Breast Reconstruction with Flap Surgery

Overview

Breast reconstruction using flap procedures takes tissue from other areas of the body, such as the belly, back, or thighs, to create a new breast shape. Surgeons typically perform this method after a mastectomy, when all breast tissue is removed. The process involves a plastic surgeon moving a section of skin, fat, and sometimes muscle, called a “flap,” to the chest to rebuild the breast.

Flap Source	Typical Location	Tissue Used
Belly	Lower abdomen	Skin, fat
Back	Upper back	Muscle, skin
Thighs/Buttock	Inner thigh, buttocks	Skin, fat

Key facts About Flap Reconstruction:

Specialized plastic surgeons perform this surgery.
The reconstructed breast is shaped to look as natural as possible.
Surgeons usually do the surgery at the same time as a mastectomy but may need more operations.
The new breast does not have the same feel or sensation as a natural one.
Many people report improved confidence and comfort with their bodies after surgery.

Possible Complications

Surgery-Related Side Effects

Breast reconstruction can lead to different types of surgical risks. Common issues include delayed healing of wounds, infection, and bleeding at the site. Some people may also react to anesthesia, which can cause symptoms like nausea or confusion.

Risk	Description
Slow healing	Incisions may take longer to close fully.
Infection	Bacteria can enter through wounds.
Bleeding	Extra blood loss might occur during or after surgery.
Anesthesia effects	Patients may feel sick or confused after waking up.

Tissue Flap Complications

Using tissue flaps for breast reconstruction comes with extra risks. Tissue necrosis may happen if the flap does not get enough blood. There can also be a loss of sensation at the donor site, and some people develop a bulge or hernia in the belly if abdominal tissue was used.

Radiation therapy, sometimes needed as part of cancer treatment, can make healing harder and increase the risk of these problems. In some cases, doctors may delay flap surgeries until after radiation is complete to lower the chance of these complications.

Steps to Get Ready

People preparing for flap surgery to rebuild a breast should meet with a board-certified plastic surgeon who understands breast reconstruction. Both the breast cancer surgeon and plastic surgeon work together so the patient receives a well-coordinated care plan. During these discussions, they review available reconstruction choices, including what might work best depending on the person’s body type and overall health.

A person’s abdominal strength can sometimes affect their surgery options. Thin patients need extra attention since there may be less tissue available for the reconstruction. When planning, the surgeon will show pictures of different results, and talk about surgery locations and what kind of follow-up might be needed. Here are some ways to prepare:

Adjust or stop certain medications as instructed by your healthcare team.
Quit smoking if you currently smoke. Smoking hinders the healing process.
Take any required medical tests or evaluations.
Follow the care team’s instructions closely.

Some might consider surgery on the other breast for a more balanced look. It’s important to talk with the plastic surgeon about the benefits and possible drawbacks.

Step	Why It’s Important
Stay updated on advancements in medicine.	Promotes healing and minimizes risk.
Stop smoking.	Improves recovery.
Attend evaluations.	Confirms readiness for surgery.
Talk about both breasts.	For balance and symmetry.

Different Methods for Flap Surgery

Flap surgery for breast reconstruction uses tissue such as skin, fat, and sometimes muscle taken from another area of the body. The section of tissue, often called a flap, is shaped to form the new breast mound.

Surgeons may use a pedicle flap, where tissue remains attached to its original blood supply, or a free flap, where tissue and blood vessels are completely removed and reconnected using microsurgery techniques. Both methods have specific steps and recovery times.

Table: Flap Surgery Methods and Features

Flap Type	Tissue Source	Muscle Used	Blood Vessel Connection	Notes
Pedicle Flap	Various (usually belly or back)	Often Included	Original blood supply kept for some vessels	Moves under the skin
Free Flap	Various	Sometimes	Blood vessels reconnected to chest	Needs microsurgery

Blood flow is essential for the tissue to survive and heal properly. People with blood vessel issues such as diabetes, vascular disease, or those who smoke may face higher complications and might need to take extra steps before surgery.

TRAM: Transverse Rectus Abdominis Muscle Flap

This method uses skin, fat, and sometimes muscle from the lower stomach area (rectus abdominis muscle) to make the new breast mound. Surgeons can perform TRAM flap surgery as a pedicle flap, where the entire muscle stays in place and only part of it is moved, or as a free flap, where only a piece of the muscle is used and blood vessels are reattached using microsurgery.

Sparing as much muscle as possible helps keep the patient’s core stronger after surgery. Both techniques offer natural tissue for shaping and may also give a tummy tuck result, but may affect abdominal strength.

DIEP: Deep Inferior Epigastric Perforator Flap

The DIEP flap also uses tissue from the lower belly. Unlike the TRAM procedure, the deep inferior epigastric perforator flap technique takes only the skin and fat, leaving most of the abdominal muscle behind. This helps keep abdominal wall strength and lowers the chance of muscle weakness.

Surgeons use a microscope to connect small blood vessels from the flap to the blood vessels in the chest. Recovery may still involve swelling or discomfort in the belly area, but core strength is less affected compared to TRAM flaps.

SIEA: Superficial Inferior Epigastric Artery Flap

The SIEA flap uses skin and fat from the lower abdomen, but relies on more surface-level blood vessels instead of deep ones. This technique does not disturb the abdominal muscles at all and can give the same result as the DIEP flap for some patients. Not everyone has large enough superficial blood vessels for this surgery, so the surgeon will check for suitable blood vessels before choosing this method.

TUG: Transverse Upper Gracilis Flap

For this flap, the surgeon removes muscle and fatty tissue from the upper inner thigh and lower buttocks area. The surgeon then shapes this tissue into a breast mound. A bonus of the TUG flap is that it may help shape the donor area for a smoother look. This method often suits people who do not have enough extra tissue in the belly.

PAP: Profunda Artery Perforator Flap

The PAP flap uses fat and skin from the back of the upper thigh and does not take any muscle. By leaving the muscle behind, this process helps prevent weakness in the leg. The surgeon detaches the tissue and connects the blood vessels to those in the chest. People who are lean or lack tissue in the abdomen may find the PAP flap to be a good choice.

Latissimus Dorsi: Back Muscle Flap

With the latissimus dorsi flap, the surgeon takes tissue from the back, including the muscle, skin, and fat. The surgeon moves the tissue under the skin to the chest area while keeping its original blood supply intact. Since this technique provides only a small amount of tissue, surgeons often pair it with a breast implant to achieve the desired shape and size. Recovery usually includes soreness in the back and shoulder area.

Gluteal: Buttocks Tissue Flap

Gluteal flap surgery, sometimes called IGAP or SGAP, involves taking skin and fat from the buttocks and moving it to the chest to create the new breast. This is a free flap operation, so surgeons must reconnect blood vessels using microsurgery.

Surgeons consider this option when a person does not have enough tissue available from the stomach or back. This procedure does not use the gluteal muscle, keeping the strength of the buttocks mostly unaffected.

What Happens After Surgery

After flap surgery, most people have bandages or a special support bra. Surgeons may leave thin plastic tubes under the skin for a week or more to drain extra fluids. Pain, swelling, and tiredness are common, but medicine helps reduce discomfort. The care team instructs patients not to do heavy lifting or reach above their head for some time.

Short walks and gentle activity can start a few days after surgery if cleared by the care team. The donor site, where the tissue came from, may feel tight, numb, or sore. Some people take weeks or months to regain their normal strength and range of motion, especially after larger flap surgeries or when the abdominal area was used.

Helpful Reminders

Follow all instructions from the surgeon closely.
Watch the incision sites for swelling, redness, or signs of infection.
Call the surgery team if there are concerns.

Creating the Nipple and Areola

Nipple and areola reconstruction is an option for those who wish to match the appearance of their other breast or achieve a more natural look. Surgeons usually perform it sometime after the initial flap surgery, once the new breast mound has settled and healed.

The surgeon may use small cuts and local tissue to shape a new nipple. Medical tattooing can then be done to add color to the nipple and areola area so that it looks more like natural skin. Some people decide not to have this step, while others feel it helps restore their confidence and sense of self.

Screening for Future Breast Health

Routine breast cancer checks remain important even after reconstruction. If only one breast is rebuilt, regular mammograms are still needed for the natural breast. Reconstructed breasts made entirely from your own tissue usually do not need mammograms, but regular physical exams and breast self-checks are still useful. If there are any changes, lumps, or areas of concern, patients should inform their doctor.

Checklist for Future Screening

Schedule mammograms as directed for any natural breast tissue.
Do monthly self-exams on both the reconstructed and natural breast.
Report any changes to a healthcare provider right away.

What to Expect After Breast Reconstruction

The outcome of breast reconstruction using implants is not always obvious right after surgery. Healing takes time, and the appearance of the new breast will change as the tissue recovers. Patients often have follow-up visits with their care team at Healthnile to review progress and talk about next steps.

Key Benefits of Breast Reconstruction

Creates a breast shape
Makes the new breast look more similar to the natural side with clothing
Reduces the need for an external breast prosthesis

Possible Emotional Benefits

May help improve confidence and self-image
May lessen some emotional reminders of cancer treatment

Important Considerations

The reconstructed breast will not look or feel exactly like the natural one did before surgery.
Normal sensation is not fully restored in the new breast.

Aspect	What To Expect
Appearance	More natural shape under clothes
Sensation	Usually different from before
Self-image	May improve for some, varies by person
Need for prosthesis	Often reduced or not needed