I take you on a Journey of the amazing and complex system of blood vessels used in breast reconstruction in Episode 2. My “guest navigator” is Dr. Tim Matatov, a board-certified trained microsurgeon whose professional focus is performing autologous breast reconstruction for those affected by breast cancer. Let’s dive into to this podcast, Blood Vessels in Breast Reconstruction.
Learning the Blood Vessels in Microsurgery
Microsurgery is a subspeciality of plastic surgery and takes additional years of training and practice. Microsurgeons, like Dr. Matatov, perform a variety of autologous breast reconstruction using various flaps comprising this system of blood vessels. These flaps are often referred to using acronyms to describe the part of the body they come from. Here is a list of breast reconstruction flaps performed at Dr. Matatov’s practice.
- DIEP flap: deep inferior epigastric perforators using the tummy tissue.
- TDAP: Thoracodorsal artery perforator using tissue from the back.
- DCIA: Deep Circumflex iliac artery, using the “love handle” area.
- PAP flap: profunda artery perforator, using tissue from the upper thigh
- Stacked Flap: combining flaps surgeries and stacked to achieve volume
The Mechanism and Location of the Blood Vessels
Dr. Matatov points out, like our fingerprint, patients present with unique vascular systems and why these flap options are important to know. The DIEP flap, the type of autologous breast reconstruction I chose to have, is the most commonly used or primary area utilized to rebuild the breast.
Our circulatory system is a closed system. I like Dr. Matatov’s analogy of the arterial system being like tap water coming into the house; oxygen, nutrient dense blood is pumped from the heart and through the arterial system, redder looking blood.
The cells then use the oxygen continuing through this closed system going into the venous system. The venous system gets rid of this deoxygenated blood and why it is a darker color, like the veins, venous system, you see in your arms. The blood flow going into the tissues needs to roughly be the same going out.
Imaging and Harvesting Blood Vessels
Superficial inferior epigastric artery (SIEA) and veins are closer to the skin and on top of the muscle. The deep inferior epigastric perforators (arteries) lie under the muscle. Dr. Matatov routinely performs a CT angiogram on his patients to find where these blood vessels lie under the skin. He finds it allows him to be significantly more accurate. A decision is made regarding which blood vessel system in each patient is going to result in optimal outcomes and flap success with little or no necrosis. Necrosis is the break down of tissue due to blood flow causing wound healing issues or worse, flap loss.
The deep inferior epigastric artery is within the rectus muscle and dives under the muscle. Intricacy and care preserving motor nerves and muscle is taken in the hands of highly skilled and trained microsurgeons. The longer and stronger the blood vessels found in the abdominal area, the better the match is to connect the vessels in the breast when the tummy flap is transferred with these harvested blood vessels.
Think of pipes matching pipes as in Dr. Matatov’s description. You want them to match as much as possible. Microsurgeons use tools in surgery to image these vessels looking for optimal perfusion, the flow or passage of blood through the vessels. This is when the skill of the microsurgeon comes into play. The number of successful surgeries they have performed becomes important because they must often look for alternate vessels when a dominant vessel is not available. There are times when microsurgeons choose more than one vessel to optimize blood flow.
The Anastomosis of the Vessels in Breast Reconstruction
It is important to discuss which flaps your microsurgeon performs often and with great success during your consult. Taking care of the surrounding tissue both from the area the flap is harvested from and the breast area the flap is transferred to is of utmost importance. Preserving motor nerves in the tummy tissue for DIEP flap leads to less chance of abdominal hernia.
As Dr. Matatov states, as you gain more experience, you can get very accurate in connecting the necessary blood vessels in breast reconstruction to get predictable results. The anastomosis or tying together and connecting these blood vessels when they have carefully been harvested creates a healthy reconstructed breast for the patient.
Microsurgeons perform autologous reconstruction in much the same way but with subtle and unique methods they have perfected in their own practice. However, for all well trained and highly skilled plastic surgeons, it is optimal blood flow they are all looking for and hope to achieve with any transferred tissue from whatever part of the body they are taking it from. This results in optimal surgical outcomes for patients.
Dr. Matatov is a great navigator of this blood vessels system and explains the multitude of steps, options, and microsurgical techniques used to reconstruct the breast. We hope you enjoy Ep. 2: Blood Vessels in Breast Reconstruction of the DiepCJourney Podcast.