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Plastic and Reconstructive Surgery

UCLA Breast Reconstructive Center offers full range of options to meet every patient's needs

12/01/2005

Plastic surgeons in the UCLA Breast Reconstructive Center work as part of a multidisciplinary team along with breast oncologists, breast surgical oncologists, radiation therapists and the personnel in the Revlon UCLA Breast Center to provide reconstructive consultations and care for patients with breast cancer and other breast-related problems.

The UCLA plastic surgeons tailor their reconstructions to their patients’ individual oncologic needs. They are facile with every technique of breast reconstruction, from autologous tissue reconstructions to prosthetic implants. Factors influencing their recommendations include the timing of the reconstruction (whether immediately following mastectomy or delayed), the need for adjuvant cancer therapy (chemotherapy or radiation), the medical history and the body habitus of the patient, as well as the patient’s preference. The central mission in each case is the optimization of form, function and safety for the patient.

Autologous reconstruction

While they are technically demanding and labor intensive, autologous breast reconstructions offer some important advantages over prosthetic implants. Autologous reconstructions can appear more natural than implant reconstructions. They also tend to be more durable over time, allowing patients to avoid the revision operations that many patients with implants require years after the original reconstruction.

UCLA plastic surgeons specialize in the “gold standard” of breast reconstruction, the deep inferior epigastric perforator (DIEP) flap. This operation is a microvascular muscle-sparing variant of the TRAM (transverse rectus abdominis myocutaneous) procedure. Preserving the rectus abdominus muscle is less morbid to the abdominal wall, decreases postoperative pain, and minimizes the risks of abdominal weakness and bulging. The technique has continued to evolve; now UCLA surgeons are often able to spare the entire rectus muscle by performing a DIEP flap. The microsurgically transferred free flap also enjoys a healthier, more robust blood supply compared to pedicle flap alternatives, resulting in fewer subsequent complications with the flap.

UCLA has one of the largest microsurgery programs in the United States, performing approximately 150 free-flap breast reconstructions annually. The high patient volume has allowed UCLA’s surgeons to develop an expertise that contributes to the center’s outstanding outcomes. At UCLA, the success rate for microvascular breast reconstruction is 99.5 percent, well above national averages for these procedures.

Also contributing to UCLA’s excellent outcomes is a specialized postoperative flap unit, staffed by specially trained nurses that monitor flaps for perfusion problems. Their alert and responsive care ensures a smooth post-operative course for recovering flap patients.

For patients who are not good candidates for the muscle-sparing TRAM or DIEP procedures, UCLA plastic surgeons can offer numerous alternative autologous breast reconstruction options. Tissue can be harvested using similar microvascular surgical techniques from the buttock, thigh or hip areas to create a new breast mound. In some cases, patients may prove to be better candidates for a pedicle flap, in which case the latissimus dorsi muscle and skin from a patient’s back can be tunneled through the axilla to reconstruct the breast.

Prosthetic implant reconstructions

The use of saline or silicone implants can be an excellent option for breast reconstruction in selected patients. Patients who do not require adjuvant radiation therapy and patients who lack adequate autologous tissue in their lower abdomen to create adequate breast volume (especially in cases of bilateral reconstructions) are the best candidates for this type of reconstruction.

Center surgeons

Consultations with one of the UCLA Breast Reconstructive Center surgeons can be obtained by calling the UCLA Division of Plastic and Reconstructive Surgery at (310) 825-5510.

Andrew Da Lio, M.D.
Director of Microsurgery

Christopher Crisera, M.D.

Jaco Festekjian, M.D.

James Watson, M.D.

Journal articles

  1. Grotting, J.C., et al., Conventional TRAM flap versus free microsurgical TRAM flap for immediate breast reconstruction. Plast Reconstr Surg, 1989. 83(5): 828-41
  2. Shaw, W.W. and Ahn, C.Y., Microvascular free flaps in breast reconstruction. Clin Plast Surg, 1992. 19(4): 917-26
  3. Blondeel, P.N., One hundred free DIEP flap breast reconstructions: a personal experience. Brit J Plast Surg, 1999. 52: 104-11
  4. Futter, C.M., et al., A retrospective comparison of abdominal muscle strength following breast reconstruction with a free TRAM or DIEP flap. Brit J Plast Surg, 2000. 53: 578-83
  5. Mehrara, B.J., et al., Complications after microvascular breast reconstruction: Experience with 1195 flaps. Plast Reconstr Surg, in press




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