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Center for Restorative Breast Surgery: All Women Seeking Breast Reconstruction Should Be Better Informed

NEW ORLEANS, April 25, 2019 /PRNewswire/ -- World-renowned surgeons at the Center for Restorative Breast Surgery in New Orleans have just published an article in this month's edition of the Journal of Plastic and Reconstructive Surgery that unveils their newest pioneering advancement called the APEX Flap. In this landmark publication, entitled "Myth-busting the DIEP Flap and An Introduction to the Abdominal Perforator Exchange (APEX) Breast Reconstruction Technique: A Single-Surgeon Retrospective Review," lead author, Dr. Frank J. DellaCroce, exposes little known problems with popular reconstructive procedures for women facing mastectomy. They further describe how their group has innovated to fix the fundamental flaws of the widely known "DIEP" technique. "What we learned, is that despite popular perception, the DIEP procedure doesn't always deliver on its promise of being a quality way to spare abdominal muscles and strength when performing natural tissue breast reconstruction.  When forced, it can leave damage in the abdominal wall and produce a reconstructed breast with internal scarring and hard spots known as fat necrosis." The surgeons spent over 8 years pioneering a way to reliably reduce the problems, improve cosmetic results, and add lasting softness to the newly reconstructed breast. Duly named the APEX Flapsm, to represent the quality improvements, this procedure has been performed routinely over the last decade at the Center for Restorative Breast Surgery (CRBS) with enhanced clinical outcomes compared to the DIEP alone.

As the paper states, the blood vessels can take unexpected paths as they pass through the abdominal structure and may not naturally fall in the right location for the older procedures. In these cases, doctors may cut through the "6-pack" muscles that are in the way, defeating the basic purpose of the DIEP technique. After seeing women referred in from around the country with problems, a pattern was noted in some women who had significant abdominal issues or rock hard breasts after surgery. "They were surprised to learn that before our publication there was no framework to standardize how these procedures should be done or what they should be called," states DellaCroce.

A total of 364 procedures were performed between 2011 and 2017 in the study with very low rates of abdominal problems or breast fat necrosis. Before the development of the APEX conversion, surgeons were left to choose between cutting the muscle and nerve bundles to bring more vessels together or sacrificing those vessels and reducing blood flow in the new breast fat.  "We're now able to produced consistently softer breasts compared to the DIEP alone and more reliably protect abdominal strength." The surgeons at the CRBS use the APEX Flapsm as an alternative to TRAM Flap conversion when DIEP isn't the best choice for maximization of blood flow and muscle preservation.

"The point is to deliver what patients think they are getting when they choose to have a procedure of this type." Dr. DellaCroce and his colleagues also encourage practitioners to photographically document the quality of abdominal structure preservation in the patient's medical record. "This encourages precision I think. It lets us gather data about what we're doing and I believe it's reassuring for the patients. If you can't record the quality, you can't make any assumptions about how your work was done", states DellaCroce, "documentation of this type is common in other fields like Orthopedics and laparoscopic surgery so adding it here is sensible and patients should ask about it." 

"The APEX Flap really brings this art into line with the premise of its concept. We have found that many women are not getting the results they expected from their DIEP Flap surgeries," states Dr. DellaCroce. "We set out to open the dialogue on the little discussed problems with existing procedures and create a solution for women who want the best in overall outcomes. We believe that open disclosure, technical progress, and objective documentation of work quality are how we best move forward with serving women who seek natural tissue breast reconstruction.  The APEX Flap advancement is a big step in that direction." 

CENTER FOR RESTORATIVE BREAST SURGERY SERVICE INFORMATION: The Center for Restorative Breast Surgery was established to serve as a dedicated center of excellence for women seeking the most advanced methods of breast reconstruction. David S. Cabiling, MD; Frank J. DellaCroce, MD, FACS; Scott K. Sullivan, MD, FACS; Chris Trahan, MD, FACS; and M. Whitten Wise, MD are pioneers in the art of rebuilding breasts lost to cancer, preventive mastectomy, developmental defects, and deformities associated with previous surgery. Their sophisticated microsurgical techniques allow for recreation of the breast with natural tissue while preserving strength and restoring beauty. Together, with Board Certified Breast Surgical Oncologists Alan Stolier, M.D., FACS and W. Karl Ordoyne, M.D., FACS, they comprise a group of international leaders in breast cancer surgery options, pioneering groundbreaking procedures including nipple sparing mastectomy, the Stacked DIEP, the gluteal flap, BODY LIFT Flap, and APEX® technique. They have performed thousands of breast reconstruction procedures for women facing breast cancer, seeking BRCA risk reduction, or searching for solutions to existing breast deformities. Their Center is tailored and staffed to cater to the needs of clientele who travel from all over the world for their services. For more information please visit

Plastic and Reconstructive Surgery® is the official medical journal of the American Society of Plastic Surgeons and is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

About ASPS: The American Society of Plastic Surgeons (ASPS) is the world's largest organization of board-certified plastic surgeons. Representing more than 7,000 Member Surgeons, the Society is recognized as a leading authority and information source on aesthetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. ASPS advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery.

About Wolters Kluwer Health: Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with annual revenues (2013) of €3.6 billion ($4.7 billion), approximately 19,000 employees worldwide and operations in over 40 countries across Europe, North America, Asia Pacific, and Latin America. Follow our official Twitter handle: @WKHealth.


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SOURCE Center for Restorative Breast Surgery