Autologous Tissue Reconstruction
What to Expect
Flap-based breast reconstruction moves fatty tissue from elsewhere on your body to the breast site. This procedure allows for the reconstructed breasts to seem more like normal breasts when compared to a breast reconstructed with an implant. In addition, the flap-based reconstructed breast will adjust with changes in weight. Flap surgery is a longer and more complicated procedure than an implant procedure and can add approximately three to eight hours to the procedure. Microsurgery is used to connect the blood vessels from the transferred tissue to the existing blood vessels on your chest. The recovery time is longer for flap surgery due to multiple surgery sites.
Despite the longer operative time, the operation does not alter vital functions in a major way. The level of invasiveness of the procedure is akin to a “tummy tuck” with hernia repair, but because of the need for flap monitoring, the patient will stay in the hospital for at least five days.
There is a possibility for additional procedures following your flap reconstruction. There is a possible impact on the area of tissue retrieval, such as loss of sensation or increased risk for a hernia. Tissue death (necrosis) may occur due to insufficient blood supply. However, a surgeon can trim this area if it is small enough. Loss of sensation may occur at the tissue donor site. There is also a risk of lumps forming due to firm scar tissue replacing fat tissue that had its circulation cut off, which can also be removed.
As with any surgical procedure, medical risks, bleeding, and wound complications may occur. These wounds however hardly ever require re-operations. The scars are frequently touched up during the revisional symmetry procedures.
Because of the underlying abdominal skin, the lower abdomen may have some areas with decreased sensation. While hernias or bulges are incredibly uncommon, a mesh may be used to reinforce the donor site.
Despite the hardship of postoperative recovery, breast free flap reconstructions (DIEP flaps) carry high long-term patient satisfaction rates.
TRAM Flap
TRAM (transverse rectus abdominis myocutaneous) uses skin, fat, blood vessels and muscle in the lower abdomen, between the waist and pubic bone to rebuild the breast. TRAM flap tissue is very similar to breast tissue, making it a good substitute and the most commonly performed flap surgery. The risk of TRAM flap surgery is that abdominal function may be compromised by cutting through the muscle.
DIEP Flap
DIEP (inferior epigastric perforators) utilizes blood vessels that run through the abdomen, along with the skin and fat connected to them, to reconstruct the breast while sparing any muscle. The blood vessels are harvested and grow with the autologous tissue.
Latissimus Dorsi Flap
Latissimus dorsi flap uses the muscle on your upper back, along with the skin, fat and blood vessels attached for breast reconstruction. It is closer to the chest than the abdominal flaps, and is a good choice for women that cannot have TRAM, DIEP, or SIEA flaps due to reasons such as a lack of tissue.