Breast reconstruction using your own tissue

Breast reconstruction using your own tissue involves transferring a flap of skin, fat and sometimes muscle from another part of your body (the donor site) to your chest wall to create a breast shape. Flap reconstruction can be used to create a new breast after a mastectomy, or to replace breast tissue that has been taken away during a lumpectomy (wide local excision). Breast reconstruction using tissue from someplace else on your body is popular because it usually lasts a lifetime.

The flap is usually taken from either your back or tummy (abdomen). Some types of reconstruction use both a flap of tissue and an implant to help give the right shape, especially if a larger breast is being reconstructed. Because the skin used is taken from another area of the body, it may be a slightly different shade or texture from the rest of the breast. This method is particularly suitable for creating a moderate to large-sized breast and one that has a natural droop.

Flap surgery is commonly used when women:

Have had or need radiotherapy as part of their treatment

Can’t have an implant or tissue expansion because their chest skin and muscle is too tight, or because a lot of skin and muscle has been removed from the breast

Have large or droopy breasts and don’t want to make their breasts smaller

Don’t want a breast implant

This type of surgery involves a longer operation and more recovery time than an implant-only reconstruction. But you will be less likely to need further surgery in the future than with reconstruction using implants alone. A reconstructed breast using tissue instead of an implant may also provide a better match with your other breast in the long term. This is because tissue reacts to gravity, aging and weight change more naturally.

Advantages

Gives a more natural shape and feel to the reconstructed breast.

Suitable for small and large breasts.

Can create a breast with a more natural droop.

Can often avoid the need for an implant.

Disadvantages

The operation will leave a scar on the part of your body that the tissue flap was taken from, and an oval patch of skin on the reconstructed breast. Because this patch of skin has come from a different part of your body, it may be a different texture and color from the breast skin.

It involves having surgery to an additional part of your body.

You’ll have a longer operation, hospital stay and recovery.

Reconstructed breasts have little or no sensation (they feel numb).

TYPES OF OWN TISSUE RECONSTRUCTION

There are two ways in which surgery involving a tissue flap may be done:

Pedicled flap

The flap remains attached to its blood vessels at one end.

Free flap

The flap is completely detached from the body along with its blood vessels and re-attached in the position of the reconstructed breast.

The type of operation is usually referred to by the initials of the area of the body from where the tissue is taken, for example the name of the muscle used. The most common types of flap surgery are:

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TRAM

Transverse rectus abdominis muscle (from the lower abdomen)

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DIEP

Deep inferior epigastric perforator (from the lower abdomen)

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LD

Latissimus dorsi (from the back)

RADIOTHERAPY AFTER RECONSTRUCTION USING YOUR OWN TISSUE

There is a risk that radiotherapy may shrink or harden the tissue used to form the new breast and affect how the breast looks. So if your doctors think you may need radiotherapy after a mastectomy, they may suggest you have a delayed breast reconstruction.