Introduction:
A breast reconstruction procedure is used to restore the breast's appearance after breast tissue removal due to cancer or other conditions. Different methods are available for breast reconstruction, including musculocutaneous flap reconstruction. Musculocutaneous flap breast reconstruction is a surgical procedure used to reconstruct the breast after lumpectomy (surgical removal of cancerous tissue along with some normal tissue surrounding it) or mastectomy (surgical removal of a breast). Musculocutaneous flap reconstruction is done by taking a muscle section and skin from the back of the patient and transplanting it to the breast tissue, which helps reconstruct the breast shape. It can be used in combination with breast implants. This muscular breast reconstruction helps give a natural feel and appearance to the breast which is reconstructed. It can also be used in people who have undergone radiation therapy. This procedure is done under general anesthesia and takes several hours.
What is Meant by Muscle Flap Surgery?
In the case of muscle flap surgery only muscle is being used for defect coverage. It is done to provide a good vascularised soft tissue. This provides good resistance against infection, promotes wound healing, and provides a vascularised surface for the skin grafts.
What Are the Different Types of Flaps Used in This Procedure?
The different types of flaps that are used in musculocutaneous flap reconstruction include the following:
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Latissimus Dorsi Flap - It is the most commonly used musculocutaneous flap for breast reconstruction. In this method, a section of muscle and skin is taken from the back of the patient from the latissimus dorsi muscle and is transplanted to the breast region.
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Thoracodorsal Artery Perforator Flap (TAP) - This type of flap is used when there is a smaller reconstruction of the breast. In this method, a small section of fat and skin is taken from the back, supplied by the thoracodorsal artery.
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Lumbar Artery Perforator Flap (LAP) - In this technique, a section of fat and skin is taken from the patient's lower back, which is supplied by the lumbar artery. This type of flap is used when there is a larger breast reconstruction.
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Gluteal Artery Perforator Flap (GAP) - A section of fat and skin is taken from the buttocks of the patient where the gluteal artery supplies it. It is also used when there is a larger reconstruction of the breast.
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Transverse Rectus Abdominis Myocutaneous Flap (TRAM) - A section of muscle fat and skin is taken from the abdomen of the patient where the inferior epigastric artery supplies it. This type of flap reconstruction is used when larger breast reconstruction is needed.
Which Are the Two Musculocutaneous Flap Reconstruction Methods?
The two main methods of doing muscular cuteness flap breast reconstruction are:
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Pedicle Flap Technique - In this method, a section of skin and muscle is taken from the back of the patient, which is left back to its original blood supply, the thoracodorsal artery. After that, the flap is tunneled below the skin in the chest area, which helps to reconstruct the breast tissue. In this method, the flap is already attached to the blood supply, which will decrease the risk of complications. The disadvantage of this method is that the flap can reach only a certain distance from the original blood supply, which limits the use of a larger breast reconstruction.
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Free Flap Technique - A section of skin and muscle is taken from the back of the patient, which is completely detached from the original blood supply. This flap is then reattached to the blood vessels present in the chest region with the help of a microsurgery technique. This technique can be used in cases for the larger reconstruction of breasts and can be shaped more easily. This method requires a high level of surgical skill and is usually technically challenging, which carries a higher risk of complications.
How Is Musculocutaneous Flap Reconstruction Done?
The steps in performing musculocutaneous flap reconstruction include the following:
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Anesthesia - General anesthesia is given to the patient to reduce the pain and discomfort during the procedure.
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Preparation of the Donor Site - An incision is made on the back of the patient to get access to the donor site, usually on the latissimus dorsi muscle. The underlying skin and muscles are removed from the surrounding tissue and blood vessels.
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Harvesting the Flap - The skin and muscle flaps are carefully removed from the surrounding tissues while preserving the blood supply.
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Shaping the Tissue - The removed flap is reshaped and molded to the appropriate shape and size, which is required for the reconstruction of the breast. Excessive tissue is trimmed off, and surgical mesh is used to give additional support.
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Preparing Blood Vessels - The blood vessels present in the chest are prepared to receive the flap. In a pedicled flap, the blood vessels are attached to their original location in the back, while in a free flap, the blood vessels will be detached from the original location and have to be reattached to the blood vessels present in the chest with the help of microsurgery techniques.
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Transferring the Flap - The flap is transferred to the breast region and secured using surgical clips or sutures. In some cases, breast implants are also inserted to give extra volume and shape to the reconstructed breast.
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Closing the Incision - Both the incisions made on the donor site and breast region are closed using surgical staples or sutures. In case of excess fluid, it is drained, which helps reduce the risk of infection.
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Recovery - The patient is carefully monitored for several days after the completion of surgery. A compression garment helps in decreasing the swelling and helps in supporting the reconstructed breast. The patient is advised to avoid heavy activities for a few weeks to improve healing.
Conclusion:
In conclusion, musculocutaneous flap reconstruction is a type of surgical procedure that helps restore the function and appearance of the breast after lumpectomy or mastectomy. A section of skin and muscle is taken from the back of the patient, and it is transplanted to the breast region, which helps reconstruct the shape of the breast. Using the patient's tissue gives a natural appearance and feels during reconstruction. It can also be used to reconstruct damaged tissue. This procedure helps in improving symmetry and gives a natural-looking appearance. It will promote sensory nerve reinnervation. It is an effective and reliable method that will improve patient satisfaction.
