Smoking is not a contraindication.
Silicon
Gel Implant:
Appropriate in elderly patients with a subpectoral
pocket
Subglandular pocket may be possible where skin is
good and some breast tissue is present. Simple operation.
Tissue
expansion followed by silicon gel implant:
Prior tissue expansion with an expandable saline prosthesis
first creates some ptosis of the new breast
A combined device (Becker Prosthesis) may be used
Silicon implant may be combined with an LD Flap
Lat
Dorsi Myocutaneous Flap:
Versatile flap based on terminal branch of subscapular
artery
Flap necrosis is rare
Satisfactory results
Low J-shaped flap improves the quality of reconstruction
Free
Lat Dorsi Myocutaneous Flap:
Satisfactory method of reconstructionwithout a prosthesis
Good alternative when Tram cannot be performed due
to previous procedures
Good donor-site scar
Salvage procedure after failure of TRAM
The
Superior Gluteal Free Flap:
Gluteus maximus myocutaneous flap based on Sup gluteal
artery
