Contemporary Microsurgical Breast Reconstruction: Abdominally Based Flaps

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The document is a comprehensive review of abdominally based microsurgical techniques for postmastectomy breast reconstruction, focusing on methods like the TRAM, DIEP, and SIEA flaps. It begins with an overview of breast reconstruction, highlighting the benefits and different approaches, including prosthetic devices and autologous tissues. The article emphasizes the popularity of abdominally based techniques due to their natural and aesthetically pleasing outcomes.<br /><br />The TRAM flap, introduced in the 1980s, has been noted for causing abdominal donor-site morbidity, like bulge or hernia. This led to the development of perforator flap-based reconstructions, preserving more muscle integrity. DIEP and SIEA flaps offer alternatives, with the former becoming the standard for autologous reconstruction. The DIEP flap maintains muscle and nerve integrity, while the SIEA flap, though muscle-sparing, has vascular limitations, leading to higher complications.<br /><br />Despite the advantages of flap-based reconstructions, implants are more commonly used because of their accessibility and shorter recovery time. Economic factors also influence this choice. However, autologous reconstructions reduce long-term risks like implant rupture and evolve with the patient's body changes.<br /><br />The article also covers necessary preoperative assessments, detailing the patient's medical history, physical examinations, and imaging for surgical planning. It underscores the importance of understanding a patient's unique situation, factoring in previous surgeries, and potential adjuvant therapies like chemotherapy or radiation.<br /><br />Operational details highlighted include optimizing workflow through team coordination, the importance of precise perforator and vessel selection for success, and the benefits of modern techniques like loupes-only microsurgery for efficiency. The authors advocate for enhanced recovery protocols to improve outcomes and recommend methods to minimize complications.<br /><br />The review acknowledges innovations like hybrid reconstructions and the potential benefits of robotic-assisted procedures, presenting future directions in microsurgical breast reconstruction that can address current limitations and expand patient eligibility.

Keywords

microsurgical techniques

breast reconstruction

TRAM flap

DIEP flap

SIEA flap

autologous tissues

perforator flaps

preoperative assessments

hybrid reconstructions

robotic-assisted procedures