Autologous Tissue Surgery

Autologous Tissue Surgery for Breast Reconstruction
Autologous breast reconstruction surgery uses tissue from your own body to recreate the breast. Also called tissue flap surgery, the new breast volume is created entirely with living tissue for a natural, long-lasting result.

There are two techniques used for positioning the tissue flap to create the new breast:

  • Pedicle flap — In this procedure tissue is moved to the chest without cutting the original blood supply, by tunneling the flap under the skin and attaching in the chest area.
     
  • Free flap — Because the tissue is cut free, the surgeon moves the flap to the chest and attaches the blood vessels in the new location.

There are a number of options for flap surgery, identified by the areas of the body that provide the tissue.

  • TRAM flap — TRAM (Transverse Rectus Abdominis Myocutaneous) uses skin, fat and rectus muscle(s) from the lower abdomen to form breast tissue. Historically the most commonly performed flap-based procedure, TRAM removes the same tissue as for an abdominoplasty (tummy-tuck), producing similar scarring and contouring as with a tummy-tuck.
     
  • GAP and TUG flap — For women with insufficient abdominal tissue for breast reconstruction, GAP (Gluteal Artery Perforator) flaps are tissue and skin taken from the buttock area, and TUG (Transverse Upper Gracilis) acquires tissue and muscle from the inner thigh, near the groin.
     
  • DIEP flap — The DIEP (Deep Inferior Epigastric Perforator) flap is similar to TRAM in that the tissue comes from the lower abdomen, but works without removing muscle. Preserving the abdominal muscles prevents weakening of the area and the chance of developing hernias. In DIEP flap surgery, very small arteries and veins are separated from the abdominal muscle for reattachment in the chest, leaving the muscle intact.

The DIEP flap has many advantages for women who are good candidates for the procedure, but can only be performed by highly trained surgeons skilled in microsurgery. Virginia Mason plastic surgeons have more than 15 years experience performing microvascular surgical procedures.

What to Expect After Autologous Breast Reconstruction Surgery
Tissue flap surgery is complex and takes many hours to complete. You may spend about five days in the hospital where special attention will be given to the blood supply and health of the transplanted breast tissue. Typically, women have soreness and swelling in the breast and in the area where tissue was removed, and you may need pain medication for one to two weeks. Women should plan on avoiding strenuous activity for several weeks, though many find they can return to light activity and work in three to six weeks.

Risks of Autologous Breast Reconstruction Surgery
In addition to the same risks as other surgery, including bleeding, poor healing or infection, other risks with tissue flap surgery include:

  • Flap or tissue death — Tissue can deteriorate if the blood supply is compromised. In this event more surgery may be needed.
  • Muscle weakness — If muscle is taken in the tissue removal, weakness at the site could result.
  • Pain — Longer term pain or discomfort may result.
  • Complicated healing — Blood or fluid can collect near the wounds.

For more information about autologous tissue breast reconstruction, call (206) 341-0564.