A flap procedure is a type of breast reconstruction surgery. It is used to restore the shape of the breast after mastectomy. Mastectomy is a procedure that removes the breast as a treatment for breast cancer.
A flap procedure is an alternative to using breast implants. It replaces breast tissue with tissue from another area of the body, such as the abdomen. Many women think that flap procedures provide a more natural appearance than implants. However, there are increased risks associated with flap surgery.
These risks include:
- hernia where the tissue was removed
- loss of sensation at the donor site
- changes of sensation in the breast
- necrosis, or tissue death, in the breast
Three types of tissue flap can be used to reconstruct the breast:
- A TRAM flap uses skin, fatty tissue, and muscle from the lower abdomen.
- A latissimus dorsi flap uses skin and muscle from the back.
- A DIEP flap uses the abdominal blood supply, fat, and skin, but preserves the muscle.
The tissue flaps are moved into place on the chest wall using one of two techniques:
In a rotation-flap procedure, the tissue flap is left attached to its original blood supply at one end. The free end is tunneled under the skin. It is then rotated into position on the chest wall.
In a free-flap procedure, the tissue flap is completely disconnected from its original blood supply. It is reconnected to an existing blood supply in the chest using microsurgery.
Once the tissue flap has been positioned, the surgeon shapes it into the contour of a breast. The shape may need to be refined with additional surgeries.
Breast reconstruction can be performed in conjunction with your mastectomy, if you do not require radiation. If radiation is necessary, reconstruction should be postponed until several months after your last treatment. This will allow any side effects to become clear. Radiation can cause tissue deformation and hardening. It may make you unsuitable for a flap procedure.
Your surgeon may suggest implanting a tissue expander at the time of your mastectomy. This stretches the skin. The expander makes it it easier to perform reconstructive surgery when you are ready.
Discuss all of your surgical options with your doctor.
Breast reconstruction with tissue flaps carries the same risks as any surgery. These include bleeding and infection. However, this surgery also presents unique wound healing challenges. TRAM flaps and latissimus dorsi flaps remove muscle from the abdomen or back.
This poses a risk of:
- postoperative hernia
- abdominal bulging
In an interview with Healthline, Dr. David S. Goldberg emphasized the importance of selecting the right surgeon and the right hospital. Doing so can reduce complications and maximize your results.
Dr. Goldberg, a plastic surgeon from Monterey, CA, said, “It is critical to find a breast center that specializes in this technique. You’re not just choosing a plastic surgeon. You need a multidisciplinary team that includes a plastic surgeon, oncologist, and radiologist. They must be used to working together. That will give you the best chance for a good outcome.” (D.S. Goldberg, personal communication, July 18, 2012)
Using your own tissue can result in a cosmetically appealing breast. The size, fullness, and shape of the new breast can be closely matched to your other breast. However, your breast will not look or feel the same as it did before surgery.
“Flap procedures produce the most elegant and sophisticated results,” said Dr. Goldberg. “They are considered the gold standard of breast reconstruction.” (D.S. Goldberg, personal communication, July 18, 2012)
Surgeons continue to refine their techniques and materials. Progress has led to better options and more natural results. One of the most promising new techniques is autologous fat grafting. This technique uses modified liposuction techniques. It transfers fat stem cells from where you don’t need them and puts them in the breast.
This technique is already in use to add fullness and correct defects in reconstructed breasts. According to Dr. Goldberg, surgeons may soon be able to use it to reconstruct an entire breast. (D.S. Goldberg, personal communication, July 20, 2012)