Reconstructive Surgery

Breast Reconstructive Procedures

Breast reconstruction offers much hope for a woman losing her breast to cancer. Reconstruction can often be performed immediately after the mastectomy, so the woman does not have to live with one breast. Depending on health conditions, however, a mastectomy patient may have to wait before undergoing reconstructive surgery. In either case, reconstructive surgery holds much promise that the post-operative breast can match the natural breast again.

Dr. Nassif Soueid, director of Microsurgery for St. Joseph's Breast Center and a board-certified plastic and reconstructive surgeon, is one of only a handful of doctors trained to perform these advanced reconstructive breast procedures.

The Surgery

When reconstructive surgery is performed immediately following mastectomy, a breast mound is created in place of the breast that has been removed. This is done in the hospital under general anesthesia.

Dr. Soueid will work with your Breast Surgeon to ensure the best possible conditions for reconstruction.

Breast reconstruction usually involves more than one operation, and follow up procedures may be performed on an outpatient basis. Follow-up procedures may only require local anesthesia, and often involve a skin expander with a breast implant, and reconstruction of the nipple and areola. Sometimes surgery is the performed on the natural breast to match the reconstructed breast; however, this creates additional scars.

Once the breast mound is in place, Dr. Soueid may follow up with a skin expander and breast implant or flap reconstruction.

DIEP Flap

Deep Inferior Epigastric Perforator Flap 

The DIEP Flap is the next logical progression and major breakthrough in a woman's quest to use her own tissue for the reconstruction of a breast following mastectomy. A breast is comprised of skin and fatty tissue. The DIEP Flap makes use of a woman's abdominal skin and fat to reconstruct her breast. Unlike the TRAM Flap which also makes use of abdominal skin and fat, the DIEP Flap spares the abdominal muscles.

This critical difference in the procedures is a major advance for the active woman of 2000 and beyond. It allows activity to be resumed earlier following surgery, and with virtually no chance for an abdominal hernia or bulge that is reported to occur in up to 20% of TRAM patients. No mesh or foreign material is required to close or reinforce the abdominal wall as may be indicated in TRAM patients. This is frequently required in women undergoing bilateral breast reconstruction. The fringe benefit for patients who undergo a DIEP Flap is the tummy tuck closure of the abdominal wall. The DIEP Flap exceeds the TRAM taking it to the next level.

There is no need for the breast to have a muscle incorporated in it, as the normal breast gland does not have muscle in it either. The rectus abdominus muscle sacrificed in the TRAM Flap is not functional in the chest. In fact, the abdominal muscle eventually atrophies, or withers away, once transferred to the chest. Therefore, the woman has forfeited the rectus abdominus muscle. Any bulk needed to create a breast can be obtained from the skin and fat of the abdomen.

SIEA Flap

Superficial Inferior Epigastric Artery Flap

For some women the blood vessels just under the skin in the lower abdomen may be chosen as the feeding vessels for the required tissue. The procedure is otherwise the same as the SIEA flap.

SGAP Flap

Gluteal Artery Perforator Flap

For the thin woman or those with otherwise inadequate tummy tissue, the breast may be reconstructed with tissue borrowed from the gluteal area. Skin, fat, and the tiny feeding blood vessels are taken using a fine incision along the panty line.

I-GAP Flap

Inferior Gluteal Artery Perforator Flap

Our newest development, the In-The-Crease IGAP is an excellent option for many women. Excess skin and fat are borrowed from the inferior buttock, leaving an improvement in buttock shape, and a scar that is completely hidden.