Breast Reconstruction Using Your Own Tissues (Flap Procedures)

illustration depicting a free flap in which the tissue is cut free from its original location and reattached in the chest area

DIEP flap

The DIEP (deep inferior epigastric perforator) flap uses fat and skin from the same area as the TRAM flap but does not use the muscle to form the breast shape. This method uses a free flap, meaning that the tissue is completely cut free from the tummy and then moved to the chest. As in the free TRAM surgery, a microscope is needed to connect the tiny blood vessels. There’s less risk of a bulge or hernia because no muscle is taken. A related procedure, known as a SIEA (superficial inferior epigastric artery) flap, uses basically the same tissues but different blood vessels. 

illustration showing the donor site for a DIEP flap, flap with skin, fat and blood vessels and the postoperative appearance with flap in place

Latissimus dorsi flap

The latissimus dorsi flap is often used along with a breast implant. For this procedure, the surgeon tunnels muscle, fat, skin, and blood vessels from your upper back, under the skin to the front of the chest. This provides added coverage over an implant and makes a more natural-looking breast than just an implant alone. This type of reconstruction can sometimes be used without an implant. . Rarely, some women can have weakness in their back, shoulder, or arm after this surgery. 

illustration showing the latissimus dorsi muscle and the skin and muscle removed for LAT flap. also shows the implant under muscle in the breast, the flap in position and the postoperative appearance

Gluteal free flap (GAP flap)

The gluteal free flap or GAP flap is a type of reconstruction surgery that uses tissue from the buttocks to create the breast shape. The gluteal free flap might be an option for women who cannot or do not wish to use the tummy sites due to thinness, previous incisions, failed tummy flap, or other reasons, but it’s not offered at all surgical centers. The method is much like the free TRAM flap mentioned above, except no muscle is taken. The skin, fat, and blood vessels are cut out of the buttocks and then moved to the chest.

illustration showing the donor site of a GAP flap and the postoperative appearance with flap in position

Inner thigh or TUG flap

A newer option for women who can’t or don’t want to use TRAM or DIEP flaps is a surgery that uses muscle and fatty tissue from along the bottom fold of the buttock extending to the inner thigh. This is called the transverse upper gracilis flap or TUG flap, and it’s only available in some medical centers. The skin, muscle, and blood vessels are cut out and moved to the chest, and the tiny blood vessels are connected to their new blood supply.

Women with thin thighs don’t have much tissue here, so the best candidates for this type of surgery are women whose inner thighs touch and who need a smaller or medium-sized breast. If you have larger breasts, you might need a breast implant as well. Sometimes the location of the donor site causes healing problems , but they tend to be minor and easily treated.

illustration showing the donor site (gracilis muscle), the flap with skin, fat, a piece of muscle and blood vessels and the postoperative appearance with flap in position

Fat grafting

A newer technique can take a person’s fat from one part of the body (buttocks, thighs, or abdomen) and transfer it to the reconstructed breast to help fix any shape abnormalities that may be seen after the initial breast reconstruction surgery is done. The fat is obtained by liposuction, cleaned and then dissolved so it can be injected easily into the areas it is needed. This procedure has been found to be safe as far as cancer recurrence in patients who have had mastectomies.

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Last Medical Review: June 1, 2016 Last Revised: August 18, 2016

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