If you’re exploring breast reconstruction with your own tissue rather than with breast implants, you may already know about reconstruction with DIEP, TRAM and Latissimus Dorsi (Lat). These autologous (using your own tissue) flaps are reconstructive techniques that can be used to rebuild your breasts after mastectomy: a “flap” of tissue, complete with its blood supply is moved up to the chest and then shaped into a breast.
But do you also know about other tissue flap procedures that are used for breast reconstruction?
The Lat and TRAM are more traditional procedures that use skin, fat and muscle to recreate breasts: Lat uses skin, fat and muscle from the back, while TRAM uses skin, fat and muscle from the abdomen. DIEP flaps use abdominal skin and fat, but preserve muscle, which is the primary reason that DIEP is now the most commonly performed natural tissue flap to accomplish breast reconstruction, according to the American Society of Plastic Surgeons.
The abdomen is the most common tissue source for breast reconstruction, generally because most women have plenty of tissue to spare in that location. But a flap of tissue can be harvested wherever there is enough fat to build a breast, as long as the flap has a healthy and robust blood supply. Although performed less frequently and by fewer qualified surgeons than DIEP, LAT and TRAM, the following flaps are offered by some plastic surgeons as an alternative for women who don’t have enough abdominal tissue for reconstruction or the blood flow in the abdomen is compromised:
From the abdomen:
The Stacked DIEP uses fat and skin to recreate a single breast. It’s a standard DIEP flap that is either folded over or removed in two flaps which are then “stacked” on the chest; this procedure was developed for very thin women who have one breast removed and who don’t have enough tissue for flap reconstruction.
From the buttocks/upper hip:
The GAP flap uses fat and skin from the upper buttock (SGAP). A variation (IGAP) uses tissue from the lower buttock. This is a long, complex surgery, and most surgeons do not perform GAP. Those who do tend to prefer SGAP. (IGAP is rarely used since the advent of the PAP flap --see below.)
The LAP flap uses fat and skin from the “love handles”—the upper hip.
From the thigh:
The TUG flap uses skin, fat and the gracilis muscle from the upper inner thigh (also results in a thigh lift). This procedure is usually adequate for only a small to moderate-sized breast.
The PAP flap uses skin and fat from the upper thigh beneath the buttock. (The incision is hidden in the crease between the buttock and thigh.)
From the back/underarm:
The ICAP flap tunnels underarm tissue under the skin to the chest (similar to the way a LAT is performed); when used for breast reconstruction, it is usually combined with a breast implant.
The TDAP flap uses skin and fat from the back. Like the LAT flap, a section of tissue is tunneled under the skin from the back to the chest; but unlike the LAT, no muscle is sacrificed. It is usually used to augment a breast created with another type of flap or used with a breast implant.
Ask your plastic surgeon about these procedures, and be sure that you understand and integrate the side effects, risks and limitations of each into your breast reconstruction decision making.