San Antonio surgeons reach breakthrough on reconstructive surgery

Revolutionary way to reconstruct breasts after mastectomy

It's a revolutionary way to reconstruct breasts after a mastectomy. It's called DIEP flap -- deep inferior epigastric perforator.

PRMA Center for Advance Breast Reconstruction in San Antonio is one of the largest plastic surgery groups in the country specializing in the DIEP flap procedure.

Dr. Peter Ledoux  says it is a great alternative to implants because it is part of the person's natural body.

"The breast is mostly fat with some breast tissue, so if we can put a block of fat and skin from the stomach in place of the breast, it's a much more natural, and long-lasting result," Ledoux said. "It lasts forever."

DIEP flap, unlike the TRAM flap procedure, does not take any of the stomach muscles. Blood vessels are transferred with the tissue to create living, breathing breasts. 

But sometimes there can be complications.

"We found that almost all of the time, there's enough arterial blood flow getting into the flap. But because of the venous anatomy, there's sometimes not enough blood flowing out of the flap, so the flap gets congested," Ledoux said.

And when there is not enough blood circulation, the flap turns purple and can die. It happens in 3 to 5 percent of the cases. For those patients, it means an additional two or three surgeries.

"That is devastating for a patient. We try to get this done in one sitting -- at the same time as the mastectomy. So it really is a setback when the flap fails," Ledoux said.

PRMA surgeons set out to find a solution. 

They conducted a study of 800 patients, and 1,600 flap surgeries. They found they could save the flap by removing an extra superficial vein.

"If the flap gets congested, we will hook up one of those superficial veins to help get the blood out of the flap so it remains healthy," Ledoux said.

The procedure worked in 99 percent of the cases studied. 

The finding are  published in Plastic & Reconstructive Surgery, the primary journal of the American Society of Plastic Surgeons.

For more information about DIEP flap, visit PRMA's website.

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