Flap Reconstruction Surgery: Important Stats and Abstract Information

If you’ve had breast cancer and are considering reconstruction surgery, it’s possible that one of the options you may be looking into is flap reconstruction surgery.

Breast reconstruction utilizing “flap” techniques are procedures where body tissue is used to reconstruct the shape of your breast after surgery. While it’s a relatively common type of reconstructive surgery these days, we feel it’s important that you should learn as much as possible about the benefits and risks, and discuss them with your doctor before you have the procedure.

That’s why we at The Center for Natural Breast Reconstruction are always looking for better ways to educate and inform our patients before a decision.

One way we ensure our patients have access to the latest in medicine and medical technology is to have our surgeons and staff constantly learning, researching, and writing about their findings.

In fact, some of our latest research on reconstructive flap surgery was recently submitted to the American Association of Plastic Surgeons by our Dr. Kline. This specific abstract documented the success rate of our reconstructive flap surgeries with regard to the role of autogenous microvascular breast reconstruction in the community.

Check it out…


PURPOSE: To present the continuing role of autogenous microvascular breast reconstruction in the community

METHODS: 1393 free perforator flaps for breast reconstruction were performed by two surgeons from October, 2003 to October, 2016. All flaps were performed in two community hospitals. Types of flaps included DIEP unilateral (122 flaps), DIEP simultaneous bilateral (866 flaps), DIEP bipedicle (106 flaps), sGAP unilateral (55 flaps), sGAP simultaneous bilateral (202 flaps), iGAP unilateral (2 flaps), iGAP simultaneous bilateral (18 flaps), PAP unilateral (5 flaps), PAP bilateral (10 flaps), SIEA unilateral (3 flaps), SIEA simultaneous bilateral (2 flaps), and TFL perforator (1 flap). The series includes a large number of both immediate and delayed reconstructions, prior failed reconstructions, and patients with a history of radiation.

RESULTS: Overall flap survival rate was 98.2%. DIEP survival rate was 99.1%. sGAP survival rate was 95.7%. No primary unilateral flaps were lost, and no bilateral losses occurred. Including those patients whose initial flaps failed, 99% of patients were ultimately successfully reconstructed with autogenous tissue.

CONCLUSION: Implant-based reconstruction is an appropriate initial choice for many patients, but autogenous microsurgical reconstruction still remains an excellent option, whether as an initial choice, or for patients with a prior history of failed reconstruction. With proper preparation and institutional support, perforator flap breast reconstruction can be performed with a high degree of success in a community hospital setting.

On top of the abstract, our physicians—Richard M. Kline Jr., M.D. and James E. Craigie MD—also wrote the chapter on GAP (buttock) flaps for the book Perforator Flaps for Breast Reconstruction.

Check out the book chapter here.

As we mentioned earlier, we are passionate about continuing to learn, receive training, and interact with the scientific community to ensure we provide our patients with the safest, most advanced care.

And, while we’re doing our job to make sure we’re properly training our staff and staying up-to-date with the latest in medical technology, there’s one thing we encourage you to do as well—always ask for medical procedure stats.

Much like the abstract we provided above, your doctor should be able to provide you with stats on the procedures he or she conducts.

When patients come to us and ask questions on success rates, we can happily tell them the different percentage rates of success for the various procedures we provide. Equipping our patients with this information empowers them to make wise, educated decisions about their own health.

So, please, before you move ahead with a specific procedure, ask your doctor for the stats. If they have a high success rate with their surgeries, then you’re in the right place. If they don’t, it’s time for you to find another doctor.

We wish you the best as you move forward with any new procedure you may need!

Did you find the book chapter insightful? Let us know what you learned and what you thought was helpful to know in the comments below!

I’m Not Happy With My Implants — Is Flap Surgery Possible?

This week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q: I had a double mastectomy last August with immediate expander reconstruction. My expanders were replaced in January with silicone implants and needless to say I’m not thrilled with them. They are hard, cold and I now have ripples across them. My surgeon is going to remove more excess skin in hopes to alleviate the “wrinkling” effect, but I’m honestly not sure if I even want to have this done. I originally wanted to have a tissue transfer (abdominal) but was advised to try the implant route first.

I know that I don’t have a lot of abdominal fat and would probably end up with very small breasts if I went this route instead. I don’t mind the smallness but am concerned on the dangers of having a tissue transfer and wonder if this would be a better, more natural breast for me. I’m not getting the feeling that my surgeon is comfortable with this type of surgery and would like more information on your facility. I feel like I have so many questions that no one can seem to answer. Is there someone that I can reach out to?

A: We would be very happy to discuss your situation with you. It is very rare for someone not to have enough stomach or buttock tissue, especially with subsequent fat grafting, to provide an acceptable breast size. Flap surgery can be a little intimidating, but our success rate over the last ten years is 98.4%. We have helped many women who have started out with implant reconstruction, only to decide that it was not the right choice for them.
Our nurse Chris or P.A. Kim can call to discuss your situation further, if you wish.

Thank you for your question.

Dr. Richard M. Kline

Center for Natural Breast Reconstruction

Have a question about breast reconstruction or post-surgical care you’d like answered from our surgical team? Just ask us!

Help! Is This Long-Term Pain After Breast Reconstruction Normal?

DIEP flapThis week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your questions when considering reconstruction or pain after reconstruction.

Q: I had flap surgery in October 2010. Since then, I have experienced pain to the touch in that area, all day, almost every day. Is this normal? 

A: I’m sorry you are having pain in your reconstructed breast. If you have not had your surgeon examine you, that should be your first step to get to the cause of the pain. After breast reconstruction is completed, the new breast should not be painful.  Some people who have implant reconstruction can have pain related to capsular contracture or implant rejection.

If I had more details about your situation, I could possibly give you more information. I would strongly recommend that you make sure your surgeon and or oncologist thoroughly look in to the cause of the pain. I would also not wait a long time to do this. Let me know if you would like to give me more info.


Q: I’m considering breast reconstruction. How long will it take for breast to look normal? What are the differences in the different types of procedures?

A: Thank you for your question. All types of breast reconstruction require time to complete and almost always more than one surgery. Depending on the circumstances, some patients may require chemotherapy and/or radiation. If this is the case, treatments can delay the completion of the process. I tell my patients to allow 3-6 months after any procedure for the results to settle and swelling to resolve.

There are generally two types of reconstruction: implant reconstruction and reconstruction using your own tissue. Implants are generally less natural and for some patients, the results are less permanent. Using your own tissue can be grouped into procedures that sacrifice muscles in the body and those that preserve muscle and use only skin and fat. The latter muscle-sparing procedures are our specialty and require expertise in a specific type of microsurgery.                

I hope this helps! Let me know if you need more info.

Dr. James Craigie

Center for Natural Breast Reconstruction

Have a question about breast reconstruction you’d like answered from our surgical team? Just ask us!

Will Medicare Cover My Flap Surgical Procedure?

This week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q: If I have had cancer and a breast was removed, will Medicare cover the flap procedure?

A: Yes, if you have had mastectomy, Medicare will absolutely cover the reconstruction procedure of your choice.  It will also cover surgery on the other breast to improve symmetry, if necessary. Let me know if you have any other questions you would like answered or want to talk in depth about the procedure with one of our clinical staff members.  We’re always happy to help!

Thank you for your question.

Dr. Richard M. Kline

Center for Natural Breast Reconstruction

Have a question about breast reconstruction or post-surgical care you’d like answered from our surgical team? Just ask us!

Answering Your Breast Implant Questions

dr. richard klineThe question below is answered by Dr. Richard M. Kline, Jr., of The Center for Natural Breast Reconstruction

I had cancer in my left breast 15 yrs. ago, had the lump taken out, then developed a rather large cyst in the same breast. I had the cyst removed, which left me with only half a breast. I also had 8 weeks of radiation. I wanted a breast implant but the doctor said I couldn’t get one. Since it has been so long, could I now get one? I am 75 but still don’t feel good about my breast. I wear a breast form, but it’s not the same.

It is sometimes possible to reconstruct a lumpectomy defect with an implant, but your history of radiation makes success less likely. To some extent, the size of the implant you would require, and the amount of radiation injury you have sustained, influence the chances for success. Flap surgery, while significantly more involved, is ideal for use in radiated tissues, as it allows us to use healthy, non-radiated tissue to replace what is missing. Age, in and of itself, does not affect the success of either surgery, as long as you are generally healthy.

—Dr. Richard M. Kline, Jr.

Do you have a question about breast implants or natural breast reconstruction? Ask the doctor by emailing us at blog@naturalbreastreconstruction.com.