We are proud to offer several types of breast reconstruction at The Breast Center Park Meadows Cosmetic Surgery. Our ultimate goals are to help women restore their sense of self, well-being, sensuality and femininity during this difficult time while helping to maximize the aesthetic outcome as well.
Dr Jeremy Williams and Dr Christopher Williams offer the latest, state-of-the-art techniques in reconstructive procedures, including autologous tissue breast reconstruction. Autologous tissue is tissue used from a patient’s own body — most commonly, the fat, skin, and sometimes muscle. The tissue is taken in the form of a flap, being the skin, fat, and muscle taken from one area of the body and relocated to another location on the body, carrying its own blood supply.
There are two forms of flaps used today in Breast Reconstruction: Pedicled and Free Flaps. Dr. Williams and Williams’ experience and success in using muscle-sparing techniques for obtaining certain flaps is unique in the Rocky Mountain region.
Understanding Flap Surgery
A Pedicled Flap is a flap that has been harvested or dissected from one part of the body and then moved from its original location to reconstruct a nearby defect, without losing or cutting its blood supply. These flaps were developed about 30 years ago, and some are still viable choices in breast reconstruction.
A Free Flap is a flap whose blood supply, the artery and vein, are cut to move the tissue to a remote location. This allows the surgeon to pick a better donor site for a flap depending on the tissue characteristics needed and not just on picking a flap based on what is close to the defect. The artery and vein must be reconnected, using a microscope, once the flap is placed in its new location. Free flaps are newer techniques, developed about 20 years ago, and since have become frequently used in breast reconstruction.
Our Surgeons' Advanced Approach
Dr Jeremy Williams and Dr Christopher Williams use microsurgical techniques to move free flaps and reconnect the blood supply. The surgeons use an operating microscope is to improve visibility and aid in proper technique when suturing the 1 to 3 millimeter veins and arteries of the flap to the chest during breast reconstruction. Without reconnecting the blood supply, the tissue would not survive.
Perforator-based microsurgical reconstruction is the most current and state-of-the-art technique. It uses both muscle-sparing and nerve-sparing techniques in an effort to limit the damage to donor sites. At these donor sites, only the artery and veins (these are the blood vessels which “perforate” the muscles) are harvested. The muscles are left in place. Often nerves can be spared as well.
These meticulous techniques take additional time and effort during surgery, but the surgeons at The Breast Center Park Meadows Cosmetic Surgery feel it is important to limit the damage to donor sites (the location of the body from which the flap is taken) in breast reconstruction whenever possible. The less a patient’s donor site is damaged, the faster the patient recovers.
What Is a TUG Flap?
Dr Jeremy Williams and Dr Christopher Williams were two of the first surgeons to offer the TUG Flap in the Rocky Mountain region. The Transverse Upper Gracilis (TUG) Flap is a newer perforator-based microsurgical technique, fast becoming an excellent option for women who desire autologous breast reconstruction and have extra skin and fat on their inner thighs.
The skin and fat removed from the inner thigh region provide excellent tissue and are relocated to the chest wall to reconstruct the breast. This is a good option for women with limited donor sites in areas such as the abdomen, yet still desire to have reconstruction through use of their own tissue and want to spare muscles in the donor site. While this is not a cosmetic procedure, many women will enjoy the benefits of a “thigh lift” through the use of this method of reconstruction. The scars usually lie along the groin crease and can usually be covered by a bathing suit or standard women’s underwear.
This procedure is one of the newest methods of breast reconstruction and requires a high degree of skill and several years of training. In fact, there are only approximately 60 surgeons (less than 5% of all plastic surgeons) in the United States who perform perforator-based microsurgical breast reconstruction procedures, like the DIEP Flap, and even fewer who perform the TUG Flap procedure.
Dr Jeremy Williams and Dr Christopher Williams are passionate about helping educate the women in Colorado and across the United States and are proud to offer this procedure in partnership with Skyridge Medical Center.
What to Expect after Autologous Breast Reconstruction
Progress with a light diet. Smaller, more frequent meals will help prevent bloating. Limit caffeine and chocolate for the 1 week.
A wire will be attached to each flap of post-operative monitoring while in the hospital. You will have a drain in the breast and both sides of the abdomen (DIEP Flap) or the Latissimus Site (Latissimus Flap). A drain kit with instructions and teaching by the nursing staff will be provided at the hospital. Empty and record (in “cc” amounts) the drainage amount once or twice per day after discharge from the hospital and bring your drain record with you to each clinic appointment.
All of your sutures will be under the skin. You will either have a layer of skin glue that resembles clear nail polish or steri-strips, similar to tape, on all of your incisions. Please do not remove the steri-strips. Your surgeon will remove the dressings, if needed.
Pain and Swelling:
While in the hospital, your pain will be monitored very carefully. Pain medication will be prescribed to you to use as needed postoperatively. You will have a pain catheter in your abdomen to help with pain control. It uses a numbing medication, not a narcotic. It is often removed at home by the patient or family. If you leave the hospital with pain catheters in place, the nursing staff will teach you to remove them. Pain is best controlled with lower doses of multiple medications such as Tylenol, Celebrex and narcotics.
You can expect moderate swelling in the reconstructed breast, underarm and abdomen. You will have numbness in the reconstructed breast and abdomen for up to 12 months. You may experience tightness in the abdomen for the first 3 months – the abdominal binder will help support this donor site.
You will have an abdominal binder around your waist to help support your abdominal donor site. Please wear this for 3 to 4 weeks. If desired, you may switch to a control-top garment (Spanx) for prolonged wear. Do not wear a compressive bra for the first 3 weeks. You may wear a light camisole for gentle support.
You may shower and wash your hair 48 hours after surgery. Shower only for the first 30 days post-operative. Try to keep the shower directed at your back and not at your incision or dressing. It is okay if the dressing gets wet in the shower. Pat it dry after your shower. For the first 4-6 weeks after surgery, do not submerge in a bathtub, pool, or hot tub. Support your drains in the shower around your neck or waist.
Take pain medication as needed for up to 4 weeks in moderation and at night if needed. While you are taking pain medicine, you are encouraged to follow a high fiber diet or take a stool softener such as Colace (available over the counter), as pain medications tend to cause constipation. Do not take Motrin/Ibuprofen or Aspirin products for 1 week after surgery. Ask your surgeon when you may resume your blood thinning medications. All other prescription medications may be resumed immediately, as discussed with your physician.
During the first 2 weeks, place pillows under your head and knees. Sleeping in a recliner may be most comfortable to keep the upper body supported. After the first 2 weeks, sleeping on your side and back is permitted, but not on your stomach. After 4 weeks, resume normal and comfortable sleeping positions.
You may walk and climb stairs immediately following surgery, but avoid standing straight at the waist for 1 week. After 2 weeks you may resume moderate activity such as brisk walking.
No sexual activity for 3 weeks. During the first 4 weeks, do not lift anything heavier than a gallon of milk (10 pounds). No heavy exercise for 4 weeks (tennis, yoga, pilates, jogging, aerobics, weights, etc.). After 6 weeks you may resume more strenuous aerobic work and lifting activities. No abdominal exercises for 8 (+) weeks.
No driving for 3 weeks after your procedure or longer if you are taking pain medicine.
Alcohol, Tobacco, and Cannabis:
Do not smoke for the first several weeks after surgery as it impedes wound healing and can lead to serious wound complications. Alcohol consumption and tobacco and cannabis use are dangerous while taking pain medicine. It has a tendency to worsen bleeding. If you use cannabis (marijuana), please discuss with your physician.
Most patients stay in the hospital for 2 to 3 days post-operatively. Your first follow-up visit will be 1 week after surgery. Drains will be removed during one of the first few visits, depending on the output of fluids. Your surgeon will then see you at appropriate intervals after this to monitor your progress.
A prescription for physical therapy will be given to you at either your pre-operative appointment or your first post-operative appointment. Gentle range of motion exercises are encouraged during the first 2 weeks.
Work and Travel:
Depending on your career and your rate of healing, you should be able to return to work within 4 to 6 weeks of surgery. If your job involves heavy lifting, please allow 8 to 12 weeks before returning to work. Your surgeon will be able to give you a better estimate depending on your physical and professional profile. Flying or traveling is permitted after the first week as tolerated.
Call your surgeon immediately if you experience any of the following: excessive pain, rapidly expanding swelling under the skin, bleeding, redness at the incision site or pus drainage from incision, spreading bright pink discoloration, or fever over 101.5° F.
Call 911 if you are experiencing a life-threatening emergency. Such symptoms include severe shortage of breath, chest palpitations, sudden or sever chest pain, or other life-threatening concerns.
If you have questions about surgical techniques such as the TUG Flap, please contact The Breast Center Park Meadows Cosmetic Surgery online or call 720-457-4461 today. Board-certified plastic surgeons Dr. Christopher Williams and Dr. Jeremy Williams are pleased to educate patients undergoing breast reconstruction throughout the Denver area, all of Colorado, and nationwide.