Remove 450 Cc Implants After Double S&N Sparing Mastectomy and Use Tissue and Blood Supply from Inner Thigh Without Flap?
- Asked by Jody Baker
- 1 year ago
History: Double S&N sparing mastectomy with submusc stretched 450cc implants. My wish is to remove implants and replace my 450cc cup with own tissue and continue to keep my own breast skin and nipples. Is it possible to undergo a third operation and use autologous tissue from inner thigh (plus bloodsupply) to replace the implants with already created and finished pocket of muscle and breast skin and nipple? Am I wrong to assume that I only need tissue no flap as there is already a pocket there? J.
Thighs as donor sites for autologous tissue breast reconstruction
It is certainly possible to replace implants (or expanders) with a patient's own tissue from a variety of different sources (ie donor sites): abdomen, thighs, back, etc. The first autologous donor site for breast reconstruction is the lower abdominal skin and fat, with (TRAM: transverse rectus abdominis musculocutaneous flap) or without (DIEP: deep inferior epigastric perforator flap) muscle. If the lower abdomen is not available (ie due to previous abdominoplasty or inadequate amount of tissue in a very thin patient), the back tissue can be used, either with muscle (latissimus musculocutaneous flap) or without (TDAP: thoracodorsal artery perforator flap). In addition, as you suggested, the inner thighs can be used either as a TUG (transverse upper gracilis) or a PAP (profunda artery perforator) flap. It is our practice's preference to use perforator flaps because they lower the morbidity of the donor sites.
The specific source is dependent on multiple factors: previous surgical history (ie abdominoplasty), body habitus, desired breast size etc. The transfer of tissue from any site to another is still called a flap whether or not you need the skin. When there is adequate skin envelopes on the breasts, the skin element of the flaps can still be included in the tissue transfer (for an additional volume) after the epidermis has been removed. After the tissue transfer procedure completely healed, if a patient desires a enlargement or reduction in the size of her breast, either fat grafting or liposuction, respectively, can be performed.
Hope this helps!
Implants a better choice for breast reconstruction after tissue expansion
While it is possible to replace the tissue expanders with flaps of your own tissue, this would involve a microsurgical procedure on both breasts, with donor site scars and a significant recovery period. Replacing with implants would be a quick outpatient operation with very little recovery time. It is important to know that the implants will feel a lot more natural than the tissue expanders, which are probably quite firm and unnaturally round.
Implant exchange for autologus tissue reconstruction
It is certainly Ok to exchange a breast implant reconstruction with autologous tissue from whereever it needs to come from. It may feel more natural. hard to say what the skin envelope will need at this point without an exam.
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Implants to flap recon options
. It appears that you have a unique problem here. From what I gather you are dissatisfied with the appearance of your implants. What you would like is reconstruction utilizing the extra skin from the medial thigh. This is called the TUG flap. It is a procedure that can be performed however, the key determinant is your overall body size as to whether or not you have enough tissue there to replace the volume that would be removed by taking out the implants. You will need the volume to reconstitute the missing implant. This is still a flap. Other options are ,diep muscle sparing free tram, superior or inferior gluteal