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 is the advantage of this technique?
Using your own tissue will not lead to any foreign body reaction - like capsular contracture can in an implant-based reconstruction. Usually, it leads to a more natural result, especially with a closer match to your unaffected side. Own tissue reconstruction follows the normal evolution of ageing in comparision to an implant-based reconstruction, which does not. Another point is that radiation doesn't have a 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. Additonally, as the surgery is more complex, there is a higher risk of additional post-operative complications. Furthermore, the operation is longer and consequently, so is the hospital stay.
Which areas of the body can be used?
Today there are a number of options available with regards to donor areas for an autologous breast reconstrcution. These range from the lower abdomen (tummy), and buttock, to the inner thigh. Depending on your body habitus, the volume needed and your own preference, the donor side is then 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 is the advantage of this technique?
Using your own tissue will not lead to any foreign body reaction - like capsular contracture can in an implant-based reconstruction. Usually, it leads to a more natural result, especially with a closer match to your unaffected side. Own tissue reconstruction follows the normal evolution of ageing in comparision to an implant-based reconstruction, which does not. Another point is that radiation doesn't have a 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. Additonally, as the surgery is more complex, there is a higher risk of additional post-operative complications. Furthermore, the operation is longer and consequently, so is the hospital stay.
Which areas of the body can be used?
Today there are a number of options available with regards to donor areas for an autologous breast reconstrcution. These range from the lower abdomen (tummy), and buttock, to the inner thigh. Depending on your body habitus, the volume needed and your own preference, the donor side is then 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.
Pedicled TRAM flap
The pedicled TRAM flap (Transverse Rectus Abdominis Muscle) has been used for breast reconstruction since the early 1980s. Until the introduction of the free TRAM flap, this was regarded as the golden standard in autologous reconstruction.
How is a breast shaped from tissue from my abdomen?
The entire rectus abdominis muscle is used to carry the lower abdominal skin and fat up to the chest. Then the breast is created out of this tissue. In order to transfer the tissue the chest , the muscle is tunneled under the upper abdominal skin.
What happens to the open wound on the abdomen?
The wound is finally closed like a tummy tuck. The scar on the abdomen is low, and extends from hip to hip.
What are the risks of this surgery in comparison to the free TRAM flap?
The pedicled TRAM flap is based on the superior epigastric vessels, which are a secondary blood supply to the the lower abdominal skin and fat. Therefore the blood supply can be more often compromised than in a free TRAM flap, where the primary supplying blood vessels are used. Furthermore, it bears the risk of abdominal weakness and bulging as the the entire muscle is removed.
