RECONSTRUCTION WITH TISSUE FLAPS

The breast can also be reconstructed by surgically moving a section of skin, fat and muscle from one area of your body to another. The section of tissue may be taken from such areas as your abdomen, upper back, upper hip, or buttocks. The reconstructed breast may be made from the tissue flap alone, or from the tissue flap plus a breast implant. The tissue flap may be left attached to the blood supply and moved to the breast area through a tunnel under the skin (a pedicled flap), or it may be removed completely and reattached to the breast area by microsurgical techniques (a free flap). Operating time is generally longer with free flaps, because of the microsurgical requirements.

Flap surgery is a major operation. It requires a hospital stay of several days, and a longer recovery time than implant reconstruction. Flap surgery also creates scars at the site where the flap was taken, and possibly additional scars on the reconstructed breast. However, flap surgery has the advantage of being able to replace tissue in the chest area. This may be useful when the chest tissues have been damaged and are not suitable for tissue expansion, when extra tissue is desired to recreate a large breast without a breast implant, or when extra tissue coverage is needed over a breast implant.

Reconstruction With Tissue Flaps

The most common types of tissue flaps are the TRAM flap, from the abdomen, and the Latissimus dorsi flap, from the upper back. These flaps are discussed in more detail on the following pages.

Who is a Candidate for Tissue Flap Surgery?

If the remaining tissues on your chest are insufficient or inadequate to allow breast reconstruction with a tissue expander, you may be a good candidate for flap surgery. It is important for you to be aware that flap surgery, particularly the TRAM flap, is a major operation, more extensive than your mastectomy. It requires good general health and strong emotional motivation. If you are very overweight, smoke cigarettes, have had previous surgery at the flap site, or have any circulatory problems, you may not be a good candidate for a tissue flap procedure. Also, if you are very thin, you may not have enough tissue in your abdomen or back to create a breast with this method.

The TRAM Flap (Pedicle or Free)

During a TRAM flap (transverse abdominus musculocutaneous flap) procedure, the surgeon removes a section of tissue from your abdomen and moves it to your chest to reconstruct the breast. The TRAM flap is sometimes referred to as a "tummy tuck" reconstruction, because it may leave the stomach area flatter.

A pedicle TRAM flap procedure typically takes three to six hours of surgery under anesthesia, a free TRAM flap procedure generally takes longer. The TRAM procedure may require a blood transfusion. Typically, the hospital stay is two to five days. You can resume daily activity after six to eight weeks, however some women report that it takes up to one year to resume a normal lifestyle. You may have temporary or permanent muscle weakness in the abdominal area. If you are considering pregnancy after your reconstruction, you should discuss this with your surgeon. You will have a large scar on your abdomen, and may also have additional scars on your reconstructed breast.

The Latissimus Dorsi Flap

During a Latissimus dorsi flap procedure, the surgeon moves a section of tissue from your back to your chest to reconstruct the breast. Because the Latissimus dorsi flap is usually thinner and smaller than the TRAM flap, an implant may be used under the flap to provide more volume and shape to the reconstructed breast.

The Latissimus dorsi flap procedure typically takes two to four hours of surgery under anesthesia. Typically, the hospital stay is two to three days. You can resume daily activity after two to three weeks. You may have some temporary or permanent muscle weakness and difficulty with movement in your back and shoulder. You will have a scar on your back which can usually be hidden in the bra line. You may also have additional scars on your reconstructed breast.