Plastic surgeons use medical devices in reconstructive surgery to optimize patient outcomes in breast reconstruction. I receive a number of inquiries from ladies asking how a flap is monitored after tissue-based breast reconstruction. This is a concerning topic for patients who know the intricacies of microsurgery but do not always think to put it on their list of questions to ask their surgeon during their consult. I would like to present this information about a perfusion monitor used for flap monitoring in microsurgical breast reconstruction.
I reached out to Dr. Minas Chrysopoulo of PRMA in San Antonio who performed my DIEP flap breast reconstruction to tell me about the monitoring system they find great success with. The information I was given about flap monitoring at my consult gave me and my husband a great deal of comfort. We felt having Dr. C being able to monitor the flap all evening from his mobile phone at home after he performed my surgery gave us added reassurance. I felt confident I would add to his high flap success rate and one of the reasons I chose him as my microsurgeon.
Methods of Monitoring the Flap
Autologous breast reconstruction, using your own tissue, involves specialized training to be able to sew tiny blood vessels together to create soft, warm, breast tissue. The most common type is the DIEP flap from the tummy, but other areas can also be used like the thigh, the buttock or wherever the patient has tissue to use. Once this tissue is taken from a part of the body and transplanted to the breast, it is monitored to make sure it remains healthy and has a good blood supply. Dr. C points out the blood flowing in and out of the newly transplanted tissue must be monitored.
The risk of tissue dying, in experienced hands when patients use a center specializing in these techniques, is less than one percent. But for patients who have a flap loss due to poor blood flow in or out of the flap, it can be a devastating experience.
The microsurgical team can monitor the tissue flap by looking at it, checking for color and warmth. Dr. C points out the exposed skin of the flap acts as a window to the flap health. If it looks ok, it tells the surgeon the fat attached to the skin is ok and healthy. The concern here is, once there are visible signs of problems, it may be too late to correct completely. Ultimately the flap can be lost, but it can also suffer from not enough oxygen (low flow) and that can create hardening of the tissue (fat necrosis). When opting for an autologous breast reconstruction, reconstruction with your own tissue, the goal is to end up with a very natural and soft feeling breast. When blood flow is compromised, that can be compromised.
T-Stat Tissue Perfusion Monitor as an Early Warning System
The concept of tissue perfusion has been a liked with blood flow, oxygen delivery or a combination of flow and nutritional supply including that of oxygen. Dr C’s team of surgeons prefer using the T-Stat, a far more detailed and sophisticated level of monitoring called a perfusion monitor. There is a sensor that looks like a small disc, it is placed on top of the new tissue and shines white light into the skin flap. It can determine if there is enough oxygen getting to the new tissue. The information is then shown on the monitor. The surgeon can also remotely access this information from wherever he is. The information picked up by the T-Stat is far more detailed than the clinical exam described in the previous paragraph. He calls T-Stat an early warning system, also referred to as a canary in a coal mine.
A true benefit to the surgeon is the remote access app for the T-Stat. The numbers can be checked on the surgeon’s phone at any time. An alarm can also be set by the surgeon, so a text notification is sent if the numbers go outside of the parameters set by the surgeon. This particular monitoring system offers the surgeon both oxygen saturation and hemoglobin concentration.
The flap has blood going in through an artery connected by the surgeon. The blood going out is from a vein, sometimes two, connected to the flap. If either one of these develop an issue it can become a problem. Dr. C points out if the blood goes in, but a blockage occurs and the blood cannot go out, the flap can become engorged and basically suffocate itself.
I invite you to view the video to understand the importance of closely monitoring your newly reconstructed breasts and to understand the value of the T-Stat system.
I encourage patients to ask how their new breast tissue is monitored after their surgery. The information in the video and blog is to provide talking points with your own surgeon for your breast reconstruction consult. The combined skill of the microsurgeon and the monitoring tools used, like the T-Stat, all help to optimize patient outcomes in breast reconstruction.
This blog on flap monitoring in microsurgical breast reconstruction is brought to you in sponsorship with T-Stat.