Corrective breast reconstruction: Free-flap procedures offer natural options if implants fail
October 13, 2021
Breast reconstruction after mastectomy for breast cancer can help women look and feel like themselves again. Approximately 80% of women who have the surgery choose breast implants, and the other 20% select a technique called flap reconstruction, in which tissue is transplanted from another part of their body to create more natural, longer-lasting breasts.
Rarely, a breast implant may leak or rupture, and in less than 1% of cases, a free-flap procedure may fail. And even with the best implant reconstructions, the look and shape of the breast can change over 10-20 years.
If you are unhappy with a breast cancer reconstruction procedure – either right away or over time – you have options to restore your confidence in your appearance. Whether you prefer new implants or a free-flap breast reconstruction, UT Southwestern’s breast reconstruction team works closely with the oncologists at Harold C. Simmons Comprehensive Cancer Center to give you personalized recommendations to optimize your outcomes.
Our plastic surgery experts have pioneered an advanced, personalized approach to corrective breast reconstruction. Using leading-edge CT angiography, we can recommend the optimal donor tissue site – from your abdomen, thigh, “love handles,” or a combination (stacked) – based on the availability of healthy blood vessels and tissue. A recent study we published showed that performing this step reduced surgical times by approximately 16% and allowed us to disturb fewer blood vessels unnecessarily.
Our two-surgeon microsurgery team has performed more than 2,000 free-flap procedures, and we have refined our approaches to offer patients more efficient reconstructions that last the rest of a patient’s life. For example, our DIEP flap procedure takes three to four hours on average – half the time it takes at most breast reconstruction centers.
Shorter, more personalized procedures result in less pain and a shorter recovery time. And offering more tissue site options after a failed implant procedure empowers patients in choosing the best corrective breast surgery for their goals.
Related reading: New breast reconstruction approach delivers efficiency, natural results for cancer patients
What to Know: Transforming Breast Reconstruction
After battling breast cancer, Wendy Razook wanted a seamless reconstruction experience. She found it at UT Southwestern, where the plastic surgery team of Dr. Sumeet Teotia and Dr. Nicholas Haddock has refined the DIEP flap procedure to shorten surgery and recovery times and produce natural results.
Using natural tissue for corrective breast reconstruction
A breast is not an isolated structure. It is connected to the surrounding tissues and muscles of the chest wall, armpit, and clavicle. Implant procedures generally don’t factor in these natural curvatures and connections. However, free-flap procedures harmonize all the associated tissues, offering a more natural look and potentially better sensation retention.
We offer a variety of flap procedures and perform hundreds of them each year, making us extremely skilled at them. Some of the more common flap procedures include:
- Deep inferior epigastric perforator (DIEP): Uses tissue from the lower abdomen.
- Lateral Thigh Flap (LTP): Uses tissue from the upper outside of the thighs.
- Lumbar artery perforator (LAP): Uses soft tissue of the waistline (flank/love handle area). The bilateral version of this procedure (both sides) involves turning the patient over during surgery, which requires a highly trained operating room team.
- Profunda artery perforator (PAP): Uses tissue from the back of the upper thigh. Our team has done more of these procedures than any other center in the world.
- Quadruple 4-flap: This variation is a combination of free flaps. Donor tissue is usually taken from the lower abdomen and thigh or sometimes the lower back.
- Stacked flaps: Uses tissue from different parts of body in combination, generally from two areas.
Using CT angiography before surgery, we locate the best blood vessels to create a roadmap for the flap procedure. Together, we’ll review your results and then we’ll recommend the best surgical approach for you.
Patients have told us that seeing their blood vessels on imaging gives them a stronger sense of ownership in choosing their procedure. By understanding their underlying vascular health, they feel more confident that their next procedure will deliver better results.
Breast Cancer Survivor Story
When Taffie Lynn Butters was diagnosed with cancer, she turned to UT Southwestern for oncology care and breast reconstruction surgery following her mastectomy. Dr. Nicholas Haddock and Dr. Sumeet Teotia were an integral part of the multidisciplinary care that Taffie received at UTSW's Simmons Cancer Center.
Enhanced breast reconstruction recovery
At UT Southwestern, our plastic surgeons are skilled at microsurgical breast reconstruction and they have extensive knowledge to provide our patients with the best results. We also have a specialized care team to support our patients’ streamlined recovery.
At UT Southwestern, our Enhanced Recovery After Surgery (ERAS) programs are innovative pathways designed to optimize our patients’ surgical experiences. Our breast reconstruction ERAS was created in collaboration with multiple specialties in order to improve patients’ surgical outcomes, communication, and overall satisfaction.
We have implemented a program called ERAS (enhanced recovery after surgery) to help patients return to their regular activities after undergoing breast reconstruction.
At our academic medical center, all our specialists – breast surgeons, anesthesiologists, nurses, physical therapists, occupational therapists, and pharmacists – collaborate in each patient’s care under one roof. Every step of planning, surgery, and recovery is backed by research and evaluated against the latest standards of care.
After surgery, our patients recover not in the intensive care unit but in a calm, quiet area with access to our specialized breast surgery team. These recovery protocols, paired with shorter corrective reconstructive procedures, allow patients to go home sooner after surgery. Most stay an average of around two days – about half the average stay at other breast centers.
The ERAS program is also reducing the need for narcotic pain medication after reconstruction. While you might take some short-acting narcotics during your stay, most patients have done well at home with non-narcotic medications that target different mechanisms of pain, such as anti-inflammatory drugs or muscle relaxers.
Choosing to have corrective breast reconstruction is a personal decision that should help you feel more comfortable with your body. Our team of experienced surgeons can correct or improve disappointing results from a previous procedure at another center – even a failed free-flap – so you can look and feel more like yourself again.
To speak with a surgeon about corrective breast reconstruction, call 214-645-8300 or request an appointment online.