Cosmetic Surgery Tips

tummy tuck with breast reconstruction

Tummy tuck with breast reconstruction surgery is a procedure that combines the benefits of a tummy tuck and breast reconstruction. In this procedure, the surgeon removes excess skin and fat from the abdomen, as well as excess breast tissue and tissue from the chest wall. This allows for an improved contour and shape of your abdomen and breasts.

As you may know, a tummy tuck is a procedure that removes excess skin and fat from the abdomen and tightens the muscles that were stretched during pregnancy. Breast reconstruction can be done at the same time as the tummy tuck or at a later date. During this procedure, your surgeon will remove tissue from one part of your body (usually from your stomach) and then use it to replace some of your breast tissue that was lost due to cancer or other types of treatments.

If you’ve had children and are looking for an easy way to get back into shape, then a tummy tuck might be right for you! This procedure can help flatten your abdomen and tighten your abdominal muscles so that they look more like they did before pregnancy.

The main benefit of combining these two procedures is cost savings—you’ll only have one surgery instead of two! And if you choose to have both procedures together, there’s no need for recovery time because they happen at the same time.

tummy tuck with breast reconstruction

It’s not uncommon for women to want to get a tummy tuck with breast reconstruction after having a mastectomy.

When you’ve had a mastectomy because of breast cancer, you may feel like your body has been through enough. And the thought of going through another surgery can be overwhelming. But most women who have experienced this are quick to say that their decision to get both procedures was worth it—and they’re not alone.

In fact, according to one study, 80% of women who underwent this combination procedure said they were satisfied with their results. Another study found that 90% of women who got both procedures were satisfied with the outcome and would recommend it to others in similar situations.

Breast Reconstruction Using Your Own Tissue (Flap Procedures)

A tissue flap procedure (also known as autologous tissue reconstruction or tissue-based reconstruction) is one way to rebuild the shape of your breast after surgery to remove the cancer. As with any surgery, you should learn as much as possible about the benefits and risks, and discuss them with your doctor, before having the surgery.

Advantages of tissue flaps

These procedures use tissue from other parts of your body, such as your tummy, back, thighs, or buttocks to rebuild the breast shape. Tissue flaps look and feel more natural and act more like natural breast tissue than breast implants. Unlike implants, tissue flaps will change like any other tissue in your body. For instance, they may get bigger or smaller as you gain or lose weight. And while breast implants sometimes need to be replaced (if the implant ruptures, for example), this is not a concern with tissue flaps. Tissue flaps are often used by themselves to reconstruct the breast, but some tissue flap procedures can be used with a breast implant if more volume is needed.

Disadvantages of tissue flaps

Tissue flap procedures can also have some downsides that need to be considered:

  • In general, flaps require more surgery and a longer recovery time than breast implant procedures
  • Flap operations leave 2 surgical sites and scars – one where the tissue was taken from (the donor site) and one on the reconstructed breast. The scars fade over time, but never go away completely
  • Some women can have donor site problems such as abdominal bulging, muscle damage or weakness, and contour distortions such as dimpling of the skin

Types of tissue flap procedures

There are many different types of flap procedures. They are often named by the muscle or artery that is being used and they mainly fall in two groups:

Pedicle flaps: A pedicle flap moves tissue from its site to the breast or chest wall while it is still attached to its original blood supply. The most common pedicle flap used for breast reconstruction is the latissimus dorsi (LD) flap, where tissue from the back (skin, fat, and muscle) is used to make a new breast. Tissue from the abdominal wall (tummy) can also be used as a pedicle flap (transverse rectus abdominis muscle or TRAM flap). But this has been largely replaced by its free flap version, where the muscle can be totally or partially saved.

Free flaps: A free flap moves tissue, fat, skin, and some or none of the muscle from one area of the body to make a new breast. This tissue is completely removed from the body and moved up to the chest. The blood vessels (arteries and veins) must then be reconnected to the chest wall vessels for the tissue to survive. This requires the use of a microscope (microsurgery) to connect the tiny vessels, and the surgery takes longer than a pedicle flap. Most of the time, free flaps don’t need to take the muscle from the donor site, so there is less risk of losing muscle strength, and the donor site often looks better than if the muscle had been removed. The main risk is that sometimes the blood vessels get clogged and the flap doesn’t work because of poor or no blood supply. The abdominal wall (tummy) is the most popular and common donor site for free flap breast reconstruction. Other possible donor site areas for breast free flap reconstruction are the thighs, buttocks, and lower back.

Restoring feeling to the reconstructed breast 

During a mastectomy, nerves are cut causing a loss of sensation (feeling) on that side. The skin on the chest wall can feel numb (no feeling) or be more sensitive. The feeling might return after a few months or years or not at all. Finding ways to restore the feeling in the reconstructed breast has become a goal of tissue (flap) breast reconstruction. It is often possible to keep a sensory nerve (a nerve that controls feeling) within the flap. On the chest wall, a nerve in between the ribs is isolated and then reconnected with the nerve of the flap. This connection helps stimulate the tissue flap to regain feeling. There are studies that show improvement of sensation using this technique.

Abdominal (tummy) flaps

An abdominal wall flap procedure uses tissues from the tummy. Most times the tummy provides enough tissue for breast reconstruction, so no breast implants are needed. The tummy flap names are based on how the tissue is transferred and if the abdominal wall muscle is used or not. The donor site of the abdominal wall flap may look like a “tummy tuck,” but it can also reduce the strength in your belly muscles and cause bulging depending on what technique was used. Tummy flaps may not be possible in women who are very thin or who have had a tummy tuck before.

There are different types of abdominal wall (tummy) flaps:

  • pedicle transverse rectus abdominal muscle (TRAM) flap leaves the flap attached to its original blood supply and tunnels it under the skin to the chest. It usually requires removing most if not all of the rectus abdominis (6-pack) muscle on that side, which means an increased risk of bulging on one side of the abdomen. This can also mean your abdominal (belly) muscles may not be as strong as before the surgery.  
  • free TRAM flap moves tissue and most, if not all, of the muscle) from the same part of the lower abdomen as a pedicle TRAM flap, but the flap is completely removed and moved up to the chest. The blood vessels (arteries and veins) must then be reattached. A microscope is required to connect the tiny vessels (microsurgery), and the surgery takes longer than a pedicle TRAM flap. The main advantage of a free TRAM flap is that the blood supply to the flap is usually better than with a pedicle TRAM flap. The main risk of free flaps is that sometimes the blood vessels get clogged and the flap doesn’t work, but this is rare. There is also a higher risk of abdominal wall weakness and bulging.

free muscle-sparing TRAM (MS-TRAM) flap is like a free TRAM flap except only part of the muscle from the same part of the lower abdomen, is completely removed and moved up to the chest. The blood vessels (arteries and veins) must then be reattached with microsurgery. Here the plastic surgeon saves most of the abdominal wall muscles; only a small piece of muscle is taken with the flap. There is less risk of abdominal wall bulging and losing abdominal muscle strength, and the donor site (abdomen) often looks better.

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