Tissue Flap Surgery for Breast Reconstruction

Surgery Overview

Tissue flap surgery is a way to rebuild the shape of a breast using skin, fat, and possibly muscle from another part of the body. It is usually done after part or all of the breast is removed (mastectomy) because of cancer. It may also be done for people who have problems with breast development.

You will likely need more than one surgery. The first surgery may be done during the mastectomy, or it may be done later as a separate procedure. The nipple and the darker area around it (areola) are created at a later time.

Your breasts will look different after surgery. Your new breast may be more firm, round, or flat than your other breast. It may also not feel the same as the breast that was removed. But over time, you may get some feeling in your new breast.

Types of tissue flap surgery

Tissue flap surgery may be done in two ways:

• "Pedicle flap" means that a flap of tissue from the back or belly is moved to the chest without cutting its original blood supply. The tissue is pulled under the skin up to the chest area and attached.
• "Free flap" means that the tissue and blood vessels are cut. After the flap is in place, the surgeon sews the blood vessels in the flap to blood vessels in the chest area. This requires careful surgery by a surgeon who does microsurgery.

Here are some of the different types of tissue flap surgery, named for the area of the body where the tissue is taken.

• TRAM (transverse rectus abdominis muscle) flap is one of the most common types of flap surgery. The surgeon takes muscle and tissue from the lower belly and moves it to the chest area. This reduces the amount of fat and skin in the lower belly and results in a "tummy tuck." TRAM may be done as either a pedicle flap or a free flap.
• Latissimus dorsi (LD) flap is a type of pedicle flap surgery. It uses muscle, fat, and skin from the upper back that is pulled under the skin to the chest area. The scar on the back can be placed at the bra line to make it less visible. Sometimes an implant is placed during the same surgery to make the breast larger.
• DIEP (deep inferior epigastric artery perforator) flap is a free flap similar to TRAM. The surgeon takes fat and skin from the lower belly area but doesn't use the muscle. By saving the muscle, it helps avoid later belly weakness. Like TRAM, it results in a "tummy tuck."
• SIEA (superficial inferior epigastric artery) flap is similar to the DIEP flap. But with this surgery, the surgeon doesn't cut through the belly muscles to get the artery used for the new breast. Like DIEP, it results in a "tummy tuck."
• Gluteal free flap is a free flap that uses muscle, fat, and skin from the buttocks to create a new breast. This may be a good choice for thin people who don't have enough belly tissue for DIEP or TRAM.
• TUG (transverse upper gracilis) flap is a free flap that uses tissue from the inner upper thigh to create a new breast. The scars are hidden inside the thigh and groin. Using the gracilis muscle from the thigh doesn't leave the leg weaker. This may be a good choice for someone who has small breasts and little belly tissue.

Another type of breast reconstruction uses just fat to create a new breast. It is called autologous fat transfer or fat grafting. Unlike tissue flap surgery, this procedure uses liposuction to remove fat from your body (often from the belly or buttocks). Then the fat cells are injected into the chest wall to create a new breast mound.

What To Expect

When you wake up from surgery, you will have bandages over the surgery sites, and you may wear a special bra that holds your bandages in place. You will also have drainage tubes to collect fluid and keep it from building up around the surgery sites.

You will stay in the hospital about 5 days so your doctor can be sure there is good blood supply to the skin over the reconstruction. A physical therapist may show you exercises while you are still in the hospital. These can help keep your shoulder from getting stiff.

Most people have soreness, redness, and swelling in the breast and the area where the tissue was taken. The swelling may last for several weeks. You may need pain medicine for a week or two. Your doctor may also prescribe antibiotics to help prevent infection.

You may be able to go back to work or your normal routine in 6 to 9 weeks. Most people need to avoid strenuous activity for several weeks.

Why It Is Done

Tissue flap surgery is usually done to restore the appearance of a breast after mastectomy. It may also be done for women who have problems with breast development.

Breast reconstruction may help a woman feel better about her appearance. Some women say it helps them feel better about their bodies, more alive, feminine, and sexual—and happier about life.

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How Well It Works

Most women who have tissue flap surgery are happy with the results. Compared to breast reconstruction with implants, tissue flap procedures require a longer surgery and recovery time but result in a more natural-looking breast.

Breast reconstruction cannot restore normal feeling to your breast, but with time, some feeling may return.

Risks

Many of the risks associated with breast reconstruction are the same as those with any surgery: infection, poor wound healing, bleeding, or a reaction to the anesthesia used in surgery.

Other risks associated with tissue flap surgery include:

• Tissue death if blood supply to the flap is not restored. This could cause the need for more surgery.
• Collection of blood or clear fluid in the wound.
• Ongoing pain or discomfort in the breast area.
• Muscle weakness in the area where muscle is removed.
• Abnormal scarring.

Some women are at higher risk for problems, so tissue flap surgery may not be a good choice for them. This includes women who:

• Are obese.
• Have high blood pressure.
• Have diabetes.
• Smoke.
• Are in poor health.