Autologous Tissue Flap

Autologous Tissue Flap

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    Dr. R. Michael Koch and Dr. Jordan Jacobs specialize in breast reconstruction surgery that uses microsurgical techniques to transfer a large section of a woman’s own tissue from part of her body to create new breasts after mastectomy. Most commonly, this tissue is taken from the belly, although other areas that tissue can be taken from include the buttock or thigh. Women typically choose this type of breast reconstruction if they are not candidates for implant reconstruction, want to simply avoid the use of an implant, or have extra tissue in one of the areas mentioned that they wouldn’t mind getting rid of while having breast reconstruction.

    What is Autologous Tissue Flap Breast Reconstruction?

    Autologous tissue flap breast reconstruction taken from the belly is also commonly known as “free tissue transfer,” or medically termed TRAM or DIEP flap surgery. With this form of breast reconstruction we replace the volume of your breasts immediately, in the same surgery in which your mastectomy is performed, using the fatty tissue from your belly.

    The first step in the flap procedure is to surgically lift the area of skin, fat and blood vessels from below your belly button — this is referred to as the “donor” tissue. We bring, or transfer, the donor tissue into your breasts to fill up the skin envelope left behind after all breast tissue is removed during the mastectomy. The breast envelope is referred to as the “recipient” site. In order for the donor tissue to survive in its new recipient location, a microscope and precision instruments are used to reattach the donated blood vessels to blood vessels in the recipient site.

    The variation in the way this procedure is termed medically comes from the technicalities of how it is actually performed:

    • Pedicled TRAM (Transverse Rectus Abdominis Myocutaneous Flap) transfers belly tissue but involves taking the abdominal muscle (rectus muscle) along with the fat to provide the blood supply. There is no microsurgery used in this technique since the fat and muscle is tunneled directly into the breast pocket.
    • FREE TRAM Flap technique involves transferring the fatty tissue into the breast pocket with a very small piece of muscle to ensure good blood supply to the fatty tissue. Microsurgery is used in this procedure.
    • DIEP (Deep inferior epigastric perforator) Flap transfers belly tissue as well, but no muscle is used. Only the blood vessels are taken with the fat, and microsurgery is used to reconnect the donor vessels to the recipient site.

    The tissue used in autologous flap surgery can be taken from other areas besides the abdomen including the back, buttock and thigh. Similar techniques described above are used to transfer the donor tissue to the breast pocket.

    What are the Advantages of New York Autologous Tissue Flap Breast Reconstruction Procedures?

    The main advantage of autologous tissue flap breast reconstruction is that you will end up with breasts that look and feel very much like natural breasts. Also, you will have fat removed from your stomach much like a tummy tuck! A significant advantage of a DIEP flap procedure in particular is that it doesn’t affect your stomach muscles, and therefore they will not be weakened.

    A tissue transfer reconstruction gives you soft, natural breasts and thus they tend to be more ptotic, or drooping, than implant reconstruction breasts. The surgery itself is more involved and therefore longer (about 8 – 10 hours) and recovery will take longer as well (typically 4 – 6 weeks). Also, there will be a scar where the donor tissue was removed.

    Am I a Candidate for Autologous Tissue Flap Breast Reconstruction?

    A woman with some amount of fat that can be taken from her abdominal area (or thigh or buttock) — enough to create the desired breast size — is typically eligible for a tissue transfer procedure. It’s also important that the blood vessels to be transferred from the donor to recipient site be in good shape and not constricted, or narrow. Women who smoke may have constricted blood vessels, so it’s important to stop smoking if you are considering autologous tissue flap breast reconstruction.

    Can I Have Nipple Sparing Mastectomy with Autologous Tissue Flap Breast Reconstruction?

    Yes, if the breast surgeon determines that you are eligible for a nipple sparing mastectomy, we can reconstruct your breasts with an autologous tissue flap breast reconstruction.

    Can I Have Autologous Tissue Flap Breast Reconstruction if I have Large and/or Sagging Breasts (Ptosis)?

    Yes, and in fact autologous tissue flap breast reconstruction can be preferable for women with large (D—DD or larger) or sagging breasts versus implants. We can fill the breast envelope with your own tissue and create breasts that “drape” properly over the chest and feel soft and natural.

    Can I Have Autologous Tissue Flap Breast Reconstruction if I’ve had Radiation Treatment for Breast Cancer?

    You certainly may be eligible for autologous tissue flap breast reconstruction after radiation. We typically recommend waiting six months for the radiated area of your breast to heal. There may be challenges with the blood vessels that might have been affected by the radiation in the chest but in general, previously radiated patients are excellent candidates for autologous reconstruction.

    For all of our tissue transfer patients, whether they’ve had radiation or not, we evaluate the health of the blood vessels in the donor and recipient site using a magnetic resonance angiogram (MRA) scan.

    What is the Surgical and Cosmetic Recovery Following Autologous Tissue Flap Breast Reconstruction?

    You can expect to remain in the hospital for 3 – 5 days after surgery. You will have drains in both the donor and recipient area that stay in for 10 – 14 days. You’ll be asked to avoid strenuous activity and/or lifting over 5 lbs for 6 weeks after surgery. You may begin gentle exercise at 4 weeks after surgery.

    Is It Possible I’ll Need Revisions to My Autologous Tissue Flap Breast Reconstruction?

    Yes; once the breasts have healed and settled there is usually some aesthetic improvement that can be made in terms of the shape of the breasts. For example, we can tighten the breast skin and make adjustments to the contour to improve symmetry and shape. Additionally, nipple reconstruction can be performed during a revision procedure if your nipples needed removal during the initial mastectomy. These revision procedures are very minimal and are done in an outpatient setting. The recovery is usually 1 week.

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    Would you like to learn more about New York Autologous Tissue Flap Breast Reconstruction? Request your consultation online, or give us a call at 800-433-7410 (New York City) or 914-366-6139 (Tarrytown), or 845-294-2018 (Goshen) or 914-293-8700 (Cortlandt Manor). At the New York Group for Plastic Surgery, we serve patients in the entire Hudson River Valley, Northern New Jersey, Eastern Pennsylvania and Western Connecticut.