Autogenous Tissue Flap Reconstruction
Autologous/ Autogenous tissue flap reconstruction is still the gold standard in breast reconstruction. It involves harvesting the patients’ own tissue together with the underlying muscle and blood supply and the flap is then repositioned into the chest.
It is particularly suitable for
- Women with large breasts
- Women who had radiotherapy or need radiotherapy
- In locally / advanced breast cancer where > 50% of breast skin are removed leaving a large defeat
- Women who don’t have enough skin to cover an implant
Tissues commonly harvested are usually from the tummy (TRAM flap) or the back (LD flap). As these tissues have their own good blood supply, they have been well documented to facilitate healing, making it more robust and reducing complications and risks associated with radiotherapy and chemotherapy.
Advantages
- No risk of rupture
- Recontruction is permanent as using own tissue and blood supply
- Feels more natural and within your own
Disadvantages
- Longer operation
- More costly
- Slight increase risk of infection due to longer surgical hours.
- Lifestyle limitations
- Risk of abdominal hernia in TRAM Flap
LD Flap (Lattisimus Dorsi flap)
LD flap reconstruction
Latissimus Dorsi is a large, broad and flat muscle on the back below the shoulder blade. It is supplied by vessels from axilla or armpit.
The LD muscle is removed together with the skin and rotated from the back towards the chest. The procedure will take between 3-6 hours and overall recovery within 2-4 weeks
The pedicled (vessels intact) LD muscle is very versatile and can be used in different situations
LD flap with implant
LD Flap for Chest Wall Cover
Post Nipple – Sparing Mastectomy with LD Flap reconstruction (without implant)
TRAM Flap (Tranverse Rectus Abdominis Muscle Flap)
The TRAM flap is a muscle- tissue flap from the abdomen - a pair of long, flap abdominal muscles (also known as the six-pack muscles).
The abdominal incision is made along the bikini line and an oval section of the skin, fat, blood vesslsed and muscles of the lower half of your belly is removed and brought towards the chest wall to recreate a breast shape.
Pedicled TRAM flap with vessels intact is a safer option than a free TRAM flap. The procedure will last between 6-8 hours and overall recovery between 3-6 weeks.
In some cases, the TRAM flap can be used for bilateral mastectomy done together at the same time.
Skin Sparing Mastectomy
Nipple Sparing Bilateral Mastectomy
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