What is 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.
Types of free-flap breast reconstruction using your own tissues
In free-flap surgery, your surgeon frees tissue from its original location and blood supply and then transfers and connects it to the blood supply in the chest. We are experts in all types of free-flap breast reconstruction.
In this procedure, your surgeon takes belly fat and blood vessels from the lower abdomen to reconstruct your breast. Types of free-flap reconstruction using abdominal tissue include:
- Free transverse rectus abdominis myocutaneous (TRAM) flap surgery: In this procedure your surgeon transfers skin, fat, blood vessels, and a small piece of muscle to the breast area.
- Deep inferior epigastric perforator (DIEP) flap surgery: Your surgeon creates an incision in the abdominal muscle to take fat and blood vessels (but not muscle) from the lower abdomen.
- Minimally invasive deep inferior epigastric perforator (mi-DIEP) flap surgery: A Penn Medicine surgeon developed this innovative procedure that uses tiny laparoscopic incisions in the abdominal muscle to reach belly fat and blood vessels underneath. Small incisions can mean less pain, less need for narcotic drugs to manage pain, and a faster recovery.
- Superficial inferior epigastric artery (SIEA) flap surgery: Your surgeon takes skin, blood vessels, and fat from the top of the muscle and makes no incisions to the muscle.
Penn Medicine surgeons are also experienced at transferring tissues from the buttocks or inner thigh. Procedures include:
- Superior gluteal artery perforator (S-GAP) flap surgery: This surgery takes tissues from the upper portion of your buttocks.
- Inferior gluteal artery perforator (I-GAP) flap surgery: This procedure uses the lower portion of your buttocks.
- Profunda artery perforator (PAP) flap surgery: This procedure uses a blood vessel, skin, and fat from the back of the inner thigh.
- Transverse upper gracilis (TUG) or transverse myocutaneous gracilis (TMG) flap surgery: This surgery transfers tissue from the upper portion of your thighs.
Who is a candidate for free-flap breast reconstruction?
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.
How to prepare for free-flap breast reconstruction
Your Penn Medicine provider will give you detailed pre- and post-surgery instructions, which may include:
- 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
Recovering after free-flap breast reconstruction
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.
Rated “exceptional” by The National Cancer Institute
Penn Medicine’s Abramson Cancer Center is a world leader in cancer research, patient care, and education. Our status as a national leader in cancer care is reflected in our continuous designation as a Comprehensive Cancer Center by the National Cancer Institute (NCI) since 1973, one of 7 such centers in the United States. The ACC is also a member of the National Comprehensive Cancer Network, one of a select few cancer centers in the U.S., that are working to promote equitable access to high-quality, advanced cancer care.
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