By Peter Ledoux, MD
and Minas Chrysopoulo, MD
Breast reconstruction following mastectomy
became popular in the 1960s and 1970s with
the advent of implants. Since that time, breast
reconstruction has progressed in many ways. In the
late 1970s and 1980s, soft tissue reconstruction had
its beginnings with the latissimus dorsi myocutaneous
flap and the Transverse Rectus Abdominis
Myocutaneous (TRAM) flap.
As microsurgery developed in the late 1980s and
1990s, it became apparent that the gold standard for
breast reconstruction was the free TRAM flap. This
technique utilizes the lower abdominal tissue (skin,
fat, and muscle) and the blood supply from the deep
inferior epigastric vessels that provide the dominant
blood supply to the lower abdomen.
In the new millennium, the TRAM has evolved
into the free deep inferior epigastric perforator
(DIEP) flap. Like the free TRAM flap, the DIEP flap
uses the lower abdominal skin and adipose tissue for
breast reconstruction, but unlike the TRAM, it preserves
the rectus muscle.The small blood vessels (“perforators”) that branch off the deep inferior epigastric
artery and vein are dissected free from the
abdominal musculature. These perforators, the deep
inferior epigastric pedicle, and the skin and fat of the
lower abdomen are then transplanted to the chest
and microsurgically anastomosed to vessels
in the chest, usually the internal
mammary artery and vein.
The DIEP procedure allows for excellent
breast reconstruction while leaving
all the abdominal wall musculature intact.
Thus, there is less chance for weakness
of the lower abdominal wall or hernia
formation. Patients also experience a
shorter and easier post-operative recovery.
For these reasons, the DIEP flap has
replaced the free TRAM flap as the new
gold standard in breast reconstruction.
Unfortunately, there are only a few
centers in the country that offer this
type of reconstruction. To this day, the
bulk of breast reconstruction is still
performed with implants.
We prefer autologous breast reconstruction
(using the patient’s own tissue)
for many reasons. Unlike implant reconstruction,
the reconstructed breast is soft
and “natural,” both in feel and appearance.
It will last a lifetime and age
appropriately as the patient ages.
The nipple reconstruction and tattooing of
the areola are performed secondarily to
complete the reconstruction.
All of the physicians we work with,
including general surgeons, oncologists,
gynecologists, primary care physicians,
and others, have been impressed by the
superior results of DIEP flap reconstruction
compared to implant reconstruction. In fact, they feel so strongly that they
prefer for all of their patients to have
this form of autologous reconstruction.
We feel it is important for all
women facing breast cancer surgery in
this country to understand they have
access to excellent reconstructive
options, such as the DIEP flap, even if
it means they have to travel.
We have a number of patients from around the
country who travel here for DIEP flap
breast reconstruction. Furthermore,
thanks to a federal mandate, breast
reconstruction is covered by insurance.
Breast reconstruction restores something
that nature has provided, but cancer
has taken away. Patients have repeatedly
stated that reconstruction has not
only allowed them to feel whole and
restored, but that it also provides a
renewed sense of hope after battling
breast cancer.
Peter Ledoux, MD
received his medical
degree from Wayne State
University in 1987.
He turned to plastic and
reconstructive surgery
while training at the
University of Texas
Health Science Center in Houston. Dr.
Ledoux joined Plastic Reconstructive and
Microsurgical Associates of South Texas in
1994. He is associated with the Methodist
Healthcare System and most often performs
procedures at Methodist Hospital on Floyd
Curl and at Methodist Ambulatory Surgical
Hospital on Huebner Road.
Minas Chrysopoulo, MD
was raised and educated
in London, England. He
has been practicing medicine
since 1996 and is a
board-certified plastic
surgeon. His specialties
include breast construction
(including DIEP flap reconstruction),
minimally invasive facial and breast surgery,
and all aspects of aesthetic cosmetic surgery.
His expertise in body contouring techniques
has been recognized nationally. Dr. Chrysopoulo
practices with Plastic Reconstructive
and Microsurgical Associates of South Texas.
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