Overview of Breast Reconstruction with Natural Tissue
In order to reconstruct the breasts after a mastectomy, most procedures use synthetic implants. But if you’re looking for more natural-looking, longer-lasting results for your breast reconstruction, breast reconstruction using your own tissue (flap procedures) may be the right choice. A tissue flap procedure takes tissue from elsewhere on your body to rebuild the breast shape.
One of two basic types of tissue flaps may be used in the procedure:
- Pedicled flaps: These flaps retain an attachment to the original blood supply.
- Free flaps: These flaps involve microsurgery to create a new blood supply.
DIEP, SIEA, SGAP, TRAM & Latissimus Dorsi Flap Breast Reconstruction
We offer five different types of flap surgery. Your surgeon will help determine the right procedure for you based on your body type and medical and surgical history.
- Deep Inferior Epigastric Perforators (DIEP) flap: Skin and fat from the abdomen are transferred to the new breast in this procedure. As the abdominal tissue is transferred to the chest wall, your surgeon will perform microsurgery to attach 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 to this type of flap surgery.
- Superior Gluteal Artery Perforator (SGAP) flap: This procedure moves tissue (excluding muscle) from the buttock and hip area to the new breast. Using microsurgery, blood vessels from the flap are connected to the vessels on the chest. This method is often recommended for patients who had defects resulting from previous breast surgery.
- Transverse Rectus Abdominus Musculocutaneous (TRAM) flap: This method of breast reconstruction moves muscle, skin, and fat from the abdomen to the new breast and can be transferred as a pedicle flap or free flap. This method is typically used for patients who are not good candidates for other free-flap reconstructions. The TRAM flap method may result in longer recovery times and a higher risk of a bulge or hernia due to the transfer of muscle from the donor site to the reconstructed breast.
- 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 the use of an implant under the flap. Most patients who have this procedure are not eligible for a DIEP, SIEA, or TRAM flap.
Planning and Recovery
You can speak to your doctor about breast reconstruction before having your mastectomy. This gives your breast surgeon and reconstructive surgeon an opportunity to work together to create a surgical strategy that is fine-tuned to your needs.
When planning your breast reconstruction, you will be presented with several surgical options and receive an explanation on the differences between each one. You will be given a recommendation based on your body type and health status.
Immediately prior to your reconstructive surgery, your surgical team will use a fluorescent imaging system called SPY Elite to help determine if your tissue is in a safe state to move forward with surgery and place an implant. The use of the SPY Elite will help lower your risk for complications after surgery.
Breast reconstruction with natural tissue is a complex surgery that may require a longer recovery period and hospital stay than your mastectomy. For a few weeks after your surgery, you may be tired and sore. Medication to control the pain and drainage tubes to remove excess fluids may be necessary for a short time.
You will have stitches after your procedure, but in most circumstances these are absorbable. Scarring may also be noticeable, but these tend to fade over time.
Many patients find they can return to normal activities after about six weeks. But don’t be discouraged if it takes your body longer. Remember, your body will be doing a lot of healing, as your reconstructed breast(s) and your donor tissue site(s) will all be healing at once.
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Frequently Asked Questions
Thanks to the Women’s Health and Cancer Rights Act (WHCRA) of 1998, all group health plans that cover mastectomies are also required to cover reconstructive procedures. In addition, breast reconstruction is covered under Medicare and in some states may also be covered by Medicaid. However, not all of your procedure cost may be covered by insurance. Contact your insurance carrier to ensure your coverage.
If you’re exploring options for insurance coverage, you may need to request a referral from your primary care doctor, depending on your health insurance plan. Check with your carrier to see if medical coverage is an option for you and, if so, whether a referral is required.
Breast reconstruction with flaps poses a number of risks. According to the American Society of Plastic Surgeons, these include: