BOSTON - For many women, the disfigurement that comes from breast cancer surgery can be as traumatic as the diagnosis and treatment of the disease. But a new surgical technique, perforator flap reconstruction, is being offered for the first time in Boston at Beth Israel Deaconess Medical Center (BIDMC) by surgeons specifically trained in the technique. This procedure offers restoration of an affected breast while allowing the return to a physically active lifestyle.
Until now, autologous breast reconstruction began with the surgeon creating a skin flap using tissue from the back, abdomen or buttocks. While eliminating the need for an implant, the surgery required the surgeon to collect muscle along with skin, fat and blood vessels. The loss of muscle support would often create weakness, contour deformities, and hernias in the abdomen or weakness and decreased range of motion of an arm or leg.
DIEP flap microsurgery takes the tissue from the lower abdomen and leaves the muscles intact. Named for the Deep Inferior Epigastric Perforator blood vessels, the surgery requires more time in the operating room but a shorter recovery interval that comes from leaving the abdominal wall intact. An analogous procedure exists for the buttocks donor site, the SGAP Flap, based on the Superior Gluteal Artery Perforator vessels.
"Data show that nearly all women are able to return to vigorous activity, including swimming, biking and tennis, within six months," says Adam Tobias, M.D., who brought the DIEP flap technique to BIDMC. "As much as 90 percent of the abdominal muscle activity returns by about one year. Success rates top 95 percent and complication rates are sharply reduced compared to other techniques."