Autologous Reconstruction in New Orleans, LA

Deep Inferior Epigastric Perforator (DIEP): The DIEP flap  is widely recognized as the gold standard in breast reconstruction. This procedure employs transferring abdominal tissue and blood vessels while still preserving function of the underlying muscles. This technique has the popular added benefit of aesthetic contouring of the abdomen, similar to a tummy tuck. Microsurgery techniques are used to reattach blood vessels, resulting in a breast reconstruction that is both enduring and natural in appearance.

Superficial Inferior Epigastric Artery (SIEA): Named after the superficial inferior epigastric artery in the lower abdomen, the SIEA flap is comparable to the DIEP flap. But unlike DIEP flap surgery, which involves deeper tissue, this procedure utilizes blood vessels that bypass the abdominal musculature. The SIEA flap stands out by eliminating the need for any incision in the fascia layer covering the rectus abdominis muscle. This innovation avoids nerve, muscle, or fascial injury to the abdominal wall. The suitability for this type of flap surgery is limited, as successful reconstruction requires an adequate SIEA, found in only 10 – 15 percent of patients identified using CT scan imaging.

Abdominal Perforator Exchange (APEX): This procedure uses the same tissue as a DIEP flap for breast reconstruction, however an APEX is performed when the positioning of the perforators in relation to the muscle is less than optimal. The small vessels used to transfer the tissue are cut and then reattached rather than cutting through muscle to obtain the proper blood supply. This allows for enhanced volume recruitment while ensuring a lower incision for a more pleasing aesthetic outcome.

Profunda Artery Perforator (PAP): An alternative for patients not eligible for abdominal-based flap surgery due to previous surgery or insufficient volume. This procedure utilizes excess tissue from the inner thigh to restore the breast. To optimize the contour of the inner thigh, we incorporate the principles of medial thigh lift. Depending on the location of the best blood vessels that provide vascularity to the inner thigh, skin, and fat, two major orientations of the flap can be utilized: transverse PAP (t-PAP) and vertical PAP (v-PAP). The t-PAP aims to conceal the incision in the gluteal crease, while the v-PAP places the incision at the transition between the front and back of the leg.

Gluteal Artery Perforator (GAP): Uses excess tissue from the buttocks to reconstruct the breast tissue. When patients are not eligible for abdominal-based flap surgery due to previous procedures or lack of available tissue, buttock flaps offer a viable alternative. An IGAP or SGAP flap can be utilized depending on the donor tissue's location. The SGAP flap, our preferred choice, not only restores the breast but also enhances the contour of the gluteal area, similar to a buttock lift. Moreover, it effectively hides the incision within the panty line area.

Stacked Hemi Abdominal Extended Perforator (SHaEP): For patients previously considered too thin for a DIEP abdominal flap or for patients with large breasts at risk of size reduction, the SHaEP flap is an excellent option. The SHaEP flap is an extended version of the DIEP flap, utilizing perforator blood vessels from the hip area to enhance the flap and recruit more healthy tissue for transfer. For this intricate and delicate procedure, engaging a highly experienced and rigorously trained surgeon like Dr. Stalder is imperative.

Stacked Flaps: "Stacked" refers to using multiple flaps to restore the breast, especially when a single donor site lacks adequate volume or skin. This method enables total autologous breast reconstruction, even in thinner patients. In the case of single breast reconstruction, the two flaps utilized are usually from the same donor area, such as stacked DIEPs, stacked PAPs, or stacked GAPs. By adopting this approach, the symmetry in the targeted body area is optimized.