Breast Reconstruction With Autologous Tissue

A ‘flap’ is a term used by plastic surgeons to refer to a composite of tissue (in this case, fat, muscle and skin) with the blood vessels that nourish it. This flap of tissue is harvested, transferred to the chest and moulded into a breast shape. In women who have previously undergone implant-based reconstruction, radiotherapy or both, autologous tissue reconstruction remains the best option to reconstruct a breast. This tissue is natural, warm, soft and lasts a lifetime. It has a natural bounce, so in every way it looks and moves like a natural breast.

These are features that can never be replicated with an implant reconstruction.

Unfortunately, the flap will not have normal sensation after reconstruction. Whilst techniques are in development to allow sensory recovery, these are not yet considered reliable or in common use. Even with these techniques, the breast skin will typically remain numb, and the recovery of sensation in the breast skin is dependent on the mastectomy performed by the breast surgeon.

Pedicled latissimus dorsi or extended latissimus dorsi flap

A pedicled flap such as the latissimus dorsi or LD flap allows your plastic surgeon to reconstruct your breast utilising muscle, fat and skin from your back without the need for microsurgery. The LD muscle is isolated on its blood supply and tunnelled through your armpit into the chest. This leaves a long but fine scar on your back, hidden under your bra and is best suited to women with moderate to larger sized breasts. A silicone breast implant can be placed under the muscle when it has been moved to your chest to augment projection and shape.  

Free flap reconstruction

A ‘free’ flap is a composite of tissue which can be moved from one part of the body to another using microsurgery. Unlike a pedicled flap, the blood supply is completely detached and re-attached to microscopic sized blood vessels in the chest or armpit. This allows the plastic surgeon true freedom in tailoring the reconstruction to each individual patient.

Many options for free flap breast reconstruction exist such as the Deep Inferior Epigastric Artery Perforator flap (DIEP), muscle sparing Transverse Rectus Abdominus Muscle flap (MS-TRAM), Transverse Upper Gracilis flap (TUG) and Superior/Inferior Gluteal Artery Perforator flap (S-GAP/I-GAP).

The DIEP flap has become the gold-standard in breast reconstruction. The lower abdominal skin and fat tissue can be harvested, transferred to the chest and moulded into a breast shape. This tissue is totally natural, warm and soft. The DIEP flap feels and moves in a way that is almost identical to a natural breast. Once microsurgery has been performed, the DIEP flap has a new blood supply which makes it a living part of the body.

The DIEP flap can be performed at the time of mastectomy, or at any time after a mastectomy has been performed. The timing of the surgery will alter the scar pattern and the appearance of the reconstructed breast.

For many ladies, the use of the abdominal tissue for breast reconstruction, and the ‘tummy-tuck' style closure of the abdomen, offers a secondary benefit to the breast reconstruction process.

The DIEP flap is the best way to reconstruct one breast and create symmetry with a natural breast on the other side. Whether performed at the time of mastectomy, or down the track, the DIEP flap can simulate and match a natural breast in shape, size, and movement.

It is important that patients considering DIEP flap breast reconstruction are healthy, and at an appropriate weight. Patients with excessive BMIs or significant health problems may not be candidates for free flap due to the increased risk of wound healing problems.

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