APEX Flap

APEX FlapSM Breast Reconstruction

What is APEX FlapSM Breast Reconstruction?

The APEX FlapSM breast reconstruction is a highly sophisticated microsurgical technique that is used to rebuild the breast lost to mastectomy. Like the DIEP Flap, excess living fat from below the belly button is transplanted to the chest to restore volume and shape. The APEX FlapSM differs from an ordinary DIEP however, as it allows for the natural anatomy and blood vessels to be rearranged to perfectly preserve the abdominal muscles and improve blood flow to the tissue transplant when necessary. This technique is an advancement over the DIEP procedure and has very specific indications and benefits.

The APEX FlapSM is one of the most advanced surgical technologies available in breast reconstruction. The ordinary DIEP can require muscle cutting to improve blood flow in the tissue in some situations. The APEX FlapSM was pioneered at the Center For Restorative Breast Surgery in 2012 to eliminate this problem. When required due to individual anatomy, the surgeons at The Center For Restorative Breast Surgery shift to The APEX FlapSM to prevent muscle damage and improve the quality of the operation. This assures the maximum opportunity for a successful procedure, with preserved strength and long-term softness in the new breast.

We believe so firmly in this quality measure that digital imaging is used to document the perfect preservation of the muscle wall in the tummy during our procedures. This standard of care elevation is unique to The Center for Restorative Breast Surgery and gives reassurance to our patients that extreme care has been applied to the details of their procedure to provide for their long-term well-being.

Our surgeons have presented this progressive work in medical conferences around the world and are proud to offer it as an elevation of the standard to our clientele.

READ TRANSCRIPT

Dr. Dellacroce (00:15):
Breast cancer care and breast reconstruction is what we do. And today I’m very pleased to announce the publication of our latest advancement that helps it all work better for you. Hi, I’m Dr. D and I’m about to share something with you that we’ve been working on for a very long time, Perhaps more important than ever. With recent headlines about breast implant safety, we set out to do some serious myth busting and along the way reinvented a 25 year old operation called The DIEP Flap. Our purpose was to dive into the little known flaws of older procedures, raise the bar and establish a long overdue standard for work in this area. The result of all this produce a new innovation that helps us better deliver the quality patients expect when they choose breast reconstruction with natural living fat. Hot off the presses, we call it the APEX flap.

(01:14):
This advancement builds on a well known breast reconstruction operation called the DIEP Flap. It’s been around for a quarter century and was supposed to help us recreate new living breasts from extra belly fat without damaging stomach muscle Along the way. The premise was good that a new breast could be made out of soft living fat without hurting the six pack muscles. But in the real world, the DIEP flap often failed to live up to its promise. It’s flawed in its purest form. It can’t always give us enough blood flow to keep the new breast soft. And when surgeons try to add more blood flow power, they end up cutting up the muscle and nerves in the stomach defeating the whole purpose. And so over time, as we begin to see more and more women referred in from all over the place with problems, it became clear that something was wrong.

(02:11):
So we made it our mission to open up the dialogue and look for ways to fix the flaws. The issues start here. Sometimes the little blood vessels are lined up nicely. We can collect things by simply spreading the muscle fibers apart. No cutting. The operation is straightforward and pure. Other times things aren’t lined up so well and one of two things can happen. Either one of the extra blood vessels is cut and we risk having part of the fat wither and turn hard, or the surgeon cuts across the muscle patching between to join vessels together, creating a whole new set of problems, cut enough of the muscle and you’ll leave loose ends that can spasm and cause pain. Cut more and you’ll be weakened. Cut more still, and you may suffer a hernia. It’s a conundrum. Either way, your surgeon’s not really to blame. It’s just the way the good Lord made us, but the implications are significant nonetheless.

(03:16):
So those are the problems. The DIEP flap by itself fails to consistently deliver what patients may think they are getting when they sign up for it. And that is where our latest work comes in. The apex flap picks up where the DIEP flap falls short in our practice. We’ve been doing this for about 10 years, but didn’t write about it until now because we didn’t want to get ahead of our skis with what we thought we were seeing, and we wanted enough experience to say something meaningful. Now the paper goes into great detail on this, but the takeaways are that this decision tree governs the whole complex of operations and is anchored centrally by the apex conversion. This allows us to branch away from the flaws of the DIEP flat when the need arises, and by doing so, gives us a significant reduction in fat necrosis while at the same time consistently maintains the promise and premise of maximum structure protection.

(04:29):
It’s done with high level microsurgery, but the goals are simple, better blood flow to avoid hard spots and perfect attention to preservation of muscle nerves and strength. Now listen closely. One of the most important parts of all of this is our suggestion that work of this type be supported with documentation of the surgical field, both for your reassurance and for the sake of furthering study. In this case, that means an image of the muscle work is always taken and placed in the medical record, which of course a patient may request copy of if she’s so desires. This is nothing exotic or out of the ordinary is very routine in other specialties like orthopedics and laparoscopic work. It helps us audit our technique and monitor quality. Ultimately, the point is to exchange hard spots in the new breasts for healthy, soft, permanent results. Our dependence on high blood vessels around the belly button for freedom to lower incisions so that we avoid high unsightly scars and the tummy look is more in line with what she expects.

(05:49):
And we exchange damage, pain, and weakness left behind by dated procedures for precision, faster recoveries and lasting strength. Remember, the only way you can have assurance that your operation, whether a DIEP flap, an apex flap or other was done according to a standard of some sort, is to add a picture of the muscle work to your medical record. Ask your doc about it. Hey, doc, do you or will you put a pick of the work you did for me in my record? It’s your right to know how your work was done. If they can’t want or don’t, let’s rubbish find another doctor. Doesn’t have to be here. There are plenty of docs out there who are very interested in doing the best work possible and are very open to your questions about quality. Do yourself a favor and look for them. Insider tip. I can assure you, if it was my wife, I would accept nothing less. The photo would be in the chart, and that’s all I have to say about that.

(07:01):
So don’t settle. Ask hard questions. Take your team to task. We are here to serve you. It’s your right to know how your work will be done and how it was done. The point at the end of the day is to make breast reconstruction work better for you. None of this is rocket science. These concepts are all basic and are now out in the open for you so that you can be a better decision maker when it counts. Before I leave you, remember, no operation is perfect, No surgeon is perfect. All surgery carries risk as a trade off for benefits. So consult with your doctor before making any decision for surgical care. Our final exchange is this, As of today, rather than uncertainty, smoke mirrors our fancy doctor talk. You are given the benefit of clear information and a new advancement developed in the interest of your health and wellbeing. Until next time, I’m Dr. D, be well. Be empowered and be encouraged.

When is APEX FlapSM Breast Reconstruction Used?

Our Center’s surgeons shift to the APEX FlapSM from the DIEP when the anatomy of an individual isn’t otherwise ideal to produce a quality result. The improvement in blood flow to the fatty tissue ensures better long-term softness in the newly created breast. Another important benefit of the APEX FlapSM procedure is that the muscle of the abdominal wall is fully protected and core strength is preserved in every patient. It is NEVER necessary to convert to a TRAM procedure for any reason with the APEX FlapSM advancement. This avoids the need for artificial mesh placement into the abdomen, prevents hernia formation, and guards against long-term abdominal weakness.

What are the Benefits of APEX FlapSM Breast Reconstruction?

Like the DIEP procedure, the APEX FlapSM technique affords the recreation of the breast with soft, warm, living fat that is permanent and doesn’t require maintenance over time. For women who’ve undergone  a mastectomy in the past, the APEX FlapSM procedure also allows for the avoidance of tissue expanders.

Women who undergo APEX FlapSM breast reconstruction benefit from improved abdominal shape, much like a “tummy tuck.” Using fat from unwanted areas of excess produces a flatter, tighter abdomen as a nice compliment to the newly reconstructed breast and the APEX FlapSM allows the abdominal incision to be kept lower in the bikini line than conventional DIEP procedures.

What are the Risks of APEX FlapSM Breast Reconstruction?

As with any surgery, the risks can be minimized by carefully following your pre-surgical instructions. If you have other medical problems or any factors which may increase your risk, we will work with you to educate you on proper preparation and arrange your clinical care regimen to maximize your safety and proper recovery.

What should I expect prior to my APEX FlapSM Breast Reconstruction surgery?

In most cases, you will be seen in our office 1-2 days prior to your surgery. At that time, we will go over the planned procedure, review consents, answer any questions you may have, and apply any surgical planning markings as may be required.

What should I expect on the day of my APEX FlapSM Breast Reconstruction surgery?

When you arrive at the hospital, you will be escorted to the preoperative holding area where you will change into a gown and be given foot coverings. The nurse or anesthesiologist will start an IV so that fluids and necessary medications may be given to you. Family members will be allowed to visit with you in the preoperative area once you are prepared for surgery.

After your surgery is complete, you will awaken in the recovery room under warm blankets with a dedicated nursing attendant at your side. You will be carefully monitored and kept comfortable. You will then be transferred to a private inpatient room that is prepared to allow you to rest and recover under the supervision of your attending physician and nurses. One adult caregiver may stay with you overnight during your hospitalization. A fold-out Murphy bed has been integrated into your room for their individualized comfort.

Your procedure will be performed in a state-of-the-art operating suite that is part of a fully accredited hospital that has been recognized by the American College of Surgeons for Excellence in care quality. Highly trained professionals using the most modern equipment and techniques will attend to you. In addition to your surgeons, the surgical team includes anesthesiologists, operating room technicians, nurses, and physician assistants.

Your Return Home

If you are traveling from out of state or internationally for care with us, your caregiver will need to be with you throughout your stay post-discharge and on the same flight home to assist you in the airport. Your caregiver’s education will be provided by our nursing staff during your time with us and our team is available to you and your assistant 24 hours/day should any questions arise after you are released from the hospital. Your arrangements for assistance after surgery should include an estimated week to ten days of availability from your caregiver.

We Are Here For You

Be reassured that you are being attended to by some of the most highly skilled and dedicated healthcare providers in the world. Do your best to relax knowing that we are going to take excellent care of you from the moment you enter our facility. Do not hesitate to ask for any special needs you may have.