Breast Reconstruction with Tissue Flaps

Tissue Flap Procedures

Breast reconstruction can also be done by using muscular flaps. Advances in microsurgery have led to the use of muscles to reconstruct and repair various parts of the body. Today, these muscle flaps are frequently used to reconstruct the breast.

The tissue flaps used to reconstruct the breast include:

TRAM Flap (transverse rectus abdominus muscle)

The TRAM flap procedure uses the muscle from the upper abdomen. This long muscle from the abdomen is carefully prepared and along with its own blood supply is transposed on to the breast area. The muscle is then folded in a creative way to create a breast mound. The TRAM flap can be used in two distinct ways to create the new breast.

? Pedicle flap. The flap is carefully dissected and its blood supply is preserved intact. it is carefully tunneled to the breast area leaving the blood supply intact

? Free flap. Sometimes the muscle flap is under too much tension and cannot be pulled to the breast area. In this scenario, the muscle is cut away from its blood supply and then re-attached to some blood vessels in the breast area. Delicate microsurgery is required to perform this type of surgery. Free flaps usually take slightly longer to perform. The aesthetic results from either flap are just about the same

Latissimus Dorsi Flap

The next most popular muscle flap used to create the breast is the muscle from the lateral chest wall. This powerful muscle used by swimmers is strong and widely used in surgery. It has its own blood supply and can be easily transposed to the chest area. Its major disadvantage is that when removed, most individuals complain of weakness in the arm and back area on that side

DIEP (deep inferior epigastric artery perforator) Flap

In some individuals neither the TRAM nor the latissimus dorsi flap is available and a flap from the lower abdominal muscles is used. This muscle is used as a free flap. The muscle together with its blood supply is detached from the groin area and then reconnected to a new blood supply on the chest wall. The procedure does take time to perform but the results are pleasing.

Gluteal Free Flap

Sometimes the muscles from the buttocks are also utilized to create a new breast. This muscle is an option for women who have no abdominal muscles or who have had previous abdominal surgery. The procedure is similar to the above flaps. The free flap is obtained and then reconstructed on the chest wall and connected to a new set of blood vessel using a microscope

When tissue flaps are used to reconstruct the breast, the surgery is always longer than that for breast implants. The surgery also leaves two major scars - one from where the muscle is obtained and other scar on the breast. The scars are a permanent reminder of what the individuals has been through. Muscle flap surgery is also fraught with more complications than breast implants. Sometimes the flaps fail to take and the muscle or the skin may die or get damaged. Muscle flaps are also difficult to use in those individuals with disease of their blood vessels like smokers, diabetics and in those who have vascular disease.

In most cases, tissue flaps are not the first choice of surgery. Women prefer breast implants but when breast implants are not an option; the other remaining options are no reconstruction or a tissue flap.