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$my_content["short_name"] = "delayed_reconstruction";
$my_content["section_heading"] = "Breast Augmentation";
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$my_content["summary"] = "Breast reconstruction may be performed after mastectomy with a flap, in which your own fat is used to replace lost breast tissue. This may be taken from your abdomen, back, or buttocks.
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$my_content["text"] = "<p>There are multiple types of flaps that can be used for breast reconstruction. The idea behind flap reconstruction is that fat from one area of your body may be used for replacement of your lost breast tissue. The benefit of flap reconstruction is that it is more natural than implant reconstruction, so it is especially good for matching an existing breast. The types of flap are reviewed below. </p>

<p><u>TRAM Flap</u><br>
TRAM flap stands for 'transverse rectus abdominus myocutaneous' flap. Basically, excess fat is taken from your abdomen and used to recreate your breast. 'Transverse' refers to the horizontal ellipse of skin that is used from the abdomen, creating a tummy-tuck like result with a low horizontal incision. 'Rectus abdominus' is the name of the muscle that is used for blood supply to the flap. The flap is therefore made up of some muscle, and some skin and fat, or is 'myocutaneous'. There are two of these rectus muscles, visible up and down on either side of the belly button, and they give athletes the 'six-pack' appearance. Blood vessels come through this muscle and into the fat above it. When the TRAM flap is performed, a section of the muscle or all of the muscle is used, and continues to be connected to the fat, even after it is in the breast. The muscle atrophies with time and is non-functional. The 'pedicled' TRAM flap is literally swung upward from the abdomen into the breast, never disconnecting the muscle, which is still connected to the upper abdomen. The 'free' TRAM flap is removed from the abdomen, and reconnected to a new blood supply in the chest or armpit. Finally, a more refined type of TRAM called the 'DIEP' (deep inferior epigastric perforator) flap carefully spares the muscle and only takes the blood vessels from the abdomen. Each of these flaps take hours to perform depending on how complicated it is. Pedicled TRAM flaps, for example, take three to six hours to perform, depending on the surgeon. DIEP flaps, however, take four to nine hours to perform, and are only performed by surgeons specially trained in performing microsurgery. Finally, the SIEA flap should also be mentioned. Like a DIEP flap, it completely spares the muscle, and uses a superficial artery and vein found in the lower abdomen (the Superficial Inferior Epigastirc Artery). This surgery has the advantage of completely sparing the muscle and fascia from any dissection whatsoever. The disadvantage is that this vessel is not always big enough to use, and only supplies half of the abdomen, so only half the volume of the abdomen can be used for breast reconstruction. </p>

<p>All types of TRAM flaps have the huge advantage of looking and feeling incredibly natural, after all, it is your own fat! The disadvantage is that the surgery now involves your abdomen as well as your breast, although for many, it may be considered an advantage, as it is a 'free' tummy tuck. Your plastic surgeon will examine you and discuss whether you are a good candidate for one of these flaps. </p>

<p><u>Latissimus Flap</u><br>
A latissimus flap uses a muscle from your back (latissimus dorsi) and the overlying fat for a breast reconstruction. The flap is simply swung forward from your back to your breast. Almost everyone will also need an implant, because there is not as much back fat as there was breast tissue. Latissimus flaps look more natural than just implants alone. They are often a good option for patients needing radiation to their chest, or a history of radiation from a previous cancer. </p>
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