Autologous Tissue Reconstruction
Not all women are candidates for tissue expanders and breast implants. Other women may be candidates for implant-based reconstruction, but may prefer to use their own tissue for breast reconstruction.
For these women, the option of tissue transfer is a logical alternative. Tissue flap surgery has the advantage of having a more natural feel and look, but is a more complex procedure with a longer recovery. There are several options available for flap reconstruction.
TRAM Flap Breast Reconstruction
The Transverse Rectus Abdominus Muscle (TRAM) flap transfers tissue from the lower abdomen (skin, fat and muscle) to the chest to reconstruct the breast mound. A TRAM flap breast reconstruction procedure may be performed as an immediate reconstruction at the same time as a mastectomy, or as a delayed reconstruction if a mastectomy was performed in the past.
A TRAM flap breast reconstruction procedure transfers lower abdominal tissue to the chest attached to its own blood supply and looks and feels like a normal breast. An additional advantage is that the patient also gets a modified tummy tuck as a result of removing the excess abdominal tissue. Nipple reconstruction typically takes place several months later, at which time the shape of the newly reconstructed breast can be revised and/or a procedure can be performed on the other breast to achieve better symmetry.
DIEP Flap Breast Reconstruction
The Deep Inferior Epigastric Perforator (DIEP) flap utilizes state-of-the-art techniques to transfer tissue from your abdomen to the chest wall to reconstruct the breast. It is similar to a TRAM flap breast reconstruction, but preserves the abdominal muscles; taking only the skin and fat from the abdomen to make the new breast. In addition to creating a natural looking breast, a DIEP flap breast reconstruction has the added benefit of contouring the abdomen, similar to a tummy tuck surgery.
Who is a candidate for DIEP Flap Breast Reconstruction?
Generally, the best candidates for this procedure are healthy individuals seeking a more natural looking result and looking to avoid the use of implants. It is often used in patients who have a history of radiation treatment, which may cause complications with implant surgeries. The DIEP flap breast reconstruction can be performed at the same time as your mastectomy or can be performed as a “delayed” reconstruction for patients who have had a mastectomy in the past and can be used to reconstruct one or both breasts if needed.
The DIEP Flap Surgery
The surgery takes 4-8 hours to perform depending on whether it is an immediate or delayed reconstruction and if the surgery is performed for one or two breasts. During surgery, the tissue from your abdomen is detached and moved to the chest. Advanced microsurgery techniques are then used to reconnect the small blood vessels of the abdominal tissue to blood vessels in the chest to reestablish blood flow. Most patients are able to go home after 3-4 days in the hospital on oral pain medications.
DIEP flap surgery has a longer recovery time than tissue expander and implant surgeries. Typically, patients are discharged on light activity for 2 weeks and return to work in about 4-6 weeks. Patients can return to heavy lifting and exercise at 6 weeks after surgery.
In most cases, additional procedures are needed to refine the shape of the breast, reconstruct a nipple, and achieve symmetry with the opposite breast. These additional procedures are usually performed after several months of healing as outpatient procedures.
TUG Flap Breast Reconstruction
For patients seeking to use their own tissue and who would like an alternative source to the tummy tissue, a Transverse Upper Gracilis (TUG) flap breast reconstruction may be a nice option. In a TUG flap procedure, the skin, fat and small portion of the muscle (gracilis muscle) is taken from your upper inner thigh and brought to your chest wall to reconstruct a new breast. This is done using the same advanced microsurgery techniques employed in the DIEP flap breast reconstruction. The scar is hidden in the groin crease and is the same scar used in cosmetic thigh lift surgery.
A TUG flap breast reconstruction procedure can be used to reconstruct one or both breasts. It is done under general anesthesia at the same time as a mastectomy or can be done as a delayed reconstruction if mastectomy was performed in the past. The amount of thigh tissue that can be utilized is usually smaller than the abdomen, so a small implant may be needed in the future to achieve a satisfactory volume. Typically, the procedure takes 4-6 hours to perform with a 3-4 day hospital stay.
After discharge from the hospital, patients are placed on light activity for 2 weeks and usually return to work in 3-4 weeks, and exercise in 6 weeks.
Latissimus Dorsi Flap Breast Reconstruction
The latissimus dorsi flap procedure takes a portion of the skin, fatty tissue and muscle from the back and transfers it under the skin to the chest wall to reconstruct a new breast. This can be done at the same time as a mastectomy or in a delayed fashion if a mastectomy was done in the past. The back tissue is not very thick, so in most cases, a small tissue expander or implant is placed under the back tissue to add volume and symmetry with the opposite breast.
This procedure is often used in patients who had previous radiation treatment or for patients who are not candidates for a DIEP flap breast reconstruction (i.e. very thin patients with inadequate abdominal tissue to create a breast). Additional surgery may be necessary in the future to replace the tissue expander with a permanent implant. The procedure takes 2-4 hours to perform and patients are typically in the hospital for 1-2 days after surgery.
After discharge, patients are on light activity for 2 weeks and typically return to work in 2-3 weeks. Upper body exercise can be resumed 6-8 weeks after surgery.
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Schedule Your Consultation
If you wish to learn more about using your own tissue for breast reconstruction, please schedule a consultation with one of our plastic surgeons. During your consultation, your concerns will be addressed and you will be educated about your breast reconstruction options. Together, we can develop a personalized treatment plan to achieve your reconstructive goals.