Reconstruction using your own tissue
This method uses skin, fat and in some instances, muscle from another part of your body to fill the empty skin enevelope of the skin-sparing mastectomy. These tissues can be moved either as a pedicled flap to the breast or, as a free flap.
What are the advantages of this technique?
Using your own tissue will not lead to any foreign body reaction like capsular contracture can in an implant-based reconstruction. It usually leads to a more natural result, especially with a closer match to your unaffected side. It follows the normal evolution of ageing in comparision to an implant-based reconstruction, which does not. Also, radiation doesn't have any major adverse effect on the outcome of the reconstruction.
What are the disadvantages?
Using tissue from another body part will lead to additional scars, which are not necessary in an implant only reconstruction. Because the surgery is more complex, there is also a higher risk of additional postoperative complications. Furhermore, the operation is longer and therefore so is the hospital stay.
Which areas of the body can be used?
Today there are a number of options available with regard to the donor area for an autologous breast reconstrcution. These range from the lower abdomen (tummy), and the buttock, to the inner thigh. Depending on your body habitus, the volume needed and your own personal preference, the donor site will be chosen.
What is the difference between a pedicled and a free flap?
With pedicled flaps, skin, muscle and fat are moved from the back or abdomen to the chest by tunnelling it under the skin so that the blood supply to the muscle doesn't need to be cut.
In a free flap, skin, fat and sometimes muscle from the donor region is transferred to the chest by completely cutting the blood supply and reconnecting to new blood supply on the chest using microsurgical techniques.
Reconstruction using your own tissue
This method uses skin, fat and in some instances, muscle from another part of your body to fill the empty skin enevelope of the skin-sparing mastectomy. These tissues can be moved either as a pedicled flap to the breast or, as a free flap.
What are the advantages of this technique?
Using your own tissue will not lead to any foreign body reaction like capsular contracture can in an implant-based reconstruction. It usually leads to a more natural result, especially with a closer match to your unaffected side. It follows the normal evolution of ageing in comparision to an implant-based reconstruction, which does not. Also, radiation doesn't have any major adverse effect on the outcome of the reconstruction.
What are the disadvantages?
Using tissue from another body part will lead to additional scars, which are not necessary in an implant only reconstruction. Because the surgery is more complex, there is also a higher risk of additional postoperative complications. Furhermore, the operation is longer and therefore so is the hospital stay.
Which areas of the body can be used?
Today there are a number of options available with regard to the donor area for an autologous breast reconstrcution. These range from the lower abdomen (tummy), and the buttock, to the inner thigh. Depending on your body habitus, the volume needed and your own personal preference, the donor site will be chosen.
What is the difference between a pedicled and a free flap?
With pedicled flaps, skin, muscle and fat are moved from the back or abdomen to the chest by tunnelling it under the skin so that the blood supply to the muscle doesn't need to be cut.
In a free flap, skin, fat and sometimes muscle from the donor region is transferred to the chest by completely cutting the blood supply and reconnecting to new blood supply on the chest using microsurgical techniques.
Microsurgery – Free Flap
Microsurgery is a general term used for surgery that requires an operating microscope. The most notable developments have been procedures that enable anastomosis (rejoining) of small vessels and nerves. This allows the complete detachment of a tissue from one body part, with reattachment to another . The advances in techniques and technology that popularized microsurgery began in the 1970s. Today, it's regarded as quite a commonplace technique and therefore free flap surgery has become a standard procedure.
What is the advantage of a free tissue transfer in comparison to a pedicled flap?
Using free flaps opens up a much wider range of reconstruction possibilities. Tissues from further away can be transferred to the chest in order to create a breast: e.g. S-GAP or TMG flap. Furthermore, as tissue can be raised with its own blood supply, there's no need for removal of muscle. Therefore the use of free flap in comparison to pedicled flap has a significant lower donor-site morbidity.
Why is a free flap surgery more complex than a pedicled flap?
The preparation of the vessels and the reattachment of the vessels using microsurgical techniques makes the procedure both more complex and lengthier.
What are the risks of a microsurgical procedure?
The most important complication of a microsurgical reconstruction to be considered is possible failure of the flap. This happens due to vascular thrombosis. There is a low rate of this happening, though - around 2%.
