Breast Reconstruction with Natural Tissue

Types of flap surgery

When it comes to performing natural tissue breast reconstruction, we use one of two basic types of tissue flaps:

• Pedicled flaps relocate tissue from another part of the body to the breast while remaining attached to its original blood supply.
• Free flap breast reconstruction involves microsurgery to move the tissue from one area of the body to the breast, requiring the tissue to be reconnected to a new blood supply.

We offer seven different types of flap surgery that take tissue from various parts of your body. Many of these procedures require microsurgery, which is surgery performed under a microscope. Your surgeon will help determine the right procedure for you based on your body type and medical and surgical history.

Abdominal flaps

Deep Inferior Epigastric Perforators (DIEP) flap: Your surgeon will transfer skin and fat from the abdomen to the new, reconstructed breast in this procedure. Because the abdominal tissue is transferred to the chest wall, your surgeon will perform microsurgery to reattach the blood vessels.

Superficial Inferior Epigastric Artery (SIEA) flap: As with the DIEP flap, the SIEA flap involves the transfer of skin and fatty tissue from the abdomen to the breast. The SIEA method uses blood vessels that aren’t as deep within the abdomen, making the procedure less invasive, but not all patients’ blood vessels are suited for this type of flap surgery.

Transverse Rectus Abdominus Musculocutaneous (TRAM) flap: This method of breast reconstruction moves muscle, skin, and fat from the abdomen to the new breast using a pedicle flap or free flap. This flap may be a good option for those who are not good candidates for other free-flap reconstructions. However, the TRAM flap method may result in longer recovery times and a higher risk of a bulge or hernia due to the transferring of muscle from the donor site to the reconstructed breast.
Buttock flaps

Superior Gluteal Artery Perforator (SGAP) flap: This procedure moves tissue (excluding muscle) from the buttock and hip area to the new breast. Then, our reconstructive surgeons use microsurgery to connect the blood vessels from the flap to the vessels on the chest. We often recommend this method for patients with defects resulting from previous breast surgery.
Back flaps

Latissimus Dorsi flap: This procedure takes skin, fat, and muscle from the latissimus dorsi, a large muscle found on your back, just below your shoulder and behind your armpit. The flap remains attached to its original blood supply in your back. The flap from this procedure may not be large enough to create a breast, necessitating an implant under the flap. Most patients who have this procedure are not eligible for a DIEP, SIEA, or TRAM flap.
Thigh flaps

Transverse Upper Gracilis (TUG) flap: A TUG flap may be an appropriate option for women who may not be a candidate for using abdominal tissue to reconstruct breasts after breast cancer. This procedure uses fat, skin, and a small piece of muscle tissue from the inner thigh (gracilis muscle) to rebuild the breast. TUG flap reconstruction offers a variety of advantages for women, including a more naturally contoured breast and the options for immediate nipple reconstruction. There is no risk of hernia or bulging following the procedure, unlike the TRAM flap. However, lower leg swelling is possible.

Profunda Artery Perforator (PAP) flap: A muscle-sparing procedure, this procedure uses a blood vessel that runs through the thigh, as well as fat and skin from the back of the upper thigh, to add volume to a reconstructed breast. Then, we carefully reattach blood vessels from the PAP to the blood vessels in your chest using microsurgery. This flap tends to work well for women with naturally small-to-medium-sized breasts, but some women may need a breast implant to achieve their desired size.