Photo courtesy of morguefile.com
Deciding upon which type of reconstruction surgery to have after losing part of your breast, or all of it, or both of them, to breast cancer is often very difficult, so I decided to devote all of my blog posts this week to a discussion of the various types of reconstruction surgery that are available, together with a little feedback from women who have undergone each type of surgery.
The SIEA Flap
The SIEA flap type of breast reconstruction is a relatively new style of reconstruction and requires microsurgery. The SIEA flap is somewhat similar to the DIEP flap in that both techniques use skin, fatty tissue and blood vessels from the abdomen, but the DIEP flap utilizes tissue from the upper abdomen, while the SIEA flap uses tissue from the lower abdomen to reconstruct a natural, soft breast following mastectomy. Also, the SIEA blood vessels are not located within muscle, so your abdominal muscles never have to be disturbed during this procedure.
The SIEA flap is more technically difficult to perform. Please ensure that your surgeon has the requisite experience and skills. Having said that, I read that the SIEA flap procedure has a less than 1% failure rate.
The SIEP flap is apparently used less frequently since the arteries required are generally too small to sustain the flap in most patients. According to PRMA – Center for Advanced Breast Reconstruction: “Less than 20% of patients have the anatomy required to allow this procedure. Unfortunately, there are no reliable pre-operative tests to show which patients have the appropriate anatomy. The decision as to which type of reconstruction to perform is therefore made intra-operatively by the plastic surgeon based on the patient’s anatomy.”
You would NOT be a good candidate for the SIEA flap if there is not enough tummy fat (for instance if you are very thing or have had a tummy tuck already), or if you are an active smoker — your abdominal scar will heal slowly, and your fat tissue is more likely to turn into scar tissue.
The SIEA flap can be used for reconstructing one or both breasts. Since you will have two surgical sites, you will have two scars.
Length of Surgery: for one breast, 5-7 hours, for both breasts, 7-12 hours (this may vary according to your surgical team).
Hospital Stay: 3-4 days (ask your particular surgeon for more information as this varies between hospitals and surgeons)
From A Practical Point of View…
One of the things that bugs me about my latissimus dorsi flap reconstruction is that I have a lot of numb areas on my breast and back. With the SIEA flap, sensory nerve reconstruction can also be performed in most patients and this can really improve long term sensation in the reconstructed breast.
Also because no muscle is moved during this operation, most women said the recovery period wasn’t too bad. Another plus is that there is little risk of developing an abdominal hernia later as there is with the DIEP flap.
One thing to note – if the SIEA flap reconstruction fails, the tissue flap may die and will have to be completely removed and you would not be a candidate to try it again for another 6-12 months.
My suggestion? Make sure you discuss your options thoroughly with your surgeon so that you know all of the pros and cons each type of reconstruction surgery will entail and choose the one that makes sense for you and your lifestyle.
If you choose to have reconstructive surgery, please read my articles Tips For Surgery – Useful Items to Take With You and My Top Favorite Things to Promote Surgery Recovery.
References:
http://prma-enhance.com/breast-reconstruction/siea-flap
http://breastcancer.about.com/od/reconstructivesurgery/tp/siea_flap.htm
breastcancer.org forums
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