Free Flaps
Breast reconstruction contributes substantially to a woman’s physical, emotional, and psychological recovery from breast cancer. Free tissue transfer provides autologous tissue for a soft and natural feeling breast of enduring permanence with a natural in
- PDF / 1,954,449 Bytes
- 10 Pages / 595.276 x 790.866 pts Page_size
- 113 Downloads / 226 Views
Free Flaps Eva M. Weiler-Mithoff and Ben K. Chew
30.1
Introduction
Breast reconstruction contributes substantially to a woman’s physical, emotional and psychological recovery from breast cancer. It enables a woman to feel whole again, rebuilds her self-confidence and restores her body image and sense of sexual attractiveness. Reconstruction of a breast involves restoration of the skin envelope and volume with the goal of re-establishing the original or desired anatomy. Autologous tissue remains the ideal material for the reconstruction of a soft and natural-feeling breast of enduring permanence with a natural inframammary fold and ptosis. Autologous tissue has natural dynamic movement and confers the greatest degree of symmetry to the contralateral normal breast, irrespective of postural position and whether in or not in a brassiere. Free from the comparative constraints of pedicled flaps, microsurgery allows the safe transfer of large amounts of tissue with a higher degree of freedom and flexibility, thereby facilitating the aim of autologous reconstruction. Despite routine application in many centres, free tissue transfer remains a major surgical procedure. Successful provision requires not just a surgeon competent in microsurgical techniques but also an appropriate operating theatre set-up, a high-powered operating microscope and trained theatre staff. 6–8 h of operating time may be required, with a subsequent hospital stay between 7 and 14 days unless patients are discharged early with drains in place. Postoperative recovery can take up to 2–3 months [1].
The ideal patient for such a procedure is one who is physically fit and healthy, with an active lifestyle and committed to complete restoration of her body image. The advantages of free flap breast reconstruction include a wide choice of potentially available donor sites that can be selected appropriately and individualised to each patient, e.g. abdomen, buttocks, and thighs. There is freedom of design without the limitations imposed by pedicles. Large defects can be covered without the need for prostheses, and long-lasting results can be achieved (Fig. 30.1). In the long term, autologous reconstruction is also cost-efficient. Free flap reconstruction can be associated with significant complications and morbidity. There is an increased risk of general complications such as deep vein thrombosis, pulmonary embolism, pneumonia and acute respiratory distress syndrome. Specific complications of free flaps include microsurgical problems requiring expedient reexploration of the anastomosis, haematoma, fat necrosis and partial or total flap loss. Significant complications may add to logistical problems and increase healthcare costs. Donor site complications such as wound-healing problems and mesh infection may prolong the recovery process and increase the length of inpatient admission. Other problems include asymmetry, abdominal weakness, bulging and incisional hernia. The main disadvantage of autologous breast reconstruction is donor site morbidity, particularly
Data Loading...
