• Breast Microvascular Surgery

    Using your own tissue to make a "living implant"

    In an autologous reconstruction, your plastic surgeon uses living tissue from elsewhere in your body to create a breast rather than using an implant. Autologous techniques offer important advantages, but can be more complex.

    Our surgeons are skilled in the most advanced autologous techniques and will advise you about the benefits and disadvantages so that you can choose the path most appropriate for your situation. The technique we recommend will depend on your health, the amount of extra tissue and its location in your body, and other factors.

    Autologous transplants usually require more time in the operating room and more time under anesthesia. They can also require more time recovering in the hospital and at home, because we must do surgery on two areas of your body.

    On the other hand, autologous tissue has a lower risk for infection than an implant, and can be especially effective if you have had or will have radiation to the chest. In fact, healthy, non-radiated tissue from your own body can actually improve the health of an area that has been treated with radiation. Implants tend to have more problems, such as infection or exposure, when placed in an area that has been treated with radiation.

    Pedicled flap

    The body tissue we use to create your new breast is called the “flap.” If a surgeon can use tissue adjacent to your breast for the flap, leaving it partly connected to its original location and blood supply, we call it a “pedicled flap.” Pedicled flaps use a technique called “tunneling.” This means the tissue remains connected to its main blood supply, and is delivered through a tunnel to the breast pocket — the same pocket a breast implant would use. There are two types of pedicled flaps; TRAM and latissimus dorsi flaps.

    TRAM flap

    The TRAM (transverse rectus abdominis) flap involves the creation of a new breast mound using skin, fat and muscle taken from the abdominal region between the waist and the pubic bone. The TRAM typically makes an attractive, long-lasting and natural-looking breast.

    To be a candidate for a TRAM flap, you must be generally healthy and you must have enough lower abdominal skin and fat to make a reasonably sized breast. If you have had a tummy tuck or other abdominal surgery, you may not be a candidate for a TRAM flap. The operation typically takes two to three hours per breast and several days in the hospital, followed by a week or more of recovery at home. Because muscle that supports the abdomen is removed, this procedure carries some risk of abdominal hernia, bulge or weakness.

    Latissimus dorsi flap

    The position of the Latissimus dorsi muscle (the muscle that runs along the back to the armpit) and surrounding tissue can be ideal in breast reconstruction because the skin retains the natural consistency and feel of normal tissue, while providing enough tissue to create the new breast mound — especially when combined with a small implant. The scar on the back can usually be positioned so that your bra or bathing suit will cover it.

    The Latissimus dorsi flap procedure usually takes two to three hours in the operating room and one to three days in the hospital. Most women do not experience any long-term reduction in strength from the loss of this muscle, as other muscles in the region tend to become stronger. Unlike a TRAM flap, the Latissimus dorsi flap produces no risk of hernia development. We advise a period of strength and motion training with a therapist. The therapist can show you how to rebuild strength, and you can complete the training at home.