Raj S. Ambay, MD, DDS, Board Certified Plastic Surgeon and Florida Hospital Surgeon talks about the sGap and how it is done.
Interview conducted by Ivanhoe Broadcast News in October 2018.
Tell us about the S-Gap tell us what it is and when you use it.
Dr. Ambay: So the S-Gap actually is named after a particular vessel in the buttocks. Basically it’s a form of breast reconstruction. So there’s multiple forms of breast reconstruction so there’s multiple forms of breast reconstruction the most common really is the implant everybody seems to know about. The other two forms of reconstruction sacrifice people’s muscle both in the abdomen or in the back. The advantage of doing something like an S-Gap is that there is no muscle, and if you have some butt to spare we can actually make a breast out of it and transplant it to the front of your chest. In short, what is really done is we take the excess tissue of the butt, and we only take the skin and fat. And we dissect these tiny little perforators, they’re almost like the size of the tip of a ballpoint pen. Then we remove that tissue and make a breast on the back table at the same time the surgeon is removing the breast for the mastectomy leaving the vessels that we need and then under a microscope we then reconnect all the vessels. So, the tissue is a living tissue just like the breast.
This seems like a breakthrough, what do you think?
Dr. Ambay: Yeah, I think it’s amazing because first of all the pain is minimal. Most people are on Tylenol the next day including the mastectomy which is unheard of. And that really happens because you’re not taking out nerves, you’re not cutting through muscle both of which is what causes so much pain. The other thing is you’re using tissue that most people are happy to get rid of. We started this technique using what we call the deep flap or the tummy tuck breast reconstruction. Then that we literally took the same tissue that discarded in a tummy tuck, and we dissected those tiny vessels out saving all the muscle and tissue taking only the skin and fat. The stuff that’s usually thrown in the trash we make it in to a breast at the back table and then we reconnect the entire thing under a microscope. That technique is in general called microsurgery. The beauty of microsurgery is if you have a vessel anywhere in your body and tissue anywhere in your body we can use it to make something.
So it sounds better than a foreign object being used.
Dr. Ambay: Absolutely it’s all you, It’s a hundred percent natural nothing artificial is placed in your body even to close everything up. In the other techniques you may have an implant, you may have a mesh, and in this technique there’s nothing. We’ve taken the excess whether, it be from your abdomen or from your buttocks, we take the excess and we make a breast out of it. It lasts forever.
It seems like if the patient had a choice they might go with this, is there a candidate that can or cannot use this?
Dr. Ambay: Yeah, I mean you generally want to be healthy so that’s the first. The surgery at least at the outset requires a lot of care of the breast in the first week or so and you want somebody who is really involved in their breast care. Someone who is healthy, someone who has support, family support behind them. I think these are great candidates for surgery in general, but for a particular surgery like this that’s where it really makes a difference.
So the post op is a little bit different compared to like an implant?
Dr. Ambay: Yeah, with the implant the implant actually the muscle is cut in the chest, and it gets placed underneath the muscle. But in this technique the post op really is just getting them moving. Just getting them walking. The post-op immediately after surgery is every hour the nurse comes in and puts this little thing called a Doppler which you can hear an artery and a vein. You can hear the swoosh of the artery and a slow hum of the vein. We actually put that probe onto the breast, and you can hear that this tissue is now living. The first twenty-four hours is the most critical time because what will happen is within the first twenty four hours we hear those signals we have a ninety percent chance of success. By the second day we have a ninety five percent chance of success. And by the third day they go home they have a ninety nine percent chance of success.
Meaning it takes?
Dr.Ambay: Correct, so with an implant you actually can have an infection, you can have the fact that the implant doesn’t take and with this you don’t have that at all because it’s all natural and it will last forever.
END OF INTERVIEW
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