Home About the Doctor Contact the Doctor Map and Location Procedures Breast Body Face Hand/Microsurgery Breast Reconstruction Photo Gallery	Breast Reconstruction - DIEP Flap Breast reconstruction is one of the most challenging and rewarding areas of plastic surgery. San Francisco plastic surgeon Dr. Kind is one of a very few surgeons performing the deep inferior epigastric perforator or DIEP flap for breast reconstruction. This technique allows for the breast to be reconstructed with the patient's own tissues, without the loss of any muscle. Dr. Kind has been performing this procedure for several years. Patients from all over Northern California and beyond have come to San Francisco to be treated by Dr. Kind. If you would like to speak to or contact one of Dr. Kind's breast reconstruction (DIEP) patients, please contact Dr. Kind's office. BREAST RECONSTRUCTION OVERVIEW There are many techniques available to reconstruct a breast following mastectomy. All of the techniques described here can be performed at the time of mastectomy. This is referred to as "immediate" breast reconstruction. Immediate breast reconstruction saves the patient at least one subsequent operation, and has been shown to have a significant psychological benefit, as the patient never experiences a mastectomy defect. There are two major types of breast reconstruction: IMPLANT RECONSTRUCTION In this type of reconstruction a breast implant is placed in a pocket created on the chest wall. Usually this requires tissue expansion. In this process a tissue expander is filled with saline over several weeks. The patient's body responds by stretching and creating new skin and muscle tissue. Once the desired size of the pocket is created, the tissue expander is removed and an implant is placed. The implants used are silastic implants filled with either saline or silicone gel. Another option that avoids the use of tissue expansion is to cover an implant with the latissimus dorsi muscle. The latissimus dorsi is a large fan-shaped muscle of the back that can be rotated to the chest. Skin can be taken if needed. Implant reconstruction procedures have the advantage of being shorter operations, and generally a fairly rapid recovery can be expected. AUTOGENOUS RECONSTRUCTION Autogenous means "one's own". In autogenous reconstruction the patient's tissue is used to create a breast. When tissue (not just skin) is moved from one part of the body to another it is called a "flap". There are several different flaps that are used for breast reconstruction. The most commonly performed is a "TRAM" flap. "TRAM" is an acronym for "transverse rectus abdominis myocutaneous". This refers to the transverse (or sideways) orientation of the skin and fat taken from the lower abdomen, supplied by blood vessels that come through the rectus abdominis muscle (see figure 1). A "pedicled" TRAM flap is when the skin and fat of the lower abdomen is elevated with the underlying rectus abdominis muscle, and transferred to the chest. The skin and fat are supplied by the "pedicle" of muscle, which carries and protects the blood vessels. The TRAM flap has many advantages. The use of the skin and fat of the lower abdomen is similar to an abdominoplasty ("tummy tuck"). Most patients are pleased to have this tissue removed. A major benefit of the TRAM, and all types of autogenous breast reconstruction, is that such reconstruction avoids the disadvantages of implant reconstruction. Breasts that are reconstructed with the patient's own tissues usually look and feel more natural, and act more like a normal breast over time. The main disadvantages of the TRAM flap is that compared to implant reconstruction it is a longer operation, usually requiring a longer hospital stay. In addition the TRAM flap requires the sacrifice of part or all of the rectus abdominis muscle. Most patients have minimal side effects from the loss of this muscle, although occasionally it can result in abdominal weakness, bulging, or (rarely) hernia. Learn more about the DIEP Flap Breast Reconstruction in San Francisco Methods by San Francisco plastic surgeon Dr. Kind. For more information on DIEP and SIEA reconstruction, please see www.sanfranciscodiep.com View before and after breast reconstruction photos.