This website contains imagery which is only suitable for audiences 18+.

Follow Our Social Media Icon Instagram

Advanced Breast Reconstruction Technique for Natural-Looking Results – LAP

There are various options available for breast reconstruction, each with its unique advantages and considerations. While some might opt for more common techniques like implant-based reconstruction or DIEP flap surgery, the lumbar free flap has emerged as a less frequently used but highly effective method for certain patients.

In this blog post, Sydney Specialist Plastic Surgeon Dr Bish Soliman will explore the lumbar free flap procedure in detail, discussing its benefits, candidacy, and how it compares to other breast reconstruction methods.

What is a Lumbar Free Flap?

A lumbar free flap, also known as a lumbar artery perforator (LAP) flap, is a type of breast reconstruction that uses tissue from the lower back region to create a new breast mound. This procedure involves harvesting skin, fat, and blood vessels from the area above the buttocks and transferring them to the chest to reconstruct the breast. The term “free flap” refers to the fact that the tissue is completely detached from its original blood supply and reconnected to blood vessels in the chest using microsurgery.

One of the main advantages of using tissue from the lower back region is that it often provides a good match in terms of skin colour and texture compared to the natural breast. Additionally, the lumbar area typically has sufficient tissue to create a breast mound without causing significant donor site morbidity. This means that patients can achieve a natural-looking breast reconstruction while minimising the impact on their lower back area.

Who is a Candidate for Lumbar Free Flap Breast Reconstruction?

Lumbar free flap breast reconstruction may be an excellent option for patients who have undergone a mastectomy or lumpectomy and desire a natural-looking breast reconstruction without using implants. This procedure is particularly well-suited for patients who have insufficient abdominal tissue for a DIEP flap or those who have had previous abdominal surgeries that may have compromised the blood supply to the abdominal area.

Patients who are non-smokers, have a stable weight, and are in good overall health are generally good candidates for lumbar free flap surgery. It is essential for patients to have realistic expectations about the outcomes of the procedure and be willing to commit to the recovery process.

The Lumbar Free Flap Procedure

The lumbar free flap breast reconstruction procedure typically takes between 6 to 8 hours and is performed under general anaesthesia. The surgery involves the following steps:

  • Marking: Dr Soliman carefully marks the lower back area to identify the perforator blood vessels that will be used to supply blood to the flap.

SUPINE POSITIONING:

  • Recipient site preparation: Dr Soliman creates a pocket in the chest wall to receive the flap and identifies the blood vessels that will be used to reconnect the flap.
  • Use of Interposition Grafts (DIEA/V): Sometimes, the distance between the donor tissue and the recipient site requires the use of interposition grafts, such as the deep inferior epigastric artery and vein (DIEA/V), to bridge the gap and ensure adequate blood flow to the transplanted tissue.
  • Harvest of DIEA/V vein grafts from the abdomen

PRONE POSITIONING:

  • Flap elevation: An incision is made in the lower back, and the skin, fat, and blood vessels are carefully dissected and separated from the underlying muscle. The flap is then completely detached from the lower back.
  • Donor site closure with drains
  • Microsurgery – connecting the grafts to the flap to gain length

SUPINE POSITIONING:

  • Flap transfer: The harvested tissue is then transferred to the chest and shaped to create a new breast mound.
  • Microsurgery: Using a microscope and specialised instruments, Dr Soliman carefully connects the blood vessels from the flap to the recipient vessels in the chest. This ensures that the flap receives adequate blood supply in its new location.
  • Closure: The incisions in the chest and lower back are closed with sutures, and drains may be placed to prevent fluid accumulation.

The microsurgery aspect of the lumbar free flap procedure requires a high level of skill and expertise, as the success of the reconstruction depends on the proper connection of the blood vessels. In cases where interposition grafts are used, additional microsurgical techniques are employed to ensure that these grafts are properly connected and integrated with the flap tissue and recipient site.

What Is a Lumbar Free Flap for Breast Reconstruction? - 1

Recovery and Results after LAP Breast Reconstruction

Following lumbar free flap breast reconstruction, patients typically stay in the hospital for 5 days for monitoring and recovery. During this time, the medical team closely observes the flap to ensure that it is receiving adequate blood supply and healing properly. You may experience some discomfort, swelling, and bruising in the chest and lower back areas, which can be managed with pain medication and proper care.

After being discharged from the hospital, you will need to take it easy for several weeks to allow your body to heal. Be aware that the use of interposition grafts can sometimes lead to a more extended recovery period, as the body adjusts to the new blood vessel connections.

You will be required to wear a supportive bra and avoid strenuous activities or lifting heavy objects. The recovery process is gradual, and it may take several months for the swelling to subside and for the final results to become apparent.

Potential complications of lumbar free flap surgery include flap failure (where the transferred tissue does not receive adequate blood supply), infection, and issues with wound healing. One common issue is that the drain may take a while to stop, leading to prolonged discomfort. Additionally, there is a high risk of seroma, which is the accumulation of fluid at the surgical site. These risks can extend the recovery period and require additional interventions to manage. However, these complications are relatively rare when the procedure is performed by a skilled and experienced plastic surgeon.

Keep in mind that the reconstructed breast will not have the same sensation as a natural breast. With the secondary procedures, Dr Soliman can perform liposuction on the other lower back or excise the skin and fat for symmetry.

Lumbar Free Flap vs. Other Breast Reconstruction Methods

When considering breast reconstruction, you have several options to choose from, including implant-based reconstruction, DIEP flap surgery, and other autologous tissue methods. Each approach has its advantages and disadvantages, and the best choice depends on your needs, preferences, and medical history.

Implant-based reconstruction involves the use of silicone or saline implants to create a new breast mound. This method is less invasive and has a shorter recovery time compared to autologous tissue reconstruction. However, implants may need to be replaced over time and can be associated with complications such as capsular contracture, rupture, and infection.

DIEP (deep inferior epigastric perforator) flap surgery is another popular autologous tissue reconstruction method that uses skin, fat, and blood vessels from the lower abdomen to create a new breast. This technique provides a natural-looking and feeling breast reconstruction and has the added benefit of improving the contour of the lower abdomen, similar to a tummy tuck. However, DIEP flap surgery is more complex and has a longer recovery time compared to implant-based reconstruction.

Lumbar free flap surgery offers several advantages over other methods, including:

  • Natural-looking and feeling reconstruction without the need for implants
  • Less risk of complications associated with implants
  • Good match in terms of skin colour and texture compared to the natural breast
  • Minimal donor site morbidity, as the lower back area can typically provide sufficient tissue without causing significant discomfort or appearance changes

However, lumbar free flap surgery is a more complex procedure that requires specialised training and expertise in microsurgery. It also has a longer recovery time compared to implant-based reconstruction.

Choosing the Right Breast Reconstruction Option

Deciding on the best breast reconstruction method is a highly personal choice that should be made in consultation with Dr Bish Soliman. Factors to consider when choosing a reconstruction option include:

  • Personal preferences and goals for reconstruction
  • Medical history and overall health
  • Body type and availability of donor tissue
  • Lifestyle and willingness to commit to a longer recovery process
  • Potential risks and complications associated with each method
  • Long-term outcomes and patient satisfaction rates

Dr Bish Soliman will take the time to understand your unique needs and concerns and provide personalised recommendations based on his expertise and experience. Dr Soliman will also discuss the expected outcomes, recovery process, and potential risks and complications associated with each option to help you make an informed decision.

FAQs about Lumbar Free Flap Breast Reconstruction

Can I have a lumbar free flap breast reconstruction immediately after my mastectomy?

  • In many cases, immediate breast reconstruction using the lumbar free flap technique is possible. This means that the reconstruction surgery is performed at the same time as the mastectomy. However, some patients may need to delay reconstruction due to various factors, such as the need for additional cancer treatments or personal preferences. Dr Bish Soliman will help you determine the best timing for your reconstruction based on your individual circumstances.

Will my reconstructed breast have the same sensation as my natural breast?

  • Unfortunately, the reconstructed breast will not have the same sensation as a natural breast, as the nerves that provide feeling to the breast skin are often damaged or removed during the mastectomy. However, some patients may regain slight sensation over time as the nerves in the surrounding skin grow into the reconstructed area. While the lack of sensation can be an adjustment, most patients find that the benefits of having a natural-looking and feeling breast mound outweigh this drawback.

How will the lumbar free flap procedure affect my ability to become pregnant or breastfeed in the future?

  • The lumbar free flap breast reconstruction procedure should not affect your ability to become pregnant, as it does not involve the reproductive organs. However, it is important to note that pregnancy and breastfeeding can cause changes in the size and shape of the breasts, including the reconstructed breast. If you are planning to become pregnant in the future, it is essential to discuss this with Dr Bish Soliman, as he may recommend delaying certain aspects of the reconstruction, such as nipple reconstruction, until after you have finished having children.

Can I have a lumbar free flap reconstruction if I have had previous radiation therapy to the chest area?

  • Yes, lumbar free flap breast reconstruction can be an excellent option for patients who have had previous radiation therapy to the chest area. Radiation can cause damage to the skin and underlying tissues, making implant-based reconstruction more challenging and increasing the risk of complications. Autologous tissue reconstruction, such as the lumbar free flap, can provide a more robust and healthy tissue foundation for the reconstructed breast in these cases. However, Dr Bish Soliman will need to carefully assess your individual situation to determine if you are a good candidate for this procedure.

How long does it take for the scars from lumbar free flap surgery to fade?

  • Scars from lumbar free flap breast reconstruction will become less visible and improve over time, but they will never completely disappear. The healing process is gradual, and it can take up to a year or more for the scars to mature and reach their final appearance. Factors such as your age, skin type, and adherence to post-operative care instructions can influence the healing process. Dr Bish Soliman will provide you with detailed instructions on how to care for your scars to promote optimal healing and minimise their appearance. In some cases, additional treatments such as scar massage, silicone gel sheeting, or laser therapy may be recommended to further improve the appearance of the scars.

Further Reading about Breast Reconstruction with Sydney Specialist Plastic Surgeon Dr Bish Soliman

Medical References about Lumbar Free Flap Breast Reconstruction

About Dr Bish Soliman

Dr Bish Soliman - Sydney Plastic and Reconstructive Surgeon, about us 01 2x
Specialist Plastic, Reconstructive and Cosmetic Surgeon
FRACS (Plas), MS (Plas), MBBS (Hons 1), BCom

AHPRA Registered Medical Practitioner MED 0001679053 Specialist Registration in Plastic Surgery

Dr Bish Soliman is a Sydney-based Specialist Plastic and Reconstructive Surgeon who performs aesthetic surgery of the face, breast, and body as well as skin cancer surgery.

He currently holds two consultant microsurgery positions in major Sydney hospitals performing complex microsurgical reconstruction including DIEP breast reconstruction.

After graduating from The King’s School, Dr Bish completed a Bachelor of Commerce degree at the University of Sydney. After working briefly at a major Sydney finance firm, he decided to pursue his passion and long-term goal of a career in medicine. He graduated from the University of Notre Dame at the top of his class, receiving First class honours and the prestigious Bower and Sherrard medal. He then went on to complete his junior medical training at Westmead Hospital during which time he was awarded Junior Medical Officer (JMO) of the Year, as well as a finalist for NSW Doctor of the Year.

LEARN MORE

Next Steps

Do your Research

  • All Surgery has risks and potential complications. Please read the risks and complications page
  • Visit our procedure pages and Blogs to learn more about your intended procedure

Making The Most Of Your Consultation

  • Please arrive slightly early for your in-person consultation with Dr Bish
  • Take notes during the consultation and review all the documents provided
  • You are welcome to bring a friend or relative to help consider your options
  • You may need to undress for a physical exam so wear comfortable clothes

Want more information before scheduling your consultation?

  • Call us to find out more about surgery pricing and how you can pay for your surgery
  • Request more information about your procedure – call or contact us.

How to Book Your Consultation

  • A GP Medical Referral is now essential to see Dr Bish Soliman for any type of surgery.
  • You can book your consultation with Dr Bish Soliman by paying the consultation fee in advance – when you make your appointment.

Contact Dr Bish Soliman’s team

We look forward to hearing from you soon

Google Rating
5.0
Based on 32 reviews
×
js_loader