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Microsurgical breast reconstruction after mastectomy

microsurgical breast reconstructionmCancerPartner sat down recently with Adeyiza Momoh, M.D., an assistant professor of plastic surgery who specializes in breast reconstruction, to discuss microsurgical breast reconstruction following mastectomy. He will be speaking on this topic later this month at Hats and High Tea for Breast Cancer Awareness, a community event sponsored by the U-M Comprehensive Cancer Center’s Community Outreach Program.

mCancerParter: Dr. Momoh, what is microsurgical breast reconstruction?

Dr. Momoh: “Microsurgical breast reconstruction” describes multiple techniques that transfer tissue (skin and fat) from other parts of a patient’s body to the chest for reconstruction. The transfer requires connecting small blood vessels at the chest with the aid of a microscope. Generally, we take the tissue from the lower abdomen in most women. There are some good reasons for choosing the lower abdomen:

  • This lower abdominal tissue is similar in quality to breast tissue.
  • A good number of patients in their late 30s to 50s have ample tissue that can be used.

mCancerParter: Is one technique more popular than the others?

Dr. Momoh: Yes, of all the microsurgical tissue transfers performed, the DIEP flap is most popular. A unique characteristic of this flap has to with the avoidance of use of the abdominal muscle or fascia; only skin and fat are transferred for reconstruction.

If I had to choose a runner-up in popularity, I’d pick the TRAM flap. This flap is also taken from the lower abdomen but in addition to skin and fat some muscle is also harvested. There are several variations of this procedure, based on the amount of muscle harvested.

Tissue for breast reconstruction can also come from other parts of the body, including the buttocks and thighs. We tend to look at these locations when a particular woman’s condition rules out using abdominal tissues, for example, when she has had previous abdominal surgery or is of very slender build.

mCancerParter: Who is the ideal patient for microsurgical breast reconstruction?

Dr. Momoh: The ideal patient is relatively healthy and can tolerate an operation lasting four to eight hours. She has an adequate amount of soft tissue to create a reasonably-sized breast. She must be motivated as well, because she will be recovering from two surgical sites. Patients generally need six weeks off from work to heal, but may require more time to feel 100%.

And, very important, plastic surgeons across the board want to see their patients who smoke give it up prior to reconstruction. Smoking affects healing because it decreases blood flow to the skin. This can result in serious complications including problems with wound healing and survival of the transferred flap.

mCancerParter: When we look at who chooses this technique, are there socio-economic or any other kinds of disparity? If yes, why is this so?

Dr. Momoh: Yes, there are some disparities and these relate to race and socio-economic background. For example, we know that Caucasian women receive immediate breast reconstruction more often than African Americans or Latinas do. Challenges with insurance coverage, proximity to health care providers and the support needed postoperatively are a few things that might influence the types of reconstruction patients receive.

Here at the University of Michigan Health System, we offer all women with breast cancer the same surgical options, regardless of where they live or how they are insured. This way, women have the freedom to make an informed choice that is ideal for themselves.

Take the next step:

  • Put on your best High Tea outfit and join Adeyiza Momoh, M.D., and Lisa Newman, M.D., at Hats and High Tea, Sunday afternoon, October 26. Details here.
  • Watch Linda’s story about her experience with breast reconstruction.
  • Find out more about breast reconstruction surgery at UMHS.
  • Learn about the U-M Comprehensive Cancer Center’s Breast Cancer Survivorship Initiative.

MomohAdeyiza O. Momoh, M.D. is a clinical assistant professor of surgery in the Section of Plastic Surgery at the University of Michigan Health System. Dr. Momoh received his M.D. degree from Northwestern University School of Medicine. He completed his plastic surgery training at the Baylor College of Medicine, Michael E. DeBakey Department of Surgery. Following this, he spent a year of fellowship training in microsurgical breast reconstruction and aesthetic breast surgery at the Beth Israel Deaconess Medical Center in Boston.

 

University of Michigan Comprehensive Cancer CenterThe University of Michigan Comprehensive Cancer Center’s 1,000 doctors, nurses, care givers and researchers are united by one thought: to deliver the highest quality, compassionate care while working to conquer cancer through innovation and collaboration. The center is among the top-ranked national cancer programs, and #1 in Michigan according to U.S. News & World Report. Our multidisciplinary clinics offer one-stop access to teams of specialists for personalized treatment plans, part of the ideal patient care experience. Patients also benefit through access to promising new cancer therapies.