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 your goals, medical condition, and previous surgery, are considered when choosing between using implants or using your 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 your 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 the buttocks.
Tummy Flap Procedure
Also called transverse rectus abdominis myocutaneous flap (TRAM), this is a common flap procedure that 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, the surgeon 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 Flap Procedure
Also called latissimus dorsi myocutaneous flap (LDMF), this procedure may be used when the tummy flap procedure is not an option. During LDMF, the plastic surgeon takes tissue from the back and moves it to the mastectomy site. Often a breast implant is also used.
Gluteal Free Flap
Also called gluteal artery perforator flap (GAP), this is a newer type of surgery that uses tissue from the buttocks to create a breast. During the GAP procedure. the surgeon takes skin, fat, blood vessels, and muscles from the buttocks and moves it to the mastectomy site to create a breast.