Breast reconstruction with flap surgery
Breast reconstruction with flap surgeryArticle SectionsDefinitionBreast reconstruction is a surgical procedure that restores shape to your breast after mastectomy — surgery that removes your breast to treat or prevent breast cancer. Breast reconstruction with flap surgery is a type of breast reconstruction that involves taking a section of tissue from one area of your body and relocating it to your chest to create a new breast mound. Breast reconstruction with flap surgery is a complex procedure performed by a plastic surgeon. Much of the breast reconstruction using your body's own tissue can be accomplished at the time of your mastectomy. However, you'll need a second operation to achieve a correctly positioned, natural-appearing breast or to perform nipple reconstruction. Pedicle TRAM flapIn a pedicle TRAM flap procedure, the surgeon cuts a section of skin, muscle, fat and blood vessels from your abdomen, tunnels the tissue underneath your skin to its new location, and uses it to form ...  Free TRAM flapDuring a free TRAM flap procedure, the surgeon disconnects a section of abdominal tissue — including skin, fat and sometimes muscle — from its blood supply and attaches the tissue to ...  Latissimus dorsi flapIn this flap procedure, the surgeon takes tissue from the latissimus dorsi muscle in your back, tunnels it underneath your skin to its new location and uses it to form a new breast mound. ...  RisksBreast reconstruction with flap surgery is a major procedure and carries with it the possibility of significant complications, including:
Adjuvant radiation therapy may pose complications during healing if it's given after breast reconstruction surgery. Your doctor may recommend waiting until you're finished with radiation therapy before proceeding with breast reconstruction. How you prepareBefore a mastectomy, your doctor may recommend that you meet with a plastic surgeon. Consult a plastic surgeon who's board certified and experienced in breast reconstruction following mastectomy. Ideally, your breast surgeon and the plastic surgeon will work together to develop the best surgical treatment and breast reconstruction strategy in your situation. Your plastic surgeon will describe your surgical options and may show you photos of women who have had different types of breast reconstruction. Your body type, health status and cancer treatment factor into which type of reconstruction will provide the best result. The plastic surgeon also provides information on anesthesia, where the operation will be performed and what kind of follow-up procedures may be necessary. Your plastic surgeon may recommend surgery on your opposite breast, even if it's healthy, so that it more closely matches the shape and size of your reconstructed breast. In advance of your surgery, follow your doctor's specific instructions on preparing for the procedure. This may include guidelines on eating and drinking, adjusting current medications and quitting smoking. What you can expectChances are your new breasts won't look exactly like your natural ones used to. However, the contour of your new breasts can usually be restored so that your silhouette will look similar to your silhouette before surgery. Breast reconstruction with flap surgery — using your body's own tissue to reconstruct your breast (autologous tissue reconstruction) — is the most complex reconstructive option. Your surgeon transfers a section of skin, muscle, fat and blood vessels from one part of your body to your chest to create a new breast mound. In some cases, the skin and tissue need to be augmented with a breast implant to achieve the desired breast size.
Surgical methods
Types of flap surgery
Because adequate blood supply is critical to the survival of transplanted tissue in flap surgery, your surgeon may prefer not to perform a pedicle flap procedure if you're a smoker or if you have diabetes, vascular disease or a connective tissue disorder. Also, obesity may preclude you from having a pedicle TRAM flap. In general, autologous breast reconstruction is more extensive than is a mastectomy or implant reconstruction. Flap procedures result in larger incisions that take longer to heal and may require a longer hospital stay.
Nipple reconstruction
Recovery You'll also have stitches (sutures) in place after your surgery. They'll probably be absorbable sutures, though, so you won't need to have them removed. Scarring is permanent, but the scars generally fade over time. Getting back to normal activities may take up to six weeks or more. Take it easy during this period. Your doctor will let you know of any restrictions to your activities, such as avoiding overhead lifting or strenuous physical activities. Don't be surprised if it seems to take a long time to bounce back from surgery — some women report that it takes as long as a year or two before feeling completely healed and back to normal. Generally, you'll follow up with your plastic surgeon on a yearly basis to monitor your reconstructed breast. Make an appointment sooner than that, however, if you have any concerns about your reconstruction.
Future breast cancer screening Pedicle TRAM flapIn a pedicle TRAM flap procedure, the surgeon cuts a section of skin, muscle, fat and blood vessels from your abdomen, tunnels the tissue underneath your skin to its new location, and uses it to form ... Free TRAM flapDuring a free TRAM flap procedure, the surgeon disconnects a section of abdominal tissue — including skin, fat and sometimes muscle — from its blood supply and attaches the tissue to ... Latissimus dorsi flapIn this flap procedure, the surgeon takes tissue from the latissimus dorsi muscle in your back, tunnels it underneath your skin to its new location and uses it to form a new breast mound. ... Nipple reconstructionAfter your breast has healed from reconstruction or mastectomy surgery, a plastic surgeon can reconstruct a new nipple and areola. The surgeon makes a star-shaped incision to form the new nipple and ...  ResultsKeep your expectations realistic when anticipating the outcome of your surgery. Breast reconstruction surgery offers many benefits, but it won't make you look or feel exactly like you did before your mastectomy. What breast reconstruction can do:
What breast reconstruction may do:
What breast reconstruction won't do:
RelatedLast Updated: 2010-09-03 © 1998-2013 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.com," "Mayo Clinic Health Information," "Reliable information for a healthier life" and the triple-shield Mayo logo are trademarks of Mayo Foundation for Medical Education and Research.
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