Among women who undergo mastectomy as part of their breast cancer treatment, a growing number receiver reconstructive plastic surgery. For those seeking an alternative to synthetic implants, WellSpan Health is the only facility in the area offering tissue flap breast reconstruction. 

“Flap reconstruction provides women who have undergone mastectomy a more natural reconstruction,” says Hooman Soltanian, MD, WellSpan Plastic and Reconstructive Surgeon and Associate Professor of Plastic Surgery at John Hopkins School of Medicine. “This type of reconstruction … can last the patient’s life.” 

Reconstruction Deconstructed 

In preparation for flap reconstruction, the patient undergoes lower abdomen imaging with MR or CT angiogram. These images serve as an anatomical road map of the small blood vessels (perforators). The surgeon then determines and marks the tissue harvesting site in the abdomen. During the surgery, the surgeon raises the area of skin and fatty tissue desired for harvesting and locates the imaged perforators. Those blood vessels are released from the abdominal wall, leaving the abdominal muscles intact, an evolution in flap reconstruction that prevents abdominal weakness and reduces hernia risk. 

The harvested tissue and blood vessels are then positioned over the chest. Using a microsurgical technique, the surgeon connects the blood vessels from the harvested tissue to blood vessels within the chest wall. Dr. Soltanian notes that this procedure is similar to transplant surgery; however, the same patient is both the donor and recipient of the transferred tissues. Once the blood vessels are connected, the surgeon shapes the breast(s). The abdominal donor site is subsequently closed, resulting in a flatter, tighter abdomen, which Dr. Soltanian says “mimics the effects of tummy tuck surgery.” For some patients, this aspect of the procedure grants an additional aesthetic benefit. 

In addition to benefiting breast cancer patients, this procedure may be indicated for those who have trouble with breast development or who have experienced trauma to the chest. 

Many Options for Breast Reconstruction 

Tissue flap surgery requires five to eight hours for one breast and up to twelve hours for both, though operating time can be reduced by working with a microsurgical partner. Unlike implants, the results of the procedure can last a lifetime and feel more like natural breasts. Other areas of the body can serve as a tissue donor site besides the abdomen, such as the buttocks and thighs.  

Though offering significant benefits, tissue flap is not always an appropriate reconstructive technique. Exclusion criteria include: 

+ Being significantly overweight, which increases the risk of complications 

+ Excessive thinness, which limits the amount of harvestable abdominal tissue available for transfer 

+ History of significant abdominal surgery, as this may damage the tissue that would otherwise be harvested for the procedure 

+ Significant comorbidities, such as heart or lung disease 

For women who are not candidates for tissue flap reconstruction surgery, WellSpan Health offers other reconstructive procedures. “We offer the whole spectrum of options to patients who desire breast reconstruction,” Dr. Soltanian says. “As long as they are medical and surgical candidates, we give patients a choice, helping them decide what fits their lifestyle best. And we work closely with other cancer providers — oncologic surgeons, oncologists, and radiation oncologists — to provide comprehensive care to those diagnosed with breast cancer.”  

Call 717-812-2390 to refer a patient for flap reconstruction at WellSpan Health.