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‘Local Flap’ and ‘Free Flap’ Tissue Reconstruction


Introduction to tissue reconstruction

Tissue flap reconstruction is used to rebuild the shape of the breast following mastectomy, using skin, fat and muscle from another part of your body. Breast reconstruction almost always involves more than one operation.'Local Flap' and 'Free Flap' Tissue Reconstruction london liverpool

Tissue flap surgery is an example of this, because additional incisions will need to be made at the donor site to provide tissue to reconstruct your breast. It may be possible for the initial ’tissue flap’ procedure to be undertaken during your mastectomy. This means that Mr Hassan Shaaban will take over from the surgeon conducting your mastectomy, to continue with the initial procedure, which will begin your reconstruction. Sometimes this is not possible, and you will need to return for a further surgical intervention. Tissue flap surgery is a more complex procedure than implant reconstruction. Skin, fat, muscle and sometimes blood vessels, are taken by Mr Hassan Shaaban, from a donor site elsewhere on your body. This can be from your abdomen or back and, less usually, from your buttock or thigh.  Flap reconstruction can be used to rebuild the breast mound following mastectomy, or to replace tissue taken away during a lumpectomy (wide local excision).

This procedure is particularly suitable if you have had, or will need, radiotherapy as part of your cancer treatment. It is also an option to consider if you can’t have (or don’t want) an implant or tissue expansion, because you have had a radical mastectomy removing most of the skin, tissue and muscle from your chest wall. Using your own tissue will create a more natural feel and shape to your breast, and will suit women who have both naturally large and small breasts. It is important to consider, however, that this procedure will mean that there will be another surgical site and therefore another significant scar on your body. There may also be a patch of skin on your breast with a different colour and texture, because it has been taken from a different part of your body. Your areola and nipple will be recreated some time after your tissue flap reconstruction, using a variety of techniques. The delay in this part of the procedure is to allow your body to recover fully from the tissue flap reconstruction.

Consultation

'Local Flap' and 'Free Flap' Tissue Reconstruction mr hassan shaaban london

 Mr Hassan Shaaban is a British trained, NHS Consultant Plastic Surgeon,  who specialises in Oncoplastic (post cancer) reconstruction of the breast. Mr Shaaban will spend at least an hour in consultation with you. You will have chosen one of the most experienced and highly regarded surgeons in this field, and should be reassured that with thousands of successful reconstructions behind him, Mr Hassan Shaaban is best placed to achieve the very best results for you. During your consultation, Mr Shabaan will conduct a thorough physical examination in order to determine the best possible procedure for your individual circumstances. Surgery will be tailored to your very specific needs.

It is very important that you come prepared to ask questions about the options available to you, and to voice any understandable concerns that you may have about the surgery you are about to undergo. Mr Shaaban will explain clearly and carefully any procedure that he is proposing, in order to meet your individual needs and desired outcome. No surgical intervention is going to provide a ‘perfect’ solution. Although reconstructive surgery produces very good outcomes, your expectations need to be realistic. Mr Shaaban will discuss possible outcomes with you, so that you are fully prepared going into surgery.

 Procedure

The surgery will depend upon which tissue flap technique Mr Hassan Shaaban has decided will be most appropriate to achieve the optimum outcome:

  • Local flap (pedicled) surgery means that tissue from the donor site, usually the abdomen, is tunneled up through your chest wall, under the skin. This technique means that the tissue remains connected to its original blood supply, which should ensure that the flap survives well when relocated in your chest wall to replace the skin, muscle and tissue lost during your mastectomy. The disadvantage of this technique is that the abdominal muscles will be weakened, because some skin, fat and tissue has been removed. This means that there is a greater risk of hernia in the future. Mesh may be placed in your abdomen to reduce the likelihood of a hernia occurring. Sometimes the flap is taken from your back, below the shoulder blade, and this too will mean weakness in your arm and shoulder which will necessitate subsequent physiotherapy.
  • Free flap surgery means that tissue will be completely cut away from the donor site. The tissue will then be connected to a blood supply in the chest wall or armpit using microsurgery.   The advantage of this technique is that less tissue is taken from the donor site; so there will be less likelihood of hernia in the abdomen or less weakness in your arm and shoulder following surgery. However, the reconnected blood supply can fail which can also mean that the tissue transplant will die.

Whichever procedure applies to you, there will be a dent and an additional scar on your body from where the tissue has been taken.

Recovery 

Tissue flap procedures are complex operations which will result in larger incisions, which take longer to heal. This could mean a longer recovery period and possibly a longer stay in hospital immediately after surgery. There may be drains in your chest to remove any excess fluid, which may need to remain in place for between two days and one week.

You will be very tired and sore for a few weeks, but any discomfort can usually be managed with regular painkillers such as paracetamol. You will need to rest for between six and eight weeks following your surgery and should avoid any vigorous exercise or lifting during this time. An elastic bandage or a sports bra will need to be worn to supports your breasts for a few weeks. Any scarring will be permanent, but this will generally fade over time. It may well be a year before you feel that you have fully returned to normal.

A follow up consultation will be booked with Mr Shaaban to ensure that your recovery remains on track and in order to minimise the risk of any post operative complications.

For further information or to book your consultation with Mr Hassan Shaaban in London or Liverpool, please get in contact with his team.