Microvascular Breast Reconstruction

For the past 10 years, The George Washington University Hospital has offered microvascular breast reconstruction as an alternative to implant reconstruction. With two qualified surgeons on staff, GW Hospital provides access to free-flap procedures following mastectomy or lumpectomy to patients in Washington, D.C. and the surrounding area.

Bharat Ranganath, MD, assistant professor of plastic surgery at The George Washington University School of Medicine and Health Sciences and fellowship-trained microvascular surgeon, joined the Breast Care Center at GW Hospital to offer his extensive training in the surgical technique. Dr. Ranganath has immersive training in cancer reconstruction and now offers unique options for breast cancer reconstruction after mastectomy, such as DIEP flap and alternative flaps (PAP, DUG). He practices along with Joanne Lenert, MD, assistant professor in the division of plastic surgery at The George Washington University School of Medicine and Health Sciences and plastic surgeon at GW Hospital.

“Not every hospital has qualified surgeons available to perform microvascular surgery, which is why we are proud to offer this at GW Hospital,” Dr. Ranganath says. “We complete about 50 to 60 free-flap procedures annually and boast about a 97 percent success rate. Our program is ramping up since I’ve been here, and we continue to offer new, advanced techniques and methods in microvascular reconstruction.”

Benefits and Risks of Microvascular Breast Reconstruction vs. Implant Reconstruction

Microvascular breast reconstruction presents many benefits, including:

• Approximately 97–99 percent success rate with higher long-term satisfaction rates
• Avoidance of implant rupture, capsular contracture, breast implant illness and breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)
• Better toleration of radiation therapy
• More natural feel that ages with the patient
• Tissue flaps fluctuate with the rest of the body

Risks associated with microvascular breast reconstruction include:

• Donor site surgery is required, which will leave an additional scar and may evoke a longer healing period
• Not an ideal option for women who smoke or have uncontrolled diabetes, vascular disease or connective tissue disease
• Once body tissue is used, it cannot be reused for future additional surgeries

“Currently we are implementing new techniques to eliminate concerns about the procedure,” Dr. Ranganath says. “We hope to offer reconnection of nerve grafts to bring back sensation to the breast, new lymphatic surgery methods to hook up lymphatic channels and prevent lymphedema, as well as the ability to create flaps from different areas of the body for patients without excess body tissue.”

When to Refer Patients for Microvascular Breast Reconstruction

When determining ideal candidates for microvascular breast reconstruction, evaluate these factors:

• The patient’s overall health (any underlying conditions that may increase the risk of complications or hindered recovery)
• The patient’s willingness to have an additional procedure
• The amount of tissue available for a skin graft
• The likelihood the patient needs further surgeries or treatments

“Physicians should at minimum consider referring all eligible patients to a microvascular surgeon for an evaluation,” Dr. Ranganath says. “We have a shared decision-making process with the patient regarding their options.”

The GW Hospital Breast Care Center

At the GW Hospital Comprehensive Breast Center, patients receive all breast cancer services conveniently under one roof.

The center offers advanced imaging services for women of all risk levels, including automated breast ultrasound and breast imaging using the Dilon 6800® gamma camera. If cancer is detected, the center assigns the patient to a designated patient navigator to guide through the entire treatment and recovery process. Patients also have access to advanced therapies and surgical options, including microvascular reconstruction.

“We have a strong multidisciplinary team that helps patients seamlessly navigate the breast cancer process from screening to treatment,” Dr. Ranganath says. “As far as technology and training, we can provide first-grade care that is not available elsewhere.”

Individual results may vary. There are risks associated with any surgical procedure. Talk with your doctor about these risks to find out if microvascular surgery is right for you.