In 2000 I had a gastric bypass and lost 140lbs. I have had an abdominoplasty, thigh lift and breast reduction. My doctor is suggesting that I go for a reverse abdominoplasty, which I need, and use flaps to build-up/reconstruct my breasts. Any thoughts?
What Do You Think of Using Tissue from Reverse Abdominoplasty for Breast Reconstruction?
Doctor Answers (10)
Can Reverse Tummy Tuck EXCESS tissue be used to Augment Loose, Empty Breasts?
Regarding: "What Do You Think of Using Tissue from Reverse Abdominoplasty for Breast Reconstruction?
In 2000 I had a gastric bypass and lost 140lbs. I have had an abdominoplasty, thigh lift and breast reduction. My doctor is suggesting that I go for a reverse abdominoplasty, which I need, and use flaps to build-up/reconstruct my breasts. Any thoughts?"
What your surgeons is suggesting THEORETICALLY may work IF the Breast ?Lift incisions were ONLY akin deep and NOT full thickness and you are willing to have a transverse scar across your chest.
Allow me to explain.
The loose tissue of the upper tummy which your surgeon would otherwise remove and throw away in a regular reverse tummy tuck is to be used as an auto-implant to fill your breasts. To do so the blood supply across the lower breast fold into the subcutaneous tissue must be intact. IF the breast Lift incision went deeper into the tissue it likely divided the blood supply making these areas dependent for their oxygen from the sides and below, areas which would need to be cut if this tissue was to be fitted into each breast. So everything would depend on the depth of the incision. You could STILL have the reverse tummy tuck, but if these flaps begin to appear darker, they could not be used for breast volume.
Instead, you then, may want to consider Hurwitz's spiral flap which is fashioned the the loose skin and fat of the tail of the breast which extents to the arm pit and beyond. The loose skin lifted, edges tightened and the tails is wrapped around the breast, giving it volume.
Dr. Peter Aldea
Options for breast reconstruction after weight loss and abdominoplasty
While the procedure you are mentioning has been described, it is not widely employed. It will likely be difficult to obtain enough tissue for breast reconstruction using this technique, and after abdominoplasty, the blood supply to this tissue (and that which remains on your abdomen) may be inadequate-significant complications can occur if the blood supply is inadequate.
If you want to use natural tissue to reconstruct your breasts, there are several possibilities that may be safer and more reliable for you. In particular, gluteal artery perforator free flaps (such as the SGAP flap) and lumbar artery perforator free flaps may be options. These flaps use tissue from the buttock region and love-handle region respectively. If you are interested in these options, you will want to see a sub-specialist, as these operations are not performed y most plastic surgeons.
Reverse Abdominoplasty and Reconstruction
Interesting option. It is possible and described in the literature. However, for post mastectomy reconstruction, I would be a bit concerned regarding the quality of the blood supply to the tissue. You may be at increased risk for hardening of some of the fat (aka fat necrosis). I would explore all your other options as well with your plastic surgeon. Best of luck.
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Breast enlargement after weight loss
I think it is a great idea and it sounds like you are an excellent candidate for this! There are many different techniques that I use in someone that has loss much weight but still has a large amount of loose skin. I suggest you visit my website and watch my videos. I am President of the American Society of Bariatric Plastic Surgeons and one of my specialties is body contouring after weight loss.
Using Tissue from Reverse Abdominoplasty for Breast Reconstruction
Interesting idea and could work very well. But you did not post photos!! So My guess is YES! Please discuss with the chosen surgeon in detail so you have a full informed consent and understanding.
First I would make sure that your surgeon is board certified in Plastic surgery. Secondly, I would ask to view his other work in this regard with before and after pictures. I have limited experience is this procedure and the results I have seen have been acceptable but not ideal. Wit the massive weight loss this may be a relatively good procedure, especially in fitting in your clothes.
Tal Raine MD
A reverse abdominoplasty is used for tightening the upper abdomen, and sometimes for auto breast augmentation. I personally do not like the scars from this operation and find it very difficult to make nice looking breasts with this tissue.
I would be more prone to thinking in the way of a traditional TRAM if tissue is the way you want to go. The flap in the reverse abdominoplasty may not be reliable. It might not heal well.
John Di Saia MD
Using your own tissue for breast augmentation following massive weight loss
This has essentially been done by other surgeons and one version popularized by Dr. Hurwitz is called the spiral flap. The primary problem is the bulk in the area of the vascular pedicle as well as creating a natural appearing breast crease.
Reverse abdominoplasty and breast reconstruction
While this is certainly a concept that has been used for post-mastectomy deformities, I suspect that it would be better to use an implant instead. First of all, the extra tissue usually is needed in the superior aspect of the breast. Second, depending on how the excessive reverse abdominoplasty is used, as an advancement flap or a rotational flap, there may be some risk of fat necrosis that may produce unwanted firmness, masses, or radiographic densities. Finally, it would seem to be easier to achieve symmetry and shape that is desired with implants rather than flaps that are more variable. Of course your situation and needs should be judged on its on merits.