Breast reconstruction with tissue from the abdomen
This surgical method is most frequently used in our clinic for breast reconstruction, as this form of reconstruction achieves the most natural result. It is based on the concept of replacing the similar with the most similar. As a result, the skin and fatty tissue of the abdomen are most similar to breast tissue. The prerequisite is the presence of sufficient abdominal tissue. In the standard technique used, the abdominal fatty tissue is transplanted freely, i.e. only a block of skin and fatty tissue including the supplying vascular bundle is removed and then microsurgically connected to the recipient vessels in the chest using a microscope.
For better visualization of the small vessels, a computer tomography (CT) scan with contrast medium is usually performed preoperatively. This leads to a preoperative selection of the vessels to be preferred, simplifies the intraoperative search and ultimately patient safety. In order to achieve the best possible aesthetic result, the incision and dimensions of the key landmarks are marked out for each patient before the operation.
Breast reconstruction with tissue from the thigh
The so-called transverse myocutaneous gracilis flap (TMG) consists of a part of the thigh muscle together with the overlying skin and fatty tissue. This method also ensures a very natural result with an inconspicuous scar placed in a natural body fold (thigh crease). The operation is particularly suitable for slim patients with small breasts. Similar to breast reconstruction with abdominal tissue, the vessels supplying the flap are dissected out and transplanted together with the muscle-skin-fat tissue block and sutured to the recipient vessels under microscopic magnification. The anatomy of the three components (muscle, skin and fat) allows individual adaptation of the flap to the opposite side and shaping of the flap into a tissue-own implant.
It is also possible, if the disease makes it necessary, to reconstruct both breasts at the same time in one operation using this technique.
Sometimes it is also possible to prepare a skin-fat flap without removing the muscle. The great advantage of this method for patients is that the scar is inconspicuous in the crotch and at the same time a tightening of the thigh is achieved, similar to a thigh lift. A restriction of the thigh function is not to be expected, as numerous other muscles are present in this region. Occasionally, sensory disturbances may occur on the dorsal side of the thigh for a few months. After about six months, the healing of the tissue is complete. In most cases, the tissue has then reached its final shape, so that corrective surgery can be performed, such as a lift of the other breast for alignment or reconstruction of the nipple.
The operation is performed under general anesthesia. The inpatient stay is approximately six to ten days. The risks and complications are similar to other breast reconstructions with free flaps. Wound healing disorders may occasionally occur in the area of the donor site. Patients should not spread their legs too much during the first five days so that the wound heals in a cosmetically attractive and stable manner. Prolonged sitting should also be avoided during the first two weeks. Compression pants and support bra should be worn for about two to three months.
