Breast reconstruction surgery is a common procedure for women who have had a mastectomy because of breast cancer. There are many different types of breast reconstruction surgery and each has its own set of pros and cons. In this article on autologous breast reconstruction outcomes, we’ll discuss autologous breast reconstruction to help you decide if it’s right for your situation.
This new breast reconstruction techniques is a procedure in which the patient uses her own fat, muscle and tissue to reconstruct her breasts. The tissue is taken from other parts of the body, such as the lower abdomen, thighs or buttocks.
Breast reconstruction can be carried out at various dates, based on what is ideal for each woman’s particular circumstances. It’s referred to as immediate reconstruction when breast reconstruction is performed concurrently with mastectomy surgery. The plastic surgeon reconstructs the breast after the breast has been excised by the breast cancer doctors.
To prepare for autologous breast reconstruction:
An autologous reconstruction is done with the lower abdomen, the thighs or the buttocks as the source of tissue. This procedure is less common than implants because it requires more time before healing and a longer recovery period. The body will reject foreign substances like silicone.
The most common sources of tissue for this type of reconstructive procedure are:
- Lower abdomen (tummy tuck)
- Thighs (thigh flap)
- Buttocks (gluteal flap).
Autologous Breast Reconstruction Outcomes
According to a study, women who underwent immediate autologous reconstruction were happier with their breasts one year after surgery than those who underwent immediate implant reconstruction. However, women who underwent autologous repair experienced increased pain following surgery.
At 1 year after immediate reconstruction: Women who had implant reconstruction had the same satisfaction with their breasts and psychosocial well-being as they did before surgery.
Women who underwent autologous reconstruction were happier with their breasts than they were prior to surgery, and their psychosocial wellbeing improved. After surgery, women who had autologous reconstruction experienced improved sexual health, while women who had implant reconstruction experienced worse sexual health.
After surgery, the physical condition of the chest was worse in both groups of women. Autologous repair resulted in women with worse abdominal physical recovery. After surgery, anxiety and despair subsided for both groups of women. Women who underwent autologous repair described increased discomfort following surgery that interfered with their daily lives.
Women who had implant reconstruction had less fatigue after surgery. Overall, women who had autologous reconstruction were more likely to be more satisfied with their breasts than women who had implant reconstruction, as well as better psychosocial and sexual well-being.
Autologous reconstruction breast
There are two main types of breast reconstruction surgery after mastectomies.
In a flap reconstruction, your surgeon creates a breast using autologous tissue taken from your body. The tissue is typically removed from the lower abdomen (belly). However, it can also emanate from your bottom, back, or thigh.
In order to create a new breast, your surgeon may extract fat, skin, blood vessels, and muscle from these areas of your body. Medical professionals refer to this tissue as a flap. Occasionally, surgeons will pass a flap through your body (pedicled flap). In this manner, the flap keeps its own blood flow. They could also make the flap free by cutting off its blood supply and attaching it to your chest’s blood arteries.
The types of flap reconstruction include:
- DIEP flap: Your provider takes skin, fat and blood vessels from the lower belly. A DIEP flap does not remove the underlying abdominal (belly) muscle.
- TRAM flap: Your provider removes skin, fat, blood vessels and muscle from the lower belly.
- Latissimus dorsi (LD) flap: Providers remove tissue and muscle from the back. They transplant the LD flap (still connected to its own blood supply) through the back to the breast area.
- IGAP flap: For this procedure, tissue comes from your butt. Muscle isn’t used in this procedure.
- SGAP flap: This technique also removes tissue (not muscle) from your butt. It uses a different group of blood vessels than the IGAP flap procedure.
- PAP flap: Your surgeon removes tissue from the inner and back of your thigh and uses it to form a breast. This procedure does not transplant muscle from your thigh.
- TUG flap: Similar to a PAP flap, this technique uses tissue from your thigh. A TUG flap transplants muscle as well as tissue.
- SIEA flap (or SIEP flap): This procedure is like a DIEP flap, but it uses different blood vessels. Providers don’t use this technique as often. Few people have the blood vessels necessary for the surgery to be successful.
A TRAM flap can be done with two different techniques.
There are two different techniques used to perform a TRAM flap reconstruction. The pedicled TRAM flap is the more common of the two, as it requires less time and effort for both you and your surgeons. In this method, an area of skin from your abdomen (also called the “donor site” or “donor site defect”) is carefully separated from its blood supply, moved to your chest, then reconnected with its original blood supply. This procedure allows for rapid re-growth at the donor site while keeping recovery time shorter than that associated with free flaps.
In contrast to this more straightforward approach, there’s also a technique called a free TRAM flap—a procedure where no tissue is taken from any other part of your body besides your breast itself (which makes sense because why would you want extra scars?). To do this type of surgery properly takes careful planning on behalf of both surgeon and patient; however, many people find it worthwhile because they’re not worried about lengthier recovery times or added scarrig post-surgery–and because their nipples will never be covered up again!
In most cases, an autologous reconstruction can be performed at the time of mastectomy. This is a good option for women who have a high risk of complications with implants and also want to keep their options open. Autologous reconstruction involves transferring your own tissue to recreate the breast in its natural shape and size. The procedure involves removing some of your own tissue via liposuction, which is then grafted onto the chest wall or abdomen and shaped into breasts using surgical techniques.
The advantage of an autologous reconstruction is that it uses natural, living tissue for reconstruction.
The advantage of an autologous reconstruction is that it uses natural, living tissue for reconstruction. This means that there is no need for further surgery and no foreign material in your body. It also means the recovery time is quicker than with implants or a tissue expander. Autologous breast reconstruction can be done at the time of mastectomy if you want; this gives you the option to opt out of taking medication for the rest of your life to prevent disease or cancer from developing on your reconstructed breast(s).
The downside of an autologous reconstruction is that it uses living tissue, requiring a second surgical procedure and a longer recovery period.
Autologous breast reconstruction is a less common type of breast reconstruction surgery but offers several advantages over implants.
- Less invasive. Autologous breast reconstruction involves creating new breasts from your own tissue. This means less incision and recovery time than traditional, implant-based breast reconstructions, which require an incision around the nipple or areola to insert implants.
- Better-looking results. Because you’re using your own tissues to create your new breasts, they’ll look more natural than if you’d used an implant; they will also match the rest of your body better (for example, if you have a scar on one side of the chest).
- More flexibility in size adjustments down the line: If you want larger or smaller breasts later on, this can be accomplished through further surgeries rather than having to replace your existing implants with new ones (which sometimes can’t be done).
Autologous reconstruction is a less common type of breast reconstruction surgery but offers several advantages over implants. It’s important to note that this kind of surgery does require two surgical procedures, which means more recovery time and additional cost.
Autologous breast reconstruction is a surgical procedure where an individual’s tissue is transferred to the breast area. The tissue used can be muscle, fat, or skin. It is most often used to treat breast cancer and other forms of cancer that affect the breasts by removing all or part of one or both breasts and replacing them with an implant made from the patient’s own tissue. Autologous reconstruction may also be performed after mastectomy for breast cancer treatment in order to restore symmetry between the two sides of the chest wall following removal of one or both breasts.
Autologous breast reconstruction
Autologous breast reconstruction is a procedure that uses the patient’s own tissue to reconstruct the breast. It is especially useful when there is a loss of volume in the breast following removal of cancerous tissue. Autologous breast reconstruction can also be used for cosmetic purposes, such as after pregnancy or weight loss.
The DIEP flap technique has been described as follows. A full thickness skin paddle of approximately 10 cm by 10 cm is harvested from the lower abdominal wall, including all of the epidermis and dermis. The submuscular plane is dissected to remove the external oblique muscle fascia, which is used to cover the flap after it is rotated into position on top of the chest wall. The flap can be transferred either immediately or after a delay of up to 6 weeks postoperatively in order to allow for adequate healing before reconstruction; this may be necessary if you have had radiation therapy or chemotherapy within 12 months prior to surgery or if your breast cancer was diagnosed at an advanced stage with extensive tumor invasion into adjacent structures such as lymph nodes and fascia/muscle layers.
Limitations of DIEP flap
The DIEP flap is a complex, time-consuming procedure that requires careful planning and execution. It is not for the faint of heart or those with little patience:
- It requires an operating room time of approximately 8 hours (excluding surgery performed by a general surgeon).
- The procedure is long, so you may need to be prepared to stay in the hospital for up to 7 days after your operation. Your doctor will likely recommend that you avoid strenuous activities like running or lifting heavy objects for at least 6 weeks following your surgery.
- The donor site will be sore during this recovery period; it’s important to follow instructions regarding rest and recuperation while your body heals from surgery.
The main limitation of DIEP flap is based on the need to harvest subcutaneous soft tissue, which may be limited in obese patients. This can result in insufficient quantities of fat to cover the implant, causing contour deformities or rippling at the donor site. Furthermore, there is a risk of flap failure due to inadequate blood supply from the internal mammary artery, since it branches off from a single main trunk and not two separate vessels (like other flaps).
A second operation is also required for autologous breast reconstruction after mastectomy. The main drawback with this procedure is that you must undergo two surgeries instead of one if you opt for reconstruction with an implant inserted under your chest muscle or beneath your pectoralis major muscle
The SIEA flap is a reliable, versatile method of autogenous breast reconstruction. It can be performed at the same time as single-stage breast reconstruction, or it can be used to augment a DIEP flap to produce a larger reconstructed breast contour.
The advantages of using the SIEA flap include:
- The skin envelope is very large and has good color match with surrounding tissue
- The donor site has no visible scarring after healing
- Excellent vascularity allows for rapid healing and minimal complications such as infection or necrosis (death) of tissue at the donor site
However, there are also several disadvantages:
- Large reconstructions may result in significant excess bulkiness when attempting to match natural anatomy; this can be corrected by keeping some residual glandular tissue beneath the muscle wall or by using an inverted T incision at closure of the skin flap
A new type of perforator flap, the superficial inferior epigastric artery (SIEA) flap, was first described by Hartrampf and colleagues in 1997. The procedure is a minimally invasive technique for breast reconstruction that involves harvesting a full-thickness skin paddle from the abdomen and attaching it to an area of thinned subcutaneous tissue on the breast. The SIEA flap is similar to other types of perforator flaps: it uses one or more arteries that run through fatty tissue to supply blood to the skin graft used during surgery.
There are several names for this type of flap: it can also be referred to as a deep inferior epigastric artery (DIEP) flap or free TRAM flap because both involve taking tissue from underneath your abdominal muscles.
Limitation of SIEA flap
The SIEA flap is a perforator flap that uses the superficial inferior epigastric artery (SIEA) as its pedicle. It was first described in 1997 by Hartrampf and colleagues.
Like the DIEP, the SIEA flap uses a perforator from the external iliac system as its pedicle, which may limit its use if there is insufficient soft tissue in the donor site.
The first step in the SIEA flap is to harvest a large perforator from the thigh. Unlike its DIEP counterpart, this flap uses a perforator from the external iliac system as its pedicle, which may limit its use if there is insufficient soft tissue in the donor site. The surgeon must be careful to choose one that is large enough to supply adequate blood flow to your new breast.
As with all autologous breast reconstruction procedures, it’s important that you have a surgeon who has experience performing this type of surgery and is comfortable working with these challenging areas of tissue.
Autologous breast reconstruction options are expanding
As breast reconstruction techniques continue to advance, new options are being developed to improve outcomes and patient satisfaction. The most common technique is the DIEP flap, which uses the deep layer of abdominal fat and fascia, or skin and muscle tissue on the back side of the abdomen, to create a breast implant that’s shaped to fit you perfectly. When combined with an implant for shape and volume, it can be used for complete reconstruction of a breast after mastectomy or lumpectomy.
Another option is called transverse rectus abdominis musculocutaneous (TRAM) flap surgery. This procedure involves transplanting abdominal tissue into your chest area along with an implant made from your own body fat.
Other newer options include ultrasound-guided liposuction procedures that focus on removing excess fat from areas like hips or thighs before using them for your new breasts; using fat from one part of your body instead of two parts in order to reduce scarring; using more natural-looking silicone implants rather than saline ones; and creating a nipple shield out of skin grafts instead of tattoos so that they look more realistic over time than tattoos would ever do by themselves!
The DIEP flap is a well-established technique for breast reconstruction. However, it has some limitations. The SIEA flap is another option that may be considered in patients who do not have enough soft tissue at the donor site (i.e., patients with obesity).
If you’re interested in learning more about autologous breast reconstruction or other options for improving your self image after breast cancer treatment, talk with your doctor or visit our website at www.bcrmstlouis.org to find resources near you! We hope this article has been helpful as an introduction into the world of reconstructive surgery.
Microvascular breast reconstruction
For the past 10 years, The George Washington University Hospital has offered microvascular breast reconstruction as an alternative to implant reconstruction. With two qualified surgeons on staff, GW Hospital provides access to free-flap procedures following mastectomy or lumpectomy to patients in Washington, D.C. and the surrounding area.
Bharat Ranganath, MD, assistant professor of plastic surgery at The George Washington University School of Medicine and Health Sciences and fellowship-trained microvascular surgeon, joined the Breast Care Center at GW Hospital to offer his extensive training in the surgical technique. Dr. Ranganath has immersive training in cancer reconstruction and now offers unique options for breast cancer reconstruction after mastectomy, such as DIEP flap and alternative flaps (PAP, DUG). He practices along with Joanne Lenert, MD, assistant professor in the division of plastic surgery at The George Washington University School of Medicine and Health Sciences and plastic surgeon at GW Hospital.
“Not every hospital has qualified surgeons available to perform microvascular surgery, which is why we are proud to offer this at GW Hospital,” Dr. Ranganath says. “We complete about 50 to 60 free-flap procedures annually and boast about a 97 percent success rate. Our program is ramping up since I’ve been here, and we continue to offer new, advanced techniques and methods in microvascular reconstruction.”
Benefits and Risks of Microvascular Breast Reconstruction vs. Implant Reconstruction
Microvascular breast reconstruction presents many benefits, including:
Risks associated with microvascular breast reconstruction include:
“Currently we are implementing new techniques to eliminate concerns about the procedure,” Dr. Ranganath says. “We hope to offer reconnection of nerve grafts to bring back sensation to the breast, new lymphatic surgery methods to hook up lymphatic channels and prevent lymphedema, as well as the ability to create flaps from different areas of the body for patients without excess body tissue.”
When to Refer Patients for Microvascular Breast Reconstruction
When determining ideal candidates for microvascular breast reconstruction, evaluate these factors:
“Physicians should at minimum consider referring all eligible patients to a microvascular surgeon for an evaluation,” Dr. Ranganath says. “We have a shared decision-making process with the patient regarding their options.”
The GW Hospital Breast Care Center
At the GW Hospital Comprehensive Breast Center, patients receive all breast cancer services conveniently under one roof.
The center offers advanced imaging services for women of all risk levels, including automated breast ultrasound and breast imaging using the Dilon 6800® gamma camera. If cancer is detected, the center assigns the patient to a designated patient navigator to guide through the entire treatment and recovery process. Patients also have access to advanced therapies and surgical options, including microvascular reconstruction.
“We have a strong multidisciplinary team that helps patients seamlessly navigate the breast cancer process from screening to treatment,” Dr. Ranganath says. “As far as technology and training, we can provide first-grade care that is not available elsewhere.”