Microsurgical Breast Reconstruction is ideal for women seeking the most advanced methods of breast reconstruction utilizing the body’s own tissue.

Using our advanced techniques, any breast size can be reconstructed and restored to a natural contour. Bilateral reconstruction (when both breasts are removed) is especially amenable to our muscle sparing techniques. Reconstruction can take place simultaneous to mastectomy, or at a later time.

DIEP Flap - Deep Inferior Epigastric Perforator Flap

"Perforator flaps represent the state of the art in breast reconstruction. Replacing the skin and soft tissue removed at mastectomy with soft, warm, living tissue is accomplished by borrowing skin and fatty tissue from the abdomen.
A slim incision along the bikini line is made much like that used for a tummy tuck. The necessary skin, soft tissue, and tiny feeding blood vessels are removed. These tiny blood vessels are matched to supplying vessels at the mastectomy site and reattached under a microscope.

Unlike conventional TRAM flap reconstructions, use of our refined perforator flap techniques allow for collection of this tissue without sacrifice of underlying abdominal muscles. This tissue is then surgically transformed into a new breast mound. The abdomen is the most common donor site, since excess fat and skin are usually found in this area. In addition to reconstructing the breast the contour of the abdomen is often improved much like a tummy tuck.

Restoration of the nipple and areola follow. Scars fade substantially with time. For many women the reconstructed breast may be firmer and have a more youthful appearance than their natural breasts.

SIEA Flap - Superficial Inferior Epigastric Artery Flap

Like the DIEP, the SIEA replaces the skin and soft tissue removed at mastectomy with soft, warm, living tissue by borrowing skin and fatty tissue from the abdomen.
For some women the blood vessels just under the skin in the lower abdomen may be chosen as the feeding vessels for the required tissue. The procedure is otherwise the same as the DIEP flap. A bikini line incision is designed and the necessary skin, fat, and tiny supplying blood vessels are taken.

These tiny blood vessels are matched to supplying vessels at the mastectomy site and reattached under a microscope.

Unlike conventional TRAM flap reconstructions, use of our refined perforator flap techniques allow for collection of this tissue without sacrifice of underlying abdominal muscles. In fact the use of the superficial vessels in the SIEA allows for complete avoidance of the abdominal muscles because the blood vessel used do not travel within the muscle. The vessel supplying the lower abdominal tissue are preserved and the transfered skin and fat are transformed into a new breast mound.

Like the DIEP lower abdominal tissue is harvested leaving a thin scar and a flat belly, very much like a tummy tuck.Restoration of the nipple and areola follow. Scars fade substantially with time. For many women the reconstructed breast may be firmer and have a more youthful appearance than their natural breasts.

SGAP Flap - Buttocks

The SGAP, or Superior Gluteal Artery Perforator Flap, was developed by Dr. Robert Allen in 1993. We were also the first to perform the bilateral simultaneous SGAP in 1994, and our experience has subsequently been published.

This is an excellent option for women who do not have ample abdominal tissue to donate for breast reconstruction or for those who would prefer to use the upper buttock as a donor site.

Almost all patients are candidates for use of the upper buttock (the SGAP) for breast reconstruction. This donor site can be used for unilateral or bilateral simultaneous reconstructions. This donor site differs from the IGAP in its position on the buttock, the resulting scar placement and the blood vessel used to supply the tissue. For the SGAP it is the superior (upper) gluteal artery, and for the IGAP it is the inferior (lower) gluteal artery. The SGAP scar lies in the upper buttock and is easily hidden in a French cut bikini or in underwear. The IGAP scar lies within the lower buttock crease. Otherwise these donor sites are comparable in terms of the reconstruction they provide.

Which buttock donor site to chose is a matter of preference and anatomy. Both the IGAP and the SGAP can be used for unilateral or bilateral simultaneous reconstruction.

I-GAP FLAP

The In-The-Crease IGAP (Inferior Gluteal Artery Perforator) Free Flap

Our newest development, the In-The-Crease I-GAP Flap, is an excellent option for many women. Excess skin and fat are borrowed from the inferior buttock, leaving an improvement in buttock shape, and a scar that is almost completely hidden. For women requiring bilateral reconstruction both the SGAP and the IGAP can be performed as a bilateral simultaneous operation, so that only one operation is needed to reconstruct both breasts.

Until recently, the GAP flaps have been our second choice of donor site, reserved for patients who were not candidates for the use of abdominal tissue. However, we have found that, for many women, the best of all cosmetic results comes from harvesting skin and fat from the inferior buttock. The scar ends up within the buttock crease, and is almost imperceptible, and the patient has a tighter, lifted buttock. " The scar remains in the crease and does not migrate inferiorly over time as was the case in some cosmetic buttock lift procedures of the past. This recent realization has led us to consider the In-The-Crease I-GAP a first choice in many cases. See Pictures

The In-The-Crease IGAP is harvested using the same microsurgical, muscle-sparing techniques as the DIEP, SIEA and SGAP flaps. The advantage is that there is almost always adequate volume to make an appropriate sized breast, the donor site is often improved by the operation, and the scar is completely concealed within the inferior buttock crease.

Older operations that used the lower buttock took both fat and muscle. Despite the excellent cosmetic results, this operation was abandoned because of occasional problems with the sciatic nerve in the back of the leg. By taking only the skin and fat and leaving the muscle undisturbed, injury or exposure of the nerves is not a problem. The nerves run underneath the muscle and are completely protected by it.

Excess tissue is taken from the lower buttock to create a new breast. Ample tissue is always left for comfort when sitting. Patients report no problems with sitting postoperatively. In fact many of the IGAP patient have remarkably little or no pain.

An advantage of the IGAP is that the aesthetic shape of the upper buttock is preserved.

The final result of the reconstructed breast is comparable to that of the SGAP. Deciding on the SGAP vs. the IGAP depends on patient preference and anatomy, how much tissue the patient has to donate from each site, and preference for scar location by the patient.

Restoration of the nipple and areola follow. For many women the reconstructed breast may be firmer and have a more youthful appearance than their natural breasts. Women with ample buttock tissue, sagging buttock, or sparse abdominal tissue are ideal candidates.