Free Flap Breast Reconstruction
During breast reconstruction, the breast is rebuilt using either implants or autologous tissue from the patient’s body. For the free flap approach to breast reconstruction, skin, muscle, and fat from the body are disconnected from the blood supply at the donor site and reattached to a blood supply in the recipient site. Microsurgery is then used to anastomose the blood vessels.
Breast reconstruction using autologous tissue is more expensive and invasive compared to implants, but the look and feel is more natural. Women who undergo breast reconstruction using natural tissue from their own bodies often wish to avoid the use of permanent synthetic materials.
Benefits of the free flap over the pedicled flap (flap that is transferred with its blood supply) are that it results in a superior blood flow, and there is a lower risk of fat necrosis. Depending on the flap, less muscle is often transferred in a free flap. If the blood vessels in the donor site are not of sufficient size, or if the distance between the sites is too great, a pedicled flap will be used.
Who can receive a free flap?
Women who have lost one or both breasts to cancer or other trauma may be candidates for breast reconstruction. Candidates for free flap reconstruction may demonstrate the following conditions:
- Desire to minimize muscle loss
- Do not want, or are not candidates for, implant reconstruction
- Have had failed implant reconstruction
- Have sufficient donor site tissue to create one or both breasts
- Are emotionally prepared, and have realistic expectations
What can I expect during surgery?
Breast reconstruction using autologous tissue is a major surgery that will be conducted in a hospital setting using general anesthesia.
In the deep inferior epigastric perforator (DIEP) flap approach, skin and fat (no muscle) from the abdomen, along with the deep inferior epigastric perforator artery and vein, are transferred from the donor site to create the breast mound. As in all flap surgeries, the surgeon will first mark the incision – for the DIEP this will be across your abdomen. Once the incision is made, the surgeon will then locate and disconnect the artery and vein, as well as the tissue to be transferred. Using a microscope, the flap will be reconnected at the recipient site.
For the transverse upper gracilis (TUG) flap approach, fat, skin and the gracilis muscle from the inner, upper thigh are transferred to create the new breast. The TUG flap is often used for individuals who do not have sufficient tissue in the abdominal or buttock area.
The superior gluteal artery perforator (SGAP) flap approach involves the transfer of skin and fat (no muscle) from the buttock.
The surgical steps outlined in the DIEP flap are also applied to the TUG and SGAP flaps.
What can I expect after surgery?
You can expect to recover in the hospital for the first few days after surgery so that experienced health practitioners can track your progress. The drains inserted during surgery to help prevent fluid buildup are removed after approximately 1 week. Prior to surgery you should arrange for someone to help you for the first weeks after your return home from the hospital. Recovery can be estimated to last between 4-6 weeks, though this depends on your health prior to surgery and the extent of the procedure, among other factors.
If you are interested in free flap breast reconstruction and would like to set up a consultation with one of our surgeons at our state-of-the-art facility in Kansas City, please contact us at 913-588-2000.