Autologous Tissue Reconstruction or Free Flap Reconstruction
The primary alternative to implant-based reconstruction is autologous tissue reconstruction or free flap reconstruction. During this procedure a plastic surgeon will use your own tissue--skin, fat, and sometimes muscle-- from another place on your body to create the reconstructed breast. The tissue (called a "flap") usually comes from the belly, the back, the inner thighs, or the buttocks.
Types of Autologous Tissue Reconstruction or Free Flap Reconstruction
- TRAM Flap (two types)
TRAM flap stands for Transverse Rectus Abdominus Myocutaneous flap. This type of reconstruction is when the flap is taken from your abdomen and transferred to the chest and made into a breast mound. There are two very different types of TRAM flap reconstruction and it is important to understand the difference.
- One type of TRAM flap is a Pedicle TRAM, this means we leave the flap attached to its original blood supply and tunnel it under the skin to the breast area. This type of surgery can significantly decrease the strength that you have in your abdomen.
- The other type of TRAM flap is a Muscle Sparing (MS) Free TRAM. With this type of flap, the surgeon transfers abdominal skin, fat, blood vessels, and a small portion of the muscle from its original location to the chest wall forming a new breast mound. This is done by suturing the blood vessels from the flap taken from the abdomen to blood vessels in the chest area using microsurgery. This is a more complex and longer surgery; however, it preserves the strength and function of your abdominal wall and allows for a better cosmetic shape of the reconstructed breast.
- DIEP Flap
- DIEP Flap stands for Deep Inferior Epigastric Perforator flap. In this surgery, the abdominal muscle is separated in order to get the blood vessels out but no muscle is taken.
- SIEA Flap
- SIEA Flap stands for Superficial Inferior Epigastric Artery flap. In this surgery, no incisions are made in the abdominal muscle. All the blood vessels that are taken are from the top of the muscle.
If you have had a previous major abdominal surgery such as an abdominoplasty (tummy tuck) or if you do not have enough tissue on your lower abdomen to reconstruct your breast, we can also use tissue from your buttocks or inner thighs.
- S-GAP Flap stands for Superior Gluteal Artery perforator flap. In this surgery, the upper part of buttocks is taken.
- I-GAP Flap
- I-GAP Flap stands for Inferior Gluteal Artery perforator flap. In this surgery, the lower part of your buttock is taken.
- TUG Flap
- TUG Flap stands for Transverse Upper Gracilis flap. In this surgery, the upper portion of your inner thighs is taken.
At Albany Medical Center, the most common flaps performed are the MS TRAM, DIEP, and SIEA flaps.
Breast reconstruction using a free flap is a longer and more involved surgery up front. It usually requires a longer hospital stay and recovery. Typically patients can expect to be in the hospital for four days and have a six week recovery time.
Advantages of Free Flap Breast Reconstruction
- Breasts look and feel very much like natural breasts and will continue to look better over time.
- Your own tissue is used to reconstruct your breast.
- Breasts will not deflate or need to be replaced, which may occur with a breast implant.
- No risk of infection from an implant.
- The bottom half of your abdominal skin is removed. This is similar to a “tummy tuck.”
- No risk of capsular contracture.
Disadvantages of Free Flap Breast Reconstruction
- Longer surgical time. A unilateral (one breast) surgery takes approximately 6-8 hours, and for bilateral (both breasts) surgery time is 10-12 hours. This, however, includes the time for the mastectomy.
- Breast free flap does not survive. This is a major complication but the probability is extremely low. Should this happen, your surgeon will take you back to the operating room to evaluate and salvage the flap resulting in a successful reconstruction.
- Additional scarring. There will be additional scars on your abdomen or where the tissue is taken from.