Mapping to improve free-flap transfer breast reconstruction
Free-flap transfer breast reconstruction involves transplanting tissue with a good vascularisation (blood supply) from one part of the patient’s body and using it to rebuild the breast. The blood vessels in the transplant are then joined to blood vessels in the reconstruction site using microsurgery to re-establish blood flow. A good blood supply is vital to ensure the transplanted tissue can survive.
This technique is increasing in popularity thanks to its superior cosmetic outcome, durable nature, natural appearance and increased resistance to changes following radiotherapy. As a result, it now accounts for 20% of all breast reconstruction operations in the UK.
However, free-flap transfer does have a risk of complications and around one in 10 transplants fail.
What can go wrong?
The key to successful surgery is a good blood supply. However, if the supply becomes compromised, for example if a blood clot prevents blood from reaching the flap or if the flap becomes congested, complications arise.
This can result in complete or partial necrosis (death of the tissue), delayed wound healing, prolonged recovery, repeated operations, pain, scarring and a huge emotional impact on the patient. Not to mention the cost implications to the healthcare system.
A better blood supply
RAFT’s research has focused on improving the success rate of the most common type of flap surgery, the Deep Inferior Epigastric Artery Perforator (DIEP) Flap, which takes tissue from the abdomen (essentially a tummy tuck) and uses it to reconstruct the breast.
As a good blood supply has been shown to be essential for the survival and healing of free flap transplants, our research focused on the two areas. Experimental work in relation to these areas of RAFT’s research has been competed:
Developing real time imaging techniques to allow surgeons to track the blood flow in the prospective transplant tissue before and during the operation.
Benefit: Surgeons will be able to identify the most highly vascularised tissue (tissue that has the best blood supply and best chance of survival), thus increasing the likelihood of a successful breast reconstruction operation.
Developing methods to increase vascularity (blood flow) in the proposed transplant tissue before it is used for the breast reconstruction.
Benefit: This will mean that if a patient does not have tissue that is well vascularised, surgeons will be able to use the new techniques to enhance the blood flow to the chosen tissue site, ensuring the reconstruction has highest possible chance of survival. The free-flap transfer research project will benefit women from as early as 2020.
RAFT Research Scientist and Partners:
The research for this project was conducted by Dr Anita Mohan. Academic supervision from Cambridge University was provided by Professor J Andrew Bradley, Head of the Department of Surgery and clinical supervision was provided by Mr C Malata, Consultant Plastic Surgeon and specialist in microvascular surgery and breast reconstruction.
The majority of the experimental was undertaken in collaboration with and under the supervision of Professor Michel Saint-Cyr at the Mayo Clinic, Rochester, USA. He is a Professor of Plastic Surgery and holds a Practice Chair for the Division Plastic Surgery. He is a world authority on vascular supply in perforator-based free flaps and microsurgery, has authored more than 100 publications in peer-reviewed journals and has successfully supervised MD(Res) and PhD students from across the UK, USA and Europe.
The free-flap transfer research project will benefit women from as early as 2020.