fat transfers ~ Diep ~ Siea ~ Sgap ~ Flap details..interesting.....

[Guest guest]

Yavon ~

Wow, what an interesting proceedure ! This looks like another option for many people ! ! Thank you for sharing this with me. I just had to copy it and share it with the group ! Are you going to this gentleman to see if you are a good candidate for this surgery ? ? Please keep us posted on everything !

Many blessings ~ Dede

DIEP / SIEA / SGAP Flap Details

HISTORY

The most common method of breast reconstruction using a patient's own tissues (as opposed to breast implants) has been TRAM flaps. A TRAM flap involves the surgeon removing tissue (skin, underlying fatty tissues, and muscle) from the abdomen and using it to create the new breast. The tissue needs a blood supply to keep it viable, so the surgeon has to harvest the blood vessels that run through the underlying muscle to the abdominal wall fat and skin. Although what is really needed to form the new breast is the skin and underlying fatty tissues, the blood vessels supplying those tissues go through the muscle, and that is the reason the muscle is also taken. When this type of procedure is done, patients are left with a long scar that is very similar to the scar that is left when a cosmetic abdominoplasty ("tummy tuck") is performed, with the abdominal wall nicely recontoured.

DISADVANTAGES OF A TRAM

Although TRAMs are highly successful and still a very good option for many patients, there are a few disadvantages to a TRAM flap. Because the abdominal muscles are cut and a portion removed, patients are left with some abdominal wall weakness. In addition, they are also at increased risk for abdominal wall hernias. Also, much of the discomfort many patients feel after the surgery is not in the area of the new breast but rather from the abdomen where the muscles were cut.

DESCRIPTION OF A DIEP

A DIEP flap is a microsurgical technique that many feel represents an improvement over the TRAM flap. When a DIEP flap is harvested, the skin and underlying fatty tissues from the abdomen are removed, but the muscle and abdominal wall fascia are preserved and left in place.

In a DIEP flap, what the surgeon does instead is to microsurgically dissect out the major blood vessels (called perforator vessels). This illustration represents the blood vessels being dissected from the surrounding muscle which leaves the muscle intact. These vessels that run through the muscle are called perforator vessels.

ADVANTAGES OF A DIEP

Because this approach leaves the muscle wall and its overlying fascia intact, there is much less risk of abdominal wall weakness and hernia. In addition, patients clearly have less discomfort following DIEP surgery as compared to a free TRAM flap. Because of the reduced pain and fact that the muscle wall remains intact, patients are often able to get back to their normal daily routines more quickly than after a TRAM flap reconstruction. Patients undergoing a DIEP flap have essentially the same scar as those undergoing a TRAM flap, so their abdominal wall is nicely recontoured.

CONTRAINDICATIONS OF A DIEP

As with any surgical procedure, there are disadvantages to a DIEP flap. Because it is a more complex procedure, the DIEP flap takes longer so the patient's anesthetic is also longer. If a patient has previously had abdominal surgery, or if the patient does not have enough extra skin and underlying fatty tissues in the abdomen, the patient may not be a candidate for this type of procedure. Also, because of the complexity of this procedure, there are only a handful of surgeons in the country who are experienced at performing a DIEP flap.

Determining whether a patient is a candidate for a DIEP is something the doctor must do on a case-by-case basis. However, because this is a lengthy surgery there are some conditions which may possibly prevent a patient from being a candidate for a DIEP. These contraindications are things like:

Insulin-dependent diabetes - affects wound healing after surgery Significant cardiac or pulmonary diseases/conditions - may preclude a lengthy anesthetic Significant obesity - affects wound healing after surgery and may preclude a lengthy anesthetic Age - as patients get older other health conditions are more likely to preclude a lengthy surgery or anesthetic Smoking - affects wound healing after surgery Previous abdominoplasty ("tummy tuck") - DIEP / SIEA cannot be done if there has been a previous abdominoplasty Liposuction - if a patient has previously had abdominal liposuction it may preclude having a DIEP / SIEA

As a general rule, most patients who qualify for a TRAM flap will probably qualify for a TRAM flap, with some exceptions due to the increased length of surgery. Previous c-sections, hysterectomies, and appendectomies do not normally interfere with a patient qualifying for a DIEP flap.

SIEA FLAP VARIATION

An SIEA flap is essentially a variation on the DIEP flap. The difference is in which blood vessels are utilized. The decision as to which blood vessels will be used is one which is made intraoperatively by the surgeon, based upon the patient's own anatomy. For the vast majority of patients, the DIEP flap is the best alternative. However, in the hands of a surgeon who is highly experienced with perforator flaps, it may be possible to do the SIEA flap.

Frederick J. Duffy, Jr., M.D.

7777 Forest Lane, Suite C504 Dallas, Texas 75230 Phone: 972-566-3939 Fax: 972-566-3999

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