Autologous Reconstruction in New Orleans, LA
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What is Autologous Reconstruction?
Reconstructive surgery of the breast is performed using a patient's own natural tissue after a lumpectomy or mastectomy. These techniques are nuanced, sophisticated microsurgical procedures that help patients achieve natural-looking breasts after they have been removed. At Stalder Plastic Surgery in New Orleans, LA, we offer our breast reconstruction patients comprehensive autologous surgical options. Microsurgical tissue transfer is a primary focus of Dr. Stalder's practice, with years of experience, allowing him to adopt a patient-specific approach to developing each surgical plan. While the abdominal DIEP flap is the gold standard for most patients, there are many circumstances in which we may suggest taking tissue from other donor sites on the body or employing stacked flap techniques. Contact our office to learn more about your tissue reconstruction options.
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Please call our New Orleans, LA plastic surgery office today to learn more about the various types of autologous techniques for reconstructive breast surgery. Even if you have just received a breast cancer diagnosis, we would like to join your medical team while you are on your way to recovery. We will schedule your appointment for a complete evaluation and a personal consultation with Dr. Stalder at your earliest convenience.
Deep Inferior Epigastric Perforator (DIEP)
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)
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)
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)
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)
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):
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.
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Autologous Reconstruction FAQs
How long does recovery take after autologous breast reconstruction?
Recovery time varies, but typically, patients can expect to spend 4-6 weeks for initial healing. During this time, Stalder Plastic Surgery provides comprehensive post-operative care and guidelines to ensure a smooth recovery. Full recovery and the final shape of the breast can take several months.
Are there any risks associated with this type of breast reconstruction?
As with any surgical procedure, there are risks, including infection, bleeding, and issues with anesthesia. Specific to autologous reconstruction, there may be additional concerns such as tissue failure. The team at Stalder Plastic Surgery discusses all potential risks in detail during consultation.
How does autologous reconstruction compare to implant-based reconstruction?
Autologous reconstruction uses the patient's own tissue, offering a more natural look and feel compared to implants. While implant-based reconstruction might have a shorter initial recovery, autologous reconstruction typically results in more natural movement and sensation. The choice depends on individual circumstances and preferences, which Dr. Stalder can guide you through in your consultation.
Stalder Plastic Surgery Reviews
Dr. Stalder and his staff are awesome very professional and compassionate. Dr. Stalder, Abby & Jess treated me like family. I am very satisfied with my surgery & reconstruction Dr. Stalder is the best.Dr. Stalder explained everything in detail and what to expect regarding my double mastectomy & reconstruction. Dr. Stalder is the best.
I had a double mastectomy with implants at Ochsner in 2021/2022. Post-surgery, I had chronic pain and my breasts were extremely hard and deformed. I was told for months that “It will get better” or “Give it a few more months”; however, the pain and discomfort never went away and I felt dismissed and unheard from my treatment team at Ochsner. I found Dr. Stalder through an internet search and made an appointment for consultation. Around October of 2022, we first met in his office where I voiced my symptoms and complaints and Dr. Stalder gave me what he thought my diagnosis was: capsular contracture. I thought he was crazy as my own plastic surgeon from Ochsner never once mentioned those words and Stalder had not even examined me. When I left, I searched capsular contracture on the internet and found that all of the photos showing this looked just like my breasts. I quickly booked the surgery with Dr. Stalder. Dr. Stalder performed my explant and flap surgery in January of 2023. I was told that I would likely need someone to stay with me for at least a week post-surgery. However, I was able to return home alone with friends to check on me for any needs. I went back to work in four weeks (six weeks is usually recommended). My second surgery to “smooth everything out and rearrange my nipples” was in June 2023. It was a same-day surgery and I was back to work in six days. I have had nothing but wonderful experiences at Dr. Stalder’s office. From Jessica at the front desk to Abbie (his PA) and most of all Dr. Stalder. He knows what he’s doing and his precision is excellent. He saved me from chronic pain and the thought that my breasts were always going to be deformed after my mastectomy. I would absolutely recommend him over and over again.
Very caring doctor and staff. Extremely knowledgeable and helping breast reconstruction with several options. Just a wonderful wonderful doctor. You cannot go wrong with this doctor and his staff
The best dr without a doubt and the staff is amazing. He was amazing with my surgery and my recovery.
The office is beautiful and Dr. Stalder is a gem! Truly caters to your every need! I cannot recommend him enough!