Which Tissue Flaps Are Used During Breast Reconstruction?

Tissue flap surgery has become an excellent alternative for women who want to avoid breast implants.  In most cases, it is done soon after a mastectomy other it is becoming a popular option for women who suffer from breast development problems.  There are a lot of questions surrounding this procedure.  The most common is about what type of tissue flaps are used.  This is a major area of concern for women who are nervous about the surgery.

There are two different ways the surgery can be done.  The first is using a “pedicle flap”.  This means the flap of the tissue is moved to the chest without cutting off the original blood supply.  The tissue is normally used from the stomach or back area and moved upwards to the chest.  The second option is to use a “free flap”.  A free flap breast reconstruction uses tissue and blood vessels which have been completely removed from the surrounding area.  Once the flap is in place, the blood vessels are connected to blood vessels in the chest.  In some cases, this is considered the riskier alternative of the two.

There are four different types of tissue flaps which could be used during breast reconstruction surgery.  The first is known as a TRAM or Transverse Rectus Abdominis Muscle flap.  This utilizes tissue and muscle from the lower belly and moves it into the chest area.  An additional benefit to using a TRAM flap is it reduces the amount of fat and skin in the stomach area.  The results are often described as being similar to a tummy tuck.  This option can be used both as a pedicle and free flap.

The second option is using a Latissimus Dorsi flap and is only an option for pedicle flap surgery.  It utilizes skin, muscle, and fat from the upper back region.  All of this is pulled under the skin into the chest area.  In most cases, the scar left on the back can be aligned with the bra line to make it less noticeable.

The third type of tissue flap is the DIEP or Deep Inferior Epigastric Artery Perforator flap.  This is only an option for a free flap surgery and is similar to the TRAM flap.  The only difference is the surgeon doesn’t use any of the muscle, only the fat and skin from the lower stomach area.  This can be beneficial because saving the muscle can help avoid weak stomach muscles later on.  It also results in a tummy tuck like appearance.

The final option is a Gluteal flap which is also only a free flap.  It utilizes muscle, skin, and fat from the buttock region and is often considered the best alternative for women who do not have enough belly tissue for a DIEP or TRAM.

There are a number of tissue flap breast reconstruction surgery options to choose from.  In most cases, pedicle flaps are preferred because they do not require the surgeon to eliminating the blood vessels original blood supply.  At the same time, there are a number of situations where a free flat will prove to be more beneficial.  The key is always having a serious discussion with your board certified plastic surgeon well before the surgery date. If you are considering breast reconstruction, schedule a consultation with board-certified Houston plastic surgeon Mark. A Schusterman today.