Reconstruction Using Your Own Tissue (Autologous)

Many tissues from the body can be used to rebuild the breast after mastectomy.  The best body location to take tissue from depends on your body shape. The goal is to move tissue (skin & fat) from body locations that have excess, and will have cosmetically acceptable scars.

Body Locations

Abdomen - DIEP and SIEA Flap Procedure

Both the DIEP and SIEA flaps use abdominal skin and fat from the lower part of the abdomen. The difference between the two is the choice of blood vessels that nourish the flap tissue.

In the DIEP flap, only the skin and fat tissue are taken from the donor site.  The muscle itself is not used and therefore this procedure is significantly less invasive than earlier methods of breast reconstruction.

The blood vessels of the SIEA flap are more superficial, and therefore, less dissection is required than in the DIEP flap.   The decision as to which flap is performed is based on whether or not a patient has these vessels, which is not know until the surgery is underway.

Once the abdominal tissue is safely detached from the abdomen it is re-attached to the small blood vessels in the breast area, resulting in a microsurgical tissue transfer. A small piece of cartilage on the third rib is removed to allow access to the blood vessels on your chest that the abdominal flap will be connected to. The tiny blood vessels are connected together using microsurgery techniques.  Once this is complete, the blood flow to the tissue is restored.  Next, the tissue is shaped to fit the mastectomy defect.

Due to the complex nature of the surgery, the procedure can be lengthy – often close to four hours for one breast, however the effort are rewarded by excellent cosmetic results. The procedure is much less invasive then earlier techniques, so recovery is faster.  The operation leaves a horizontal scar on the lower abdomen, similar to that created in a cosmetic tummy tuck, resulting in a slimmer abdominal contour that is appreciated by most women.

Lower back/Waist - LAP Procedure

For more information on LAP Procedures click here

IGAP Procedure (Lower Buttock) & SGAD Procedure (Upper Buttock)

For patients where the abdominal or thigh do not provide sufficient tissue, the gluteal region or buttock can also be used.  Both the IGAP and SGAP procedures use tissue from the gluteal region or buttock. The difference between the two is the choice of blood vessels that nourish the flap tissue. IGAP is the preferred procedure of choice because the scar is lower – approximate 1” above the gluteal fold but it may not be available to all patients.

The scar on the buttock and the need for a symmetry operation on the opposite buttock reduces its appeal, and requires a longer operation.  It also has a slightly higher failure rate.

Once the tissue is safely detached from the buttock it is re-attached to the small blood vessels in the breast area, resulting in a microsurgical tissue transfer. The tiny blood vessels are connected together using microsurgery techniques.  Once this is complete, the blood flow to the tissue is restored.  Next, the tissue is shaped to fit the mastectomy defect.

Inner Thigh - TUG/PAP Procedure

In patients where there is not enough abdominal fat and skin, a second choice for breast reconstruction is the upper inner thigh region. This is a new technique where an elliptical piece of skin and fat is taken from the upper inner thigh. The incision is closed as if the patient was having a thigh lift. A small muscle (the gracilis muscle) is taken with the flap in most cases, however there is no functional loss from removing this muscle.

Once the tissue is safely detached from the inner thigh it is re-attached to the small blood vessels in the breast area, resulting in a microsurgical tissue transfer. The tiny blood vessels are connected together using microsurgery techniques. Once this is complete, the blood flow to the tissue is restored. Next, the tissue is shaped to fit the mastectomy defect.