Microsurgical techniques | Breast reconstruction

Since 1999 Dr. Masia has successfully performed more than 1000 breast reconstructions with the DIEP technique, with the great satisfaction of having contributed to improve the quality of life of these patients.

In 2003, he developed a technique to preoperatively study the blood vessels that will be used during surgery, thus improving the results and minimizing the possibility of complications. Nowadays, this technique is used by a large number of plastic surgeons worldwide, these advances make breast reconstruction through microsurgical techniques is simpler and safer for patients. As Bob Allen, American plastic surgeon, father of the DIEP technique says:

“The preoperative study through the multidetector CT developed by Dr. Masia has meant the greatest advance in DIEP surgery since the beginning of this technique“.

Nowadays, we perform more than 100 breast reconstructions per year through the most advanced microsurgical techniques. Years of study and improvement of these techniques have allowed us to perform breast reconstructions using the tissue of the patients without using implants and without sacrificing any muscle.

The results obtained are excellent, with a success rate above 99%, in other words, with a possibility of complications of less than 1%.

Using the most appropriate body area for each patient and without altering muscle function we obtained good results with minimal discomfort for our patients. Through the most advanced techniques any breast measurement can be reconstructed and thus recover the natural contour. If a bilateral reconstruction is necessary (when both breasts are removed), it can be done with our techniques, maintaining the concepts of excellence and minimum functional sacrifice. Reconstruction can be performed simultaneously with mastectomy (immediate reconstruction) or at a later time (delayed reconstruction).

We offer you the necessary professional support before, during and after surgery. Please do not hesitate to contact us if you need more information or want to make an inquiry.

DIEP technique

In 1994 a microsurgical technique
called DIEPwas born. This technique allows plastic surgeons to provide the patient with a breast similar to her natural breast; with the same color, touch and evolution over time as the original breast.

A breast that increases or decreases in size when the patient becomes fat or thinner, whose skin would have a thickness and texture almost equal to the natural breast. A breast that does not need new interventions or retouching and that would not interfere with any oncological treatment that should be performed and that would allow you to perform the same activities as before, even practicing sports if you did or decided to do so now.

The DIEP is a surgical technique that allows transplanting only the skin and fat of the abdomen that we have in excess without altering the muscular function of the zone. The vascularization of the transplanted tissue is performed through very small vessels called perforators. Its dissection is extremely precise and meticulous to achieve results with minimal functional consequences and with the best aesthetic result.

The area of the abdomen is closed in the same way as an abdominal aesthetic dermo- lipectomy, an operation in which the effect of flat belly is sought through eliminating abdominal fat. The process leaves the muscle and abdominal nerves intact. By avoiding the functional loss of this muscle, the patient enjoys mobility and total abdominal strength, which will lead to a completely normal life.

The duration of the intervention is about 6 hours since all the steps must be executed with the utmost precision and care. In spite of the operative time, because of the surgical aggressiveness is minimal for the patient, postoperative recovery is very fast, patients are admitted no more than 4 days and can return to normal activity after 3 or 4 weeks.

The reconstruction of the new areola-nipple will be done after 3 or 4 months, once the transplanted tissue has reduced the inflammation to achieve complete symmetry with the contralateral breast. This will be performed by local anesthesia and does not need to stay in the clinic.

SIEA technique

One more step in breast reconstruction. The SIEA is nothing more than a small advance in the way of vascularizing the abdominal tissue that we are going to transplant to reconstruct the breast. It consists of taking advantage of superficial vessels that unfortunately only exist with an acceptable size in 30% of patients. Thus, women who can benefit from this new technique will be able to rebuild the breast in the same way as we do with the DIEP, but without open the muscle fascia. In conclusion, we will be able to reduce operative time and minimize anatomic aggression.

Through the techniques of preoperative planning with image developed in 2003 by Dr. Masia, we can know before the operation if our patient is a candidate for the realization of a SIEA or a DIEP. The domain of the surgical technique and the precise knowledge of the anatomy make these techniques in expert hands such as those of our team have reduced the chances of complications by at least 1% with a total optimization in the selection of patients and the suitability of the technique to be performed.

Unlike reconstructions with TRAM flaps, the use of our techniques of perforator flaps avoid the sacrifice of the abdominal muscles, disappearing the risk of hernias, eventrations, abdominal weaknesses, abdominal wall bulges and, of course, the loss of muscular function that limits women so much that they were subjected to this type of aggressive interventions anatomically. In fact, the use of the superficial vessels in the SIEA allows to completely avoid touching the abdominal muscles because the vessels used do not travel through the muscle. The vessel that nourishes the tissue of the lower abdomen is preserved and the transferred skin and fat are transformed into a new breast.

Like the DIEP, the removal of the tissue from the lower abdomen leaves a thin scar and leaves the contour as if an abdominal aesthetic dermo-lipectomy had been performed.

The duration of this intervention is slightly shorter, about 4 or 5 hours, and also the postoperative is shortened one day (3-4 days). At two weeks after surgery, patients can achieve a totally normal life.

Restoring the nipple and areola is the next step. The scar gradually diminishes over time. For some women the reconstruction leaves the breast firmer and with a younger appearance than the original breast.

When patients have a droopy or very voluminous breast contralateral we use surgical techniques of breast symmetry (breast lift and reduction) that we usually perform in the same surgical session of reconstruction. In this way the patient avoids having to pass 2 times by the operating theater and undergo general anesthesia.

Other microsurgical techniques

Gluteal perforator flaps (IGAP / SGAP):

This is an excellent choice for women who do not possess a sufficient amount of tissue in the abdomen for breast reconstruction. Using as a donor zone the excess fat and skin of the upper or lower part of the buttocks.

Most patients are good candidates for the use of the upper buttocks (SGAP) for breast reconstruction.

Depending on the distribution of fat in the gluteal area we will use the upper part, SGAP flap, vascularized with the superior gluteal artery, which will offer us a suitable tissue for our reconstruction and a lifting effect of the buttocks. The resulting scar is located in an area where we can cover with the underwear.

In those women who have an excess of tissue in the area of the gluteal fold we will perform an IGAP, flap vascularized through the inferior gluteal artery. The resulting scar is easily hidden under the gluteal fold. In the SGAP the upper gluteal artery is used and for the IGAP is the inferior gluteal artery.

Both IGAP and SGAP are used for unilateral or bilateral reconstruction.

Gracilis myocutaneous flap:

Although much less used, we must also know the surgical possibility offered by the inner thighs. In some women who do not have enough abdominal tissue but instead have a certain cutaneous and fatty excess in the upper inner thighs, we can extract this tissue together with the gracilis muscle. This muscle is totally expendable in people who do not perform activities of high muscular demand in the lower extremities.

The resulting scar will be tried to hide in the perineal fold and in certain patients we can even achieve the aesthetic effect of a crural lifting.

The duration of this technique is about 4 or 5 hours and like the others requires a hospital stay of about 4 days.