After a mastectomy, an operation to remove breast tissue to treat or prevent breast cancer, the breast can be reconstructed through various measures. While there are multiple options for breast reconstruction following a mastectomy, one of the best options is breast reconstruction using your own tissues. As with any type of surgery, as a patient, you should take the time to thoroughly research and understand both the benefits and risks of breast-reconstruction surgery and carefully consider and discuss all options with your physician.
Autologous-tissue reconstructions usually referred to as tissue-flap procedures, are methods used to reconstruct the breast after cancer surgery using tissue from the patient’s own body. These types of procedures use tissue from other areas of the body, like your back, stomach, thighs or buttocks, to reconstruct and reshape your breast.
Tissue-flap procedures will typically appear more natural and act like your own natural breast tissue than will saline- or silicone-based breast implants. For example, implants have the potential to shrink or enlarge as you lose or gain weight. Breast implants will need to be replaced if the implant should ruptures, which can happen if you are in some sort of accident or even from routine exercise. This, of course, is not a concern with natural tissue-flap type surgeries.
Tissue-flap surgeries result in two surgical procedures and scars, the donor site where the tissue is removed from and the site of the reconstructed breast. These scars will fade over time, but do not completely disappear without some further cosmetic procedures. Some women experience donor-site issues that can include muscle damage and weakness, including abdominal hernias.
Because tissue-flap procedures require transplanted tissue to have healthy blood vessels for optional blood flow, this procedure may not be the best choice for patients who smoke, have vascular diseases or poor circulation from vascular disease, uncontrolled diabetes or connective-tissue diseases. Types of tissue-flap procedures include:
- Deep Inferior Epigastric Perforator, or DIEP, and Transverse Rectus Abdominis Muscle, or TRAM, flap surgery utilizes tissue taken from the abdomen area.
- Latissimus Dorsi Flap Surgery utilizes tissue taken from the upper-back area.
- Gluteal Artery Perforator, or GAP, flap surgery utilizes tissue taken from the buttock area.
- Transverse Upper Gracilis, or TUG, flap surgery utilizes tissue taken from the inner thigh.
TRAM-flap surgery utilizes tissue and muscle taken from both the transverse and rectus abdominis muscles. Skin, adipose tissue, or fat, and blood vessels along with one abdominal muscle are transplanted from the abdomen to the bust. While the TRAM-flap procedure can result in a tummy tuck that will tighten the lower abdomen, this surgery can also increase the risk of a hernia as it will weaken the stomach muscles. TRAM-flap procedures are not always possible in women who have had abdominal tissue removed previously or are very thin. There are two basic types of TRAM flaps:
- A pedicle-style TRAM-flap procedure leaves the flap of tissue connected to its original blood supply of arteries and veins that are rerouted under the skin and up and into the chest. This typically requires removing a large percentage of the rectus abdominis muscle on one side, increasing the risk of bulging and/or herniation on that side of the abdomen. This can also result in your stomach muscles being weaker after the surgery.
- A free TRAM-flap procedure involves taking more tissue, and typically and less muscle, from a donor site in the lower abdomen. However, here the flap of tissue is totally removed and then reattached to the chest. The blood supply is reattached directly to the chest with microsurgery, using a microscope. This procedure takes longer than a pedicle TRAM-flap procedure, but the blood supply is usually superior to pedicle flap procedures. Additionally, this procedure normally involves less risk of loss of abdominal-muscle strength and leaves the abdomen in better condition. The main risk here is that the blood vessels can sometimes become clogged, restricting blood flow to the flap.
The deep inferior epigastric perforator flap procedure does not require the use of muscle to rebuild the breast. Instead, this procedure requires the uses of skin and adipose tissue from the same donor-site area as the TRAM-flap procedure. The DIEP procedure uses a free flap of tissue removed from the abdomen and transplanted to the chest. As with the Free-TRAM procedure, microsurgery is used to reconnect the blood supply. Because no muscle is removed there tends to be much less risk of bulging or herniation. A related procedure, known as superficial inferior epigastric artery, or SIEA-flap, procedure uses essentially the same tissues as the DIEP-flap procedures, but with different blood-supply vessels.
Latissimus Dorsi Flap
The latissimus dorsi flap uses a section of skin, muscle, adipose tissue and blood vessels taken from your upper back and routes it under the skin to the chest. While this procedure is sometimes used with breast implants to create a more natural-looking breast, it can also be used without an implant. Through rare, some women may develop a weakness in their arms, shoulder or back following this procedure.
The gluteal free-flap procedure, known as GAP, uses tissue taken from the buttocks and transplanted into the chest. This option is better for women who are unable or don’t want to use the abdominal-donor sites due to things like previous abdominal procedures or stomach-muscle thinness.
The transverse upper gracilis, or TUG, flap procedure is a newer method that offers another option to women who aren’t able or willing to use either DIEP or TRAM procedures. A strip of tissue is taken starting at one of the inner thigh muscles and ending at the bottom fold of the buttocks. This procedure is best for women with small- to medium-size breasts and whose inner thighs touch each other.
Fat transfer breast augmentation, or fat grafting, is a technique that harvests fat cells via liposuction from donor sites in the abdomen, buttocks or thighs. The fat cells are transplanted by injections to reshape the reconstructed breast. Fat grafting has been used safely and effectively on cancer patients who have undergone mastectomy procedures.