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Breast Reconstruction Using Your Own Tissue

A variety of reconstructive techniques, using either breast implants or your own tissue, are available that offer cosmetically appealing results. Multiple factors, such as the patient's goals, medical condition, and previous surgery, are considered when choosing between using implants or using the woman's own tissue (called flap procedures) to reconstruct the breast.

Flap Procedures for Breast Reconstruction

In flap procedures for breast reconstruction, tissue is moved from one area of the body to the chest in one of two ways. Using the "tunneling procedure," the section of tissue is left attached to its original blood supply, tunneled underneath the skin, and placed at the reconstruction site. Using the "free-flap procedure," the tissue is disconnected from its original blood supply and then reconnected to existing blood vessels in the chest area. Flaps of tissue for these procedures can be taken from the abdomen, back, or buttocks.

Tummy flap or transverse rectus abdominis myocutaneous flap (TRAM): A common flap procedure uses muscle, skin, and the blood supply from the stomach area. It can be performed using either the tunneling or free-flap method. With the free-flap procedure, the artery and vein in the flap are surgically attached to the artery and vein in the armpit.

After the flap has been transferred, either by tunneling or the free-flap procedure, the surgeon then shapes the flap into the contour of a breast of similar width, size, and projection as the opposite breast.

The tummy flap procedure is performed under epidural anesthesia, where medicines are placed near nerves in the back to control pain after surgery.

Transferring tissue from the abdomen to the chest also results in tightening of the stomach, or "tummy tuck." While it leaves a horizontal scar across the lower abdomen, this is generally the least objectionable place for such a scar.

Back or latissimus dorsi myocutaneous (lats) flap: When the tummy flap is not an option, the plastic surgeon can take tissue from the back and move it to the mastectomy site. Often a breast implant is also used. Less often, tissue is transferred from the buttock area to use in making a new breast.

WebMD Medical Reference

Reviewed by Arnold Wax, MD on June 20, 2009