Breast reconstruction with autologous tissue

Breast reconstruction with tissue from the abdomen | tissue from the groin – PAP flap | back muscle | tissue from the buttocks

In a breast reconstruction with autologous tissue, the patient’s own tissue is used to reconstruct the breast. Muscle and/or fatty tissue can be used in this case. Depending on the anatomical conditions and the woman’s preferences, the breast can be reconstructed with tissue from the back, abdomen, buttocks or groin area. The procedure requires extensive surgical expertise and many years of experience in the field of microsurgery. The tissue is removed and transplanted using microsurgical techniques in a complex operation that usually takes between three and six hours.

When the breast is reconstructed with the woman’s own tissue it integrates well as a natural part of the body and feels very real. Radiotherapy can usually be given without any problems after surgery.

BREAST RECONSTRUCTION WITH TISSUE FROM THE ABDOMEN

The DIEP flap has become the standard method of breast reconstruction with autologous tissue. This process is an evolution of the conventional TRAM flap method. Using this approach, only the lower abdominal fat and skin is moved to the breast region. Microsurgical methods are used to connect the vessels of the flap to the vessels of the chest wall. Unlike the TRAM flap, the DIEP flap does not include abdominal muscle. This keeps the abdominal wall entirely intact, and there is no risk of abdominal wall hernias. DIEP, SGAP and IGAP are all known as perforator flaps. These are tissue blocks that are taken from the donor site without including muscle tissue – also known as free flaps. With a perforator flap, the surgeon only follows the vessels leading to the surface of the skin.

FACTS AND FIGURES

BREAST RECONSTRUCTION WITH TISSUE FROM THE GROIN – PAP FLAP

The PAP flap represents the most recent development in autologous tissue reconstruction. A tissue flap consisting of skin and fatty tissue is removed from the inner thigh just below the buttocks. This is a development of the TMG flap in which the gracilis muscle is also removed. The texture of the fatty tissue is finer than in the SGAP and very easy to shape. PAP stands for «Profunda Femoris Artery Perforator flap». The PAP flap is also a microsurgical flap.

The reasons for the use of this flap are the same as for the SGAP or IGAP. In addition, there is sometimes not enough tissue present in the buttock area or the patient may not want to have a scar in this area. The scar is hidden in the natural crease of the thigh, with offshoots in the infra-gluteal crease. Patients with large breasts are not suitable for this type of reconstruction because there is not enough tissue available at the donor site on the thigh. This procedure is also not recommended for patients who go horse riding.

FACTS AND FIGURES

BREAST RECONSTRUCTION WITH BACK MUSCLE

This reconstruction technique involves what is known as a muscle flap with skin islands (latissimus dorsi flap). The muscle tissue has its own blood supply and is transplanted from the back to the breast region. To do this, the muscle tissue is first detached from its underlying tissue and then rotated from back to front. The new breast mound is formed using this tissue.

Depending on the size of the healthy breast, an implant may also need to be inserted to achieve the same dimensions as the breast on the opposite side. Breast reconstruction using back muscle is carried out when there is a limited amount of soft tissue in the breast region, or radiotherapy has already been carried out.

FACTS AND FIGURES

BREAST RECONSTRUCTION WITH TISSUE FROM THE BUTTOCKS

The area of the buttocks provides another source of tissue for breast reconstruction. The SGAP can be taken from the upper area of the buttocks. SGAP stands for superior gluteal artery perforator. A distinction is made between an upper (superior: SGAP) and a lower (inferior: IGAP) flap. Like the DIEP flap, this is also a perforator flap that is freely transplanted, and is therefore a free flap. The removal of a GAP flap is technically more demanding than a DIEP flap, because the vessels are much smaller and more fragile. This procedure therefore places higher demands on the surgeon and his or her experience in microsurgery.

There are several reasons to choose an SGAP. Many patients already have large scars on the lower abdomen or too little abdominal fat, so the DIEP flap is either inappropriate or not possible. Many patients also do not want scars on their back, and therefore decide against a breast reconstruction using back muscle. Others are very definite that they do not want artificial breast implants. In all these cases, breast reconstruction with autologous tissue from the buttocks is a very good alternative.

FACTS AND FIGURES

Breast reconstruction with autologous tissue Patient examples

Delayed reconstruction with TRAM (tissue from the abdomen)

Reconstruction with TRAM (tissue from the abdomen)

Skin-sparing mastectomy and immediate reconstruction with DIEP (tissue from the abdomen)

Reconstruction with latissimus dorsi (tissue from the back) and implant – donor site on the back

Skin-sparing mastectomy and immediate reconstruction with latissimus dorsi (tissue from the back) and implant

Subsequent reconstruction with latissimus dorsi (tissue from the back) and implant

Subsequent reconstruction with latissimus dorsi (tissue from the back) and implant

Skin-sparing mastectomy and immediate reconstruction with TMG (tissue from the groin)

Reconstruction with TMG (tissue from the groin)

Hautsparende Brustentfernung sofortige rekonstruktion mit SGAP