Tissue-Based Reconstruction

Flap Surgery

Autologous or Tissue-based Breast reconstruction is often referred as “Flap Reconstruction.”

A Flap is simply tissue taken from one part of your body to another.

The most common Flap surgery performed for breast reconstruction uses tissue from your lower abdomen. This usually involves a large surgical team with plastic surgeons trained in microsurgery.

Read below for more information about Tissue-based reconstruction.

Tissue-based reconstruction has various advantages & diasvantages:

  • PROS

    • Overall more national look, feel, and movement compared to implant reconstruction

    • Tissue ‘ages’ (i.e. sags) with other areas of the body

    • Less complications if requiring radiation after surgery

    • If using abdominal tissue, get a tightened abdomen

  • CONS

    • Longer surgery time and general anesthetic

    • Longer hospital stay and recovery time compared to implant reconstruction

    • “Donor Site” scar - usually along abdomen where tissue was removed

Potential Complications:

  • Hematoma: Almost any operation carries a small risk of hematoma, or abnormal collection of blood, after surgery. Although small blood vessels that are cut during surgery are usually clipped or cauterized (burned), sometimes there can be ongoing bleeding that will collect and require a return to the operating room to drain that collection. This usually is noticed if you have an area that is rapidly swelling, becoming very tight, swollen and painful, and may have skin changes (purple discoloration).

  • Seroma: Seroma refers to a collection of fluid in a space, usually weeks to months after surgery. Sometimes with DIEP/TRAM flap reconstruction, a seroma forms at the site where the belly tissue was taken. This fluid is not dangerous, and is similar to the clear/straw coloured fluid you would see in a blister. If it is small, this will sometimes go away on it’s own. If a large seroma develops, it may need to be drained by your surgeon.

  • Fat necrosis: This means that some areas areas of the transferred tissue might not have enough blood supply or develop scar tissue. Areas of fat necrosis feel hard and lumpy. They are not dangerous, and usually improve with time and massage. Very rarely, do these areas need to be removed.

  • Partial or complete ‘flap loss:’ Sometimes, there is not sufficient blood supply from the reattached vessels, and a small area of the flap may turn dark and will need to be removed (partial flap loss). Very rarely, the blood supply to the entire flap in compromised, and the flap needs to be removed.

  • Possible return to the operating room if there are concerns with the blood supply to the tissue. The nurses monitor your flap reconstruction closely after surgery. If there are any concerns with the artery providing blood to the new breast tissue, or the vein which drains the blood from the new breast, then your surgeon will take you back to the operating room to assess the connection.

Abdominal Tissue Flap:

Many women elect to have reconstruction using tissue from their own abdomen.

Tissue that is moved from one part of your body to another is called a “Flap.”

  • This is often referred to as a T.R.A.M. (Transverse Rectus Abdominis Muscle) Flap or a D.I.E.P. (Deep Inferior Epigastric Perforator) Flap.

  • The only major difference between these two flaps is that the TRAM includes a small piece of muscle, whereas the DIEP is only skin and fat; otherwise they are essentially the same. Surgeons will try to avoid muscle resection, but the decision to move small sections of muscle will be made during the surgery.

  • In both scenarios, the blood vessels from the abdominal tissue are found and attached to blood vessels at the chest under a microscope.

Latissimus Dorsi Reconstruction

In some patients, the latissimus dorsi muscle (large muscle on your back), may be moved to your chest. Very often, an implant or tissue expander can be placed below this muscle.

This flap requires lifting the muscle, fat and skin from an area on your back and tunnelling it under your armpit to reconstruct your breast.

Other “Autologous Reconstruction” options

There are many “flaps” that can be used for breast reconstruction.

As discussed above, the DIEP or TRAM flap is the most common, and the Latissimus dorsi follows. However, if you are not a candidate, for example due to prior abdominoplasty (“Tummy Tuck”), there are often other areas of the body that may be used for flap reconstruction.