What is a “skin island”?
The term “skin island” is used to describe the new patch of skin that is sometimes visible on a reconstructed breast after a “flap” procedure. Flap techniques use tissue from another part of the patient’s body to reconstruct the breast. For patients having DIEP flap breast reconstruction, the visible skin island is a patch of skin originally from the lower abdomen.
What is the purpose of a skin island?
Surgeons at PRMA may incorporate a skin island in the following situations:
1) Monitoring flap health –After breast reconstruction surgery, the visible skin island remains connected to the transplanted tissue, serving as an indicator of the overall health of the flap. Nurses and surgeons can easily monitor the tissue by evaluating the color and temperature of the skin patch. A purple, dark, or cool skin island may signal a change in blood flow, requiring immediate attention to ensure flap health.
2) Source of skin for nipple reconstruction – In breast reconstruction, the skin island serves as the foundation for creating a new nipple and areola during the revision stage (stage 2) of the procedure, when the nipple and areola are recreated. The reconstructed nipple is then tattooed to match the original color of the nipple and areola, providing a natural appearance.
3) Replace missing or contracted skin – In cases of non-skin sparing mastectomy, the skin island is utilized to recreate the breast envelope (the skin surrounding the new breast tissue) and restore a natural breast contour. For patients who have undergone lumpectomy with significant radiation damage resulting in skin contracture (severe scarring), the skin island can be strategically positioned to address contour deformities, achieving the most natural-looking breast shape in delayed breast reconstruction.
4) Reducing the tension of the breast skin after mastectomy – A temporary skin island can also be used to take the tension off the mastectomy skin flaps to promote better healing. Too much tension on fragile mastectomy flaps increases the chances of the mastectomy skin dying. Especially in cases where the mastectomy incision is located over the lower part of the breast and subjected to the weight of a heavy flap, this approach optimizes breast shaping, lifting, and other cosmetic outcomes at stage 2 of the reconstruction process, once the mastectomy skin flaps have fully healed.
Are skin islands permanent?
For most flap patients, breast reconstruction is performed in stages and the extra skin patch will be removed at stage 2.
Skin islands that are needed to restore the contour and overall shape of a natural breast may be permanent. The most common scenario in which the skin island will be kept is after a delayed breast reconstruction where the skin island replaces breast skin that was removed by a prior mastectomy, and/or severely damaged by radiation therapy.
For patients who underwent flap-based reconstruction following a non-skin sparing mastectomy, the skin island is larger and permanent as it replaces the breast skin removed during the breast cancer surgery. Likewise, for patients who have significant defects following a prior lumpectomy, the skin island may be left intact to achieve better breast contour and symmetry.
-Dr. Ochoa
The term “skin island” is used to describe the remaining visible skin from a transplanted “flap” of tissue.
Leave Comment
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I’m a ten year double mastectomy with reconstruction that is a horrible mess. Scar tissue that is pulling inward. I have more tissue under my arms than there is on my chest. I’ve had a hysterectomy that has left a scar on my lower abdomen. Can all the loose skin be used to pull around and help with a natural looking reconstruction? I have to use prosthetic breast inserts to look normal. Is there something that can be done? I’m 69 and I’m just interested in looking more normal.
September 16,2020
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Thanks for reaching out Wanda! To best advise you on a corrective breast reconstruction plan, we would need to evaluate your needs. We would be more than happy to schedule you a virtual consultation with one of our board-certified plastic surgeons. They can review your needs and provide you a personalized surgical plan. Please consider filling out our virtual consultation form at https://prma-enhance.com/schedule-a-consultation/
September 16,2020
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I don’t know if it’s skin flap or whatever but the doctor I had I feel like I should have been done better than I was. Nipple removal, hardly no color came bad. Sent me to a tattoo person (medical) lol, didn’t work. I just deal with it since like 2004 or 2006. Just ranting,
September 16,2020
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We are so sorry to hear you feel this way Tee. We would be more than happy to offer you a second option and provide you recommendations on how to reach your desired outcomes. We welcome you to fill out our virtual consultation form at https://prma-enhance.com/schedule-a-consultation/
September 16,2020
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I could really use your help. I’ve had a reconstruction with a double mastectomy and I am not satisfied. For one my breast are not even plus I don’t have nipples.
September 16,2020
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Thanks for reaching our Shequilla! We would be more than happy to offer you a second option and provide you recommendations on how to reach your desired outcomes. We welcome you to fill out our virtual consultation form at https://prma-enhance.com/schedule-a-consultation/
September 16,2020
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I want more info on this
October 16,2020
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I would like a virtual consultation. I had reconstructive surgery almost 20 yrs ago. My implants have” sunken” or I don’t know deflated? I’ve been getting strong pains in the area as well as towards my armpits. Interested in seeing if that can be fixed and if the pain is normal because of that. If surgery is possible to correct that would like a estimate. Thank you
October 17,2020
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We would be happy to schedule a virtual consultation for you! Please fill out our virtual consultation form at https://prma-enhance.com/schedule-a-consultation/
October 19,2020
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Am I a DIEP Flap Candidate?
Understanding DIEP Flap Reconstruction: FAQs, Recovery, and Best Practices
Wanda Rhodes
I’m a ten year double mastectomy with reconstruction that is a horrible mess. Scar tissue that is pulling inward. I have more tissue under my arms than there is on my chest. I’ve had a hysterectomy that has left a scar on my lower abdomen. Can all the loose skin be used to pull around and help with a natural looking reconstruction? I have to use prosthetic breast inserts to look normal. Is there something that can be done? I’m 69 and I’m just interested in looking more normal.
PRMA Plastic Surgery
Thanks for reaching out Wanda! To best advise you on a corrective breast reconstruction plan, we would need to evaluate your needs. We would be more than happy to schedule you a virtual consultation with one of our board-certified plastic surgeons. They can review your needs and provide you a personalized surgical plan. Please consider filling out our virtual consultation form at https://prma-enhance.com/schedule-a-consultation/
Tee
I don’t know if it’s skin flap or whatever but the doctor I had I feel like I should have been done better than I was. Nipple removal, hardly no color came bad. Sent me to a tattoo person (medical) lol, didn’t work. I just deal with it since like 2004 or 2006. Just ranting,
PRMA Plastic Surgery
We are so sorry to hear you feel this way Tee. We would be more than happy to offer you a second option and provide you recommendations on how to reach your desired outcomes. We welcome you to fill out our virtual consultation form at https://prma-enhance.com/schedule-a-consultation/
Shequilla Williams
I could really use your help. I’ve had a reconstruction with a double mastectomy and I am not satisfied. For one my breast are not even plus I don’t have nipples.
PRMA Plastic Surgery
Thanks for reaching our Shequilla! We would be more than happy to offer you a second option and provide you recommendations on how to reach your desired outcomes. We welcome you to fill out our virtual consultation form at https://prma-enhance.com/schedule-a-consultation/
Janne Skipper
I want more info on this
Esmeralda Mendoza
I would like a virtual consultation. I had reconstructive surgery almost 20 yrs ago. My implants have” sunken” or I don’t know deflated? I’ve been getting strong pains in the area as well as towards my armpits. Interested in seeing if that can be fixed and if the pain is normal because of that. If surgery is possible to correct that would like a estimate. Thank you
PRMA Plastic Surgery
We would be happy to schedule a virtual consultation for you! Please fill out our virtual consultation form at https://prma-enhance.com/schedule-a-consultation/