Royal Belgian Society

Flap reconstruction

Different types:

TRAM flap

In the approach of a TRAM-flap (transverse rectus abdominis myocutaneous), abdominal muscle, tissue, skin, and fat are used to create breast shape. Since patient's own body tissue is used, the result is a very natural breast reconstruction. Also, the patient will have the benefit of a flatter looking abdomen. The scar on the abdomen is low and extends from hip to hip. The TRAM flap can be used for reconstructing one or both breasts.

In a patient undergoing unilateral reconstruction, the TRAM flap can potentially offer better symmetry than using an implant. 


Hospital stay: five to seven days

Recovery time: several months

 

You are an ideal candidate if you:

  • desire reconstruction using your own tissue
  • do not want or are not a candidate for implant reconstruction
  • have enough lower abdominal wall tissue to create one or both breasts
  • have not had prior abdominal surgery
  • have previously had chest wall radiation
  • have had failed implant reconstruction
  • are having immediate reconstruction at the time of skin-sparing mastectomy
  • are having delayed reconstruction following prior mastectomy.

 

 

 

 

Abdominal free flap

With the advances in mircosurgery over the last decade, there are several new procedures available including the DIEP flap (deep inferior epigastric perforator), the SIEA flap (superficial inferior epigastric artery) and the TRAM free flap.

These microsurgical procedures can provide women with a very natural breast reconstruction when using abdominal
tissue. Because these procedures do not use the actual abdominal muscle or only a portion of the abdominal muscle, they may allow for results with fewer donor site complications. Ultimately, the final choice of flap depends on the patient's anatomy.

These are lengthier procedures with potential for other complications. As such, these procedures should only be performed by plastic surgeons who perform microsurgery regularly and in institutions with experience in monitoring these flaps.

Hospital stay: five to seven days

Recovery time: one to three months

Latissimus Dorsi flap

The latissimus dorsi flap is most commonly combined with a tissue expander or implant to give the surgeon additional options and more control over the aesthetic appearance of the reconstructed breast. At the time of breast reconstruction, the muscle flap, with or without attached skin, is elevated off of the back and brought around to the front of the chest wall. This flap provides a source of soft tissue that can help create a more natural looking breast shape
compared to an implant alone. Depending on the patient, the scar from the LD flap donor site on the back can be placed diagonally or horizontally. This scar can often be concealed under a bra strap.

 

Hospital stay: three to seven days

Recovery time: several weeks

 

You are an ideal candidate if you:

  • are thin with small breast volume
  • have excess back tissue
  • have had previous radiation and are having an implant reconstruction
  • are not a candidate for other autogenous procedures involving your own tissue
  • are having a partial breast reconstruction to correct a lumpectomy defect
  • have thin skin that requires extra coverage for an implant
  • desire a more natural appearance than that of an implant alone.

Alternative flaps

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