Autologous Reconstruction

Autologous reconstruction (sometimes called autogenous reconstruction) uses tissue -- skin, fat, and sometimes muscle -- from another place on your body to form a breast shape. The tissue (called a "flap") usually comes from the belly, the back, the inner thighs, or the buttocks to create the reconstructed breast.

The tissue can be completely separated from its original blood vessels and picked up and moved to its new place in your chest. Or the tissue can remain attached to its original blood vessels and moved under your skin to your chest. In both types, the tissue is formed into the shape of a breast and stitched into place.

Keeping the tissue attached to its blood vessels increases the chances that the transplanted tissue will be healthy and thrive in its new location.

Breast reconstruction using tissue from someplace else on your body is popular because it usually lasts a lifetime. Implants normally have to be replaced after 10 or 20 years. Also, the tissue on your belly, buttocks, and upper inner thighs is very similar to breast tissue, makes a good substitute, and feels very natural. But as with implant reconstruction, the new breast will have little, if any, sensation.

You may have autologous reconstruction at the same time as mastectomy (immediate reconstruction), after mastectomy and other treatments (delayed reconstruction), or you might have the two-step approach that involves some reconstructive surgery being done at the same time as mastectomy and some being done after (delayed-immediate reconstruction).

Autologous breast reconstruction using tissue from your abdomen (belly, tummy):

Many women are pleased with breast reconstruction using belly tissue because it's like having a tummy tuck to rebuild a breast.

Autologous breast reconstruction using tissue from your back:

Autologous breast reconstruction using tissue from your buttocks:

Autologous breast reconstruction using tissue from your thighs:

Autologous breast reconstruction using fat tissue removed from your abdomen, buttocks, and/or thighs by lipsuction:

The donor site for the tissue used for your autologous reconstruction depends on a number of factors, including:

  • Body type: It's best if you have enough extra tissue in one place to recreate the breast. If you're thin, you may not have enough extra tissue on your belly for a TRAM, DIEP, or SIEA flap and your doctor may recommend a GAP, TUG, PAP, or Latissimus Dorsi flap.
  • Medical/smoking history: If you smoke or have diabetes, your blood vessels may be narrow and less flexible, so your doctor may recommend a Latissimus Dorsi flap over the other procedures.
  • Breast size: If your breasts are large, you may have to use the donor site that has the most available extra tissue.
  • Whether you plan on getting pregnant: If you plan to get pregnant after your breast reconstruction, you may not be able to have a TRAM, DIEP, or SIEA flap using belly tissue because the stretching of the belly during pregnancy may put too much strain on the abdominal wall and the incision made to remove the flap tissue.
  • Hospitals and plastic surgeons in your area: Autologous reconstruction requires special surgical techniques, including microsurgery to reattach the blood vessels, and not all surgeons have experience with them. If you feel strongly about having autologous reconstruction, you may have to do some research to find the surgeons and facilities that offer what you want. Your doctor may be able to refer you to plastic surgeons who specialize in certain types of reconstruction. If you need to travel a distance for this surgery, talk to your insurance provider to make sure you’re covered.

Things to know about autologous reconstruction: The physical effects of each type of autologous reconstruction are highly individual to your body, your range of motion, your physical strength, and your normal day-to-day activities.

  • Remember that while you’re healing from surgery, there will be at least two areas of the body that are healing at the same time – your reconstructed breast(s) and the donor tissue site(s), depending on whether one or both breasts are being reconstructed at the same time. Some women may also have a sentinel node biopsy or axillary node dissection at the same time, which means an additional incision.
  • If you gain or lose weight, the size of an autologous tissue reconstruction can change along with the rest of your body.
  • Autologous reconstructions tolerate radiation therapy better than implants alone do. If radiation is part of your treatment plan, make sure to discuss this with your plastic surgeon.

You might find it helpful to talk to someone who had the type of reconstruction you want about her decision process, her doctors, and her satisfaction with the results. The Discussion Boards is a great place to find someone who's had the same type of reconstruction you're considering.

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