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“Skin-Sparing” Mastectomy with Reconstruction
We now offer mastectomy and reconstruction with no scars
on the breast. For some patients, all breast skin including
the nipple and areola can be preserved. The
mastectomy is performed via an incision under the arm. The reconstruction
is done using a perforator flap (DIEP,SIEA or GAP flap) placed
through the same incision. The result is a natural, normal appearance
with no scars on the breast.
This new technique is being offered in selected cases for prophylactic
mastectomy, for patients with the BRCA gene mutation, for patients
with DCIS and for patients with invasive cancer.
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DIEP FLAP
Deep Inferior Epigastric Perforator Flap
Perforator flaps represent the state of the art in breast reconstruction.
Replacing the skin and soft tissue removed at mastectomy with soft,
warm, living tissue is accomplished by borrowing skin and fatty
tissue from the abdomen.
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PAP FLAP
Profunda Artery Perforator Flap
This procedure allows the surgeon to use fat and skin from the posterior thigh underneath the buttock crease for your breast reconstruction. The main advantage of this procedure is the donor site scar falls in the crease of the buttock. This procedure is optimal for patients who have had previous surgery that precludes the use of the abdomen as a donor site.
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SGAP FLAP (bilateral simultaneous)
Gluteal Artery Perforator Flap
For the thin woman or those with otherwise inadequate tummy
tissue, the breast may be reconstructed with tissue borrowed from
the gluteal area. Skin, fat, and the tiny feeding blood vessels
are taken using a fine incision along the panty line.
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I-GAP FLAP (bilateral
simultaneous)
Inferior Gluteal Artery Perforator Flap
Our newest development, the In-The-Crease IGAP is an excellent
option for many women. Excess skin and fat are borrowed from the
inferior buttock, leaving an improvement in buttock shape, and a
scar that is completely hidden.
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SIEA FLAP
Superficial Inferior Epigastric Artery Flap
For some women the blood vessels just under the skin in the lower
abdomen may be chosen as the feeding vessels for the required tissue.
The procedure is otherwise the same as the DIEP flap.
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TUG FLAP
Transverse Upper Gracilis Flap
The TUG flap is an advanced microsurgical procedure where gracilis
(inner thigh) tissue, namely skin and fat, is transferred to the
chest wall to reconstruct a breast that has been removed by mastectomy. |
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Autologous
Augmentation
Breast Augmentation with Patients’ own Tissue
The skin and fat on the lateral chest wall can be used to augment
the breast. This tissue is taken from under the arm, next to the
breast. The tissue used is named according to the blood vessels
which supply it. The blood supply to this tissue is either from
perforators through the muscle between the ribs (intercostal perforator
artery or ICAP flap), from the blood vessels in
the armpit (axilla), or from perforators through the latissimus
dorsi muscle (thoracodorsal artery perforator or TDAP
flap). The living tissue is turned over and secured under the breast.
ICAP FLAP: Before
and After Pictures |
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