Second reconstruction options after TRAM flap?


Question from Sue: If you have a TRAM flap for one breast, what options do you have if you need to have the other breast removed at a later time?
Answers - Maurice Nahabedian Unfortunately, the TRAM flap or any abdominally based flap can only be performed one time. Should the opposite breast require reconstruction, our options would be to use an implant or to use the latissimus dorsi muscle. A third option that we have not yet discussed would be to use the upper buttock skin and fat, which is known as the SGAP flap. This is an acronym for superior gluteal artery perforator flap.
Marisa Weiss, M.D. If someone feels that they have a really big rear end and would love to make it smaller, would she ever consider this as a primary option for reconstruction?
Maurice Nahabedian The SGAP flap is probably the most difficult type of reconstruction to successfully perform. Women who are interested in this flap must be carefully selected and counseled. If there is an excessive amount of buttocks skin and fat, this flap would, unfortunately, not be a very safe option. However, in the slender woman who is interested in using her own tissues and who has insufficient quantities of abdominal skin and fat, this is a good option.
Marisa Weiss, M.D. What options does a woman have for reconstruction if she is a significant smoker?
Maurice Nahabedian Women who use tobacco are generally counseled to avoid cigarette smoking. The pedicled TRAM flap is the reconstructive technique that is most adversely affected by tobacco use. This is because the blood supply to the flap is most compromised with this form of reconstruction. In addition, the use of tobacco can adversely affect the healing of the abdominal incision, especially if there has been a large amount of undermining that is commonly associated with the pedicled TRAM flap.

With the DIEP or the free TRAM flap, the effects of tobacco use have not been associated with adverse outcomes. This is primarily because of the robust blood supply associated with these flaps. In patients who use tobacco and who are going to have a pedicled TRAM flap, there are techniques available that can improve the blood supply to the flap and minimize the untoward feeling associated with tobacco use. These techniques involve staging the reconstruction into two phases. The first phase is known as a delay procedure, which stresses the blood supply and allows it to acclimate to adequately supply the flap.

On Wednesday, November 19, 2003, our Ask-the-Expert Online Conference was called Breast Reconstruction. Maurice Nahabedian, M.D. and Marisa Weiss, M.D. answered your questions about different techniques in breast reconstruction, the pros and cons of implants and body tissue transfers, when you might want to reconstruct, and many more issues related to rebuilding your breast/s after breast cancer surgery.

The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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