Reconstruction Procedures With a Flap
Reconstruction of the breast after a mastectomy can be done with a surgical flap instead of an implant. This is a procedure where tissue is removed from another area of the body such as the abdomen or back and moved to the breast to replace the tissue that was removed. This type of reconstruction uses the patient’s own muscle, skin and fatty tissue to reconstruct the breast instead of an implant.
There are several types of flap procedures. The TRAM flap (transverse rectus abdominus muscle) utilizes abdominal skin and muscle tissue to create new breast tissue. In some cases the tissue is completely removed from the abdomen and placed in the breast area. This type of flap, where the tissue is removed and placed in another area, is called a free flap.
Another type of procedure that utilizes abdominal tissue is the abdominal pedicle flap surgery. The tissue of the abdomen is not severed from the blood vessels that feed it, but the vessels are guided under the skin to the breast area where the tissue is then sewn into place. This type of flap, with the blood supply remaining attached to its original source, is referred to as a pedicle.
A DIEP flap (deep interior epigastic arter perforator) also uses abdominal tissue, removed and replaced in the breast area as a free flap. This procedure is unique because the removal of tissue approximates a stomach lift (tummy tuck) and does not use muscle tissue, only fat and skin.
The latissimus dorsi flap procedure uses tissue from the major muscle in the back that moves the shoulder. A pedicle flap procedure, the latissimus dorsi flap is left attached to the its blood supply and is guided into place under the skin of the chest and sewn into place.
Flap procedures are not appropriate for patients who are currently smoking, are diabetic or have any other condition that slows healing of the skin.