Free-flap breast reconstruction

After a mastectomy for breast cancer, you may choose to have your breasts reconstructed. Free-flap breast reconstruction uses your body's skin, fat, and blood vessels to recreate your breasts. This complex microsurgery procedure, also called autologous tissue reconstruction, has many advantages, including:

• A natural-looking result with tissue that changes as your body changes
• A pleasing cosmetic outcome — your surgeon may take tissue from the abdomen, buttocks, inner thigh, or back
• Better tolerance of radiation for breast cancer if you need that type of treatment
• No future surgeries to replace the breast reconstruction material, which is required with silicone or saline breast implants

Free-flap breast reconstruction requires a surgeon who is trained in microsurgery. Penn Medicine is the nation’s leader in free-flap microsurgery for breast reconstruction, performing more procedures than any other health care system in the United States. Our procedures include an innovative, minimally invasive type of free-flap microsurgery, developed at Penn Medicine, which can reduce pain and speed recovery.

If you are healthy with no other medical conditions or illnesses that may prevent healing, you may be a candidate for free-flap breast reconstruction. You will need to have moderate to excess tissue at the donor site, whether from your belly or other areas of the body, and require a minimal to moderate size breast reconstruction. Your Penn Medicine surgical team can work with you to determine if this is the best option for you.

Your Penn Medicine provider will give you detailed pre- and post-surgery instructions, which may include: /p>

• Quitting smoking before surgery
• Taking pre-operative blood tests
• Fasting the night before surgery
• Avoiding lotions, deodorant, makeup, sprays, or powders on the day of surgery
• Stopping aspirin-containing products, medications which contain blood thinners, some vitamins, and herbal supplements

What are the risks of free-flap breast reconstruction?

Some medical conditions like diabetes and obesity can increase the risk of complications after free-flap breast reconstruction. If you are a smoker, your surgeon may ask you to stop prior to surgery. Complications that are possible after free-flap breast reconstruction can include:

• Infection
• Fluid buildup
• Bleeding
• Abdominal hernia or muscle weakness at the donor site
• Tissue death (necrosis) if an attached flap doesn’t get enough blood supply

Post-surgery, you may be tired, and both your donor and recipient site may feel sore for a few weeks. Your Penn Medicine provider will prescribe pain medicine to control the discomfort. Wearing recommended support garments can help keep swelling down. You may have drainage tubes after surgery to remove excess fluid. Depending on the type of flap reconstruction surgery, recovery can take up to six weeks or more.

Free-flap surgery for breast reconstruction: The Penn Medicine difference

Penn Medicine is the nation's leader in microsurgery, a complex procedure that uses autologous (your body's own) tissue for reconstructing breasts. If you choose free-flap breast reconstruction after mastectomy, you can count on Penn Medicine specialists for:

• Education for informed choices: We educate you about autologous tissue reconstruction and its advantages and disadvantages according to your situation. You can also talk with other patients who have had breast reconstruction in our Peer-to-Peer Telephone Program.
• Revolutionary procedure: One of our plastic surgeons developed a new breast reconstruction technique called minimally invasive deep inferior epigastric perforator (mi-DIEP) flap. This procedure uses tiny incisions, often resulting in less pain and faster recovery.
• Unmatched microsurgery experience: Penn Medicine performs more microsurgery free-flap breast reconstruction procedures than any other program in the nation. Our experience and expertise mean you are in good hands for the best possible results.