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, buttocks, or inner thighs 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. This is frequently referred to as a “free flap.” Or the tissue can remain attached to its original blood vessels and moved under your skin to your chest. This is often referred to as a “pedicled flap.” In both types, the tissue is formed into the shape of a breast and stitched into place.
Because pedicled flaps have been around longer and are easier to do, they tend to be more widely available. Free flaps require your plastic surgeon to have skill in microsurgery, which involves attaching the blood vessels from the tissue flap to the vessels in the chest area so that the new breast gets sufficient blood supply. Not all surgeons are trained in this type of surgery.
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 thighs is very similar to breast tissue, makes a good substitute, and can feel quite natural. But as with implant reconstruction, the new breast will have little, if any, sensation.
You may have flap reconstruction at the same time as mastectomy (immediate reconstruction), after mastectomy and other treatments (delayed reconstruction), or you might have the staged approach, which involves some reconstructive surgery being done at the same time as mastectomy and some being done after (delayed-immediate reconstruction).
In this section, you can read more about the different flap procedures. The initials in the names below refer to the specific tissue source.
Flap 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.
Flap reconstruction using tissue from your back:
- Latissimus Dorsi Flap: This approach almost always requires an implant, too, so it is not purely a flap reconstruction.
Flap reconstruction using tissue from your hip/buttocks:
Flap reconstruction using tissue from your thighs:
Multi-component/"hybrid" flap reconstruction using tissue from abdomen/hips:
Autologous breast reconstruction using fat tissue removed from your abdomen, buttocks, and/or thighs by liposuction:
The donor site for the tissue used for your flap reconstruction depends on a number of factors, including:
- Body type: If you have enough extra tissue in one place to recreate the breast, the location of that tissue can influence the type of flap reconstruction you have (such as TRAM, DIEP, GAP). 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. The latissimus flap is almost always combined with an implant. Specialized centers may be able to use multiple small flaps for one or both breasts in women who are thin and wish to avoid using implants. These stacked or “hybrid” flaps (Stacked DIEP, Body Lift Perforator, and Stacked GAP flaps) often can create enough volume for women who are very thin. They’re not widely available, however.
- Breast size: If your breasts are large, you may have to use the donor site that has the most available extra tissue. The stacked or “hybrid” techniques may be used to supply more volume when necessary. Or, a flap reconstruction could be combined with an implant.
- 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 flap 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. The TRAM flap surgery does use part of the lower abdominal muscle. The DIEP or SIEA flap using belly tissue only (no muscle) may provide a more favorable abdominal wall for pregnancy after reconstruction. Many women have gone on to have healthy, uneventful pregnancies after these surgeries. You also could use tissue from another donor site such as the buttocks or thighs.
- Hospitals and plastic surgeons in your area: Flap reconstruction requires special surgical techniques, including microsurgery to reattach the flap’s blood vessels after it is placed in the chest, and not all surgeons have experience with them. If you feel strongly about having flap 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 flap 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 and perhaps four 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.
- With all types of reconstruction (implant and flap), there is no “one and done” option: There is nearly always a later surgery to make adjustments, sometimes called “finishing work.” Examples include nipple reconstruction, reshaping a flap, removing extra fat from a donor site, or repositioning of an implant. Usually, none of these adjustments is absolutely required, so talk to your surgeon about your preferences.
- If you gain or lose weight, the size of a flap reconstruction can change along with the rest of your body. The breast(s) will get larger or smaller as your body changes.
- Flap 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.
- Once tissue is used to build a flap, tissue from that same area cannot be used again in the future.
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 Breastcancer.org Discussion Boards are a great place to find someone who's had the same type of reconstruction you're considering.
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