The spectrum of cutting-edge expertise in breast reconstruction after breast cancer removal has evolved at the current time to include expertise in microsurgical lymphedema treatment, as both can often go hand-in-hand.

 

 

Breast Reconstruction

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Most of the breast reconstruction performed is commonly for post-cancer image & form restoration.  However, there are also circumstances where Dr. Anh Nguyen performs breast reconstruction for congenital lack of breast, or breast underdevelopment, or from trauma such as burns with extensive scarring.

 

The core reconstructive steps are to:

1.      Create the missing breast mound

2.      Then at the next stage, the reconstructed breast mound is made more symmetric in size, location, and shape compared with the native, non-reconstructed side.

3.      At a subsequent step, once symmetry is obtained, a nipple-areola complex is created with surrounding local tissue.

4.      At a final stage, nipple-areolar tattooing is performed.

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Traditionally breast mound reconstruction is performed with implants & tissue expanders.  Another option is to perform a select number of basic flaps (or patient’s own tissue) such as TRAM flap (from the abdomen) or latissimus flap (from the back).

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More recently, some plastic surgeons offer a more select form of TRAM flap called a DIEP or SIEA flap from the abdomen, taking less muscle or no muscle with the tissue transfer to create the breast.

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Current cutting edge breast reconstruction expands to involve 1 or more of the following options:

1.       Expanded flap options (more than the traditional TRAM or latissimus or DIEP or SIEA flaps).  These expanded options include:

a.      TUG/DUG/VUG flaps (from inner thigh)

b.      SGAP flaps (from upper buttock) or IGAP flaps (from lower buttock)

c.      ALT flaps (from outer thigh)

d.      DCIA flaps (from the love handle)

2.       Fat grafting, with harvested fat taken through a special liposuction process from the patient’s own body, to create a full breast mound from a tight, flat mastectomy defect.  Fat transfer can also be used to thicken up the thin layers of skin over an implant, or to augment an inadequate breast mound from a flap transfer with insufficient volume.  Fat grafting can also be used to improve the condition, color, and softness of the mastectomy skin badly damaged from radiation.

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myCARE Plastic Surgery – the Center for Advanced Reconstructive & Esthetic Plastic Surgery – is privileged to offer the above cutting-edge options as part & parcel of the full treatment spectrum for breast reconstruction & microsurgical lymphedema treatment.

 

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Microsurgical Lymphedema Treatment post-Breast Cancer Resection

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This is a quickly expanding area of subspecialty expertise in plastic & reconstructive surgery that focuses on some challenges that occur from the process of breast cancer treatment, either from the oncologic breast cancer resection or from radiation treatment. 

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In order to stage the cancer and help determine the prognosis, sampling of many lymph nodes are done.  Removal of or damage to these axillary (armpit) lymph nodes and sometimes the scarred tissue from surgery or from radiation can interfere with lymphatic flow and drainage – a key function of the lymph nodes.

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Arm swelling, with an uncomfortable sensation of tightness is common.  Early conservative treatments include compression & massage.  If unsuccessful, this can progress to progressive arm swelling, skin thickening and color change, and increased infection.

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Cutting edge surgical treatments include:

1.      Lymphatico-venous anastomosis (LVA) using super-microsurgery.  Usually used for early stage cases, the diseased portion is mapped out, and at the periphery of good and diseased tissues, early stage diseased lymph vessels of microscopic calibers are hooked to (anastomosed) to small, microscopic venules to bypass the diseased lymph flow and dump it into a bigger healthier venous system to be recirculated into the body system.  The longer term results are still to be determined.

2.      Lymph node flap transfer.  There are specialized areas of the body with concentrated lymph node tissues.  Through the subspecialty expertise of microsurgical lymphedema treatment, there are tissue flaps that can be harvested with lymph nodes that can be transferred to the diseased area.  The flaps come from areas such as in the neck (submental flap, supra-cervical flap), lateral chest wall area, groin area, and omentum.  These flaps are transferred and connected to the artery and vein in the lymphedematous area, and the lymph nodes have been demonstrated to act as a pump to wick the excess lymph fluid into the venous system of the flap and transport the lymph fluid back to the body circulation and away from the diseased area.

3.      Debulking, with or without LVA or lymph node flap transfer is reserved for the most severe cases.  This option is usually reserved for lower extremities cases.

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myCARE Plastic Surgery – the Center for Advanced Reconstructive & Esthetic Plastic Surgery – is privileged to offer the above cutting-edge options as part & parcel of the full treatment spectrum for breast reconstruction & microsurgical lymphedema treatment.