Tissue-Based Breast Reconstruction

The University of Kansas Health System offers tissue-based, or “flap,” breast reconstruction for women in Kansas City who want to create their new breasts using their own tissue. This approach uses skin, muscle and fat from the body to sculpt and shape new breasts that look and feel very natural.

There are several types of tissue-based breast reconstruction. Choosing the best option for your needs requires a thorough evaluation.

Tissue-based reconstruction vs. breast implants

Breast reconstruction using your own tissue has advantages and drawbacks. Compared to implant-based breast reconstruction, using your own tissue:

  • Is a more complex and invasive procedure
  • Requires a longer recovery time and hospital stay
  • Is costlier than breast implants

However, the results of tissue-based reconstruction often look and feel more natural. Plus, because you are not putting a synthetic object in your body, you avoid the risk of implant-related complications like capsular contracture. Tissue-based breast reconstruction also has a lower risk of complications for patients who need radiation.

Types of tissue-based reconstruction

Tissue-based reconstruction can be performed in 2 ways.

  • Free-flap. Free-flap reconstruction involves cutting some of the blood vessels during surgery, but keeping others intact. This results in better blood flow and a lower risk of fat necrosis. Depending on the type of surgery, less muscle may also be used during a free-flap procedure, which helps speed recovery.
  • Pedicle-flap. When the donor flap is transferred with its existing blood supply, this is called the pedicle-flap approach. This technique is common in patients whose donor site is not sufficient in size, or the distance between the donor sites is too great.

Your surgeon will help you determine which approach is best for you. You will also decide where tissue will be taken from your body to create your new breasts. Your options include the back, buttocks, stomach or thighs.
Depending on your specific condition and body type, your surgeon may recommend one of the following:

Abdominal

  • Deep inferior epigastric perforator (DIEP): This procedure removes skin and fat (no muscle) from the abdomen to create a new breast mound. Leaving the muscle unharmed allows you to maintain core strength.
  • Transverse rectus abdominis muscle (TRAM) flap: The TRAM flap procedure is like the DIEP procedure except it includes removing a small part of the abdominal muscle. This can be done using a pedicle- or free-flap approach.
  • Superficial inferior epigastric artery (SIEA) flap: Like the DIEP procedure, the SIEA flap approach uses only skin and fat from the lower abdomen. However, the blood vessels used during SIEA do not require an incision through the abdominal muscles, which allows for better comfort after surgery.

Back

  • Latissimus dorsi flap: This method moves skin, fat and muscle from your upper back to your chest. This technique can be used with or without breast implants.

Buttocks

  • Superior gluteal artery perforator flap: This involves the transfer of skin and fat (no muscle) from the top of the buttocks to the breast. This procedure is often beneficial for patients who don’t have enough skin or tissue in the abdomen.

Thigh

  • Transverse upper gracilis (TUG) flap: Skin, fat and muscle from the inner, upper thigh are transferred to create the new breast. The TUG flap can be used for people who do not have sufficient tissue in the abdominal or buttock area.
  • Profunda artery perforator (PAP) flap: This procedure uses fat and skin from the upper thigh, underneath the buttock crease, for breast reconstruction. Using this area helps minimize the appearance of scars, as incisions are hidden in the buttock crease.

Am I a candidate?

Women who have lost 1 or both breasts to cancer or other trauma may be candidates for breast reconstruction. Those who are good candidates for tissue-based reconstruction are those who:

  • 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 1 or both breasts
  • Are emotionally prepared and have realistic expectations

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 last 4-6 weeks, depending on your health prior to surgery and the extent of the procedure.

If you are interested in tissue-based breast reconstruction and would like to schedule a consultation with one of our surgeons in Kansas City, please contact us.