The Breast Reconstruction Guidebook

Do you have excess fat in your tummy or buttocks? If you do, it can be used to rebuild your breasts after mastectomy. A bonus results from these surgeries: in addition to new breasts, you get a tummy tuck or reduced buttocks as well.

Tissue flap reconstruction uses your own fat, skin and sometimes muscle to create a breast. This procedure produces new breasts that look and move naturally, because they're made of your own warm tisue.

Flap reconstruction is more complex than implant reconstruction. Recovery can be more intense, because flap procedures involve surgery at the chest and the donor site; but the overall reconstruction timeline is shorter. Unlike traditional implant reconstruction with expanders, flap procedures form full-size breasts during the initial operation. Additional surgery later refines the breast shape and creates the nipples.

Breasts created from flaps need a healthy blood supply to survive; how the blood vessels are harvested defines different flap procedures.

Traditional attached flap surgeries use skin, fat and muscle from the back (latissimus dorsi flap) or the abdomen (attached TRAM flap). Skin and fat ar removed from the donor site, then tunneled under the skin to the chest and shaped into a breast. The new breast remains connected to its original blood supply (so it is "attached"). The downside to this technique is that it removes a perfectly health muscle to access the blood vessels within.

Free flaps are complete transplants. They use skin, fat, and only a small portion of muscle surrounding the blood vessels. This requires more surgical skill than implant or attached flap reconstruction. Free flaps can be taken from the abdomen (free TRAM) or the buttocks (free gluteal flap).

Perforator flaps are the gold standard of breast reconstruction. Aesthetically, a perforator flap is similar to a free flap, but instead of removing the muscle, a specially-trained surgeon works through a surgical microscope to extract the tiny blood vessels feeding the flap tissue. Fewer physicians are qualified to do this surgery. Perforator flaps are taken from the abdomen (DIEP flap), the buttock (SGAP flap from the upper buttock or IGAP flap from the lower buttock) and from the inner thigh (TUG flap).

Fewer surgeons are qualified or experienced with perforator flaps, so if you're interested in this technique, you may have to travel. Use the link below to find surgeons who perform perforator flaps.