Autologous (own tissue) Breast Reconstruction

The use of one’s own tissue for breast reconstruction, also known as autologous tissue, can provide patients a permanent solution that avoids common implant related complications in the long term.  This technique for breast reconstruction has been used in form or another for nearly a century but has excelled recently with the advent of, and improvement in microsurgical technique.  Today autologous breast reconstruction is typically performed using patient’s excess abdominal tissue to recreate the tissues lost as a result of mastectomy.

The original method described for breast reconstruction using a patient’s abdominal tissue is the pedicled TRAM flap.  This stands for Transverse Rectus Abdominus Myocutaneous flap and signifies the direction of tissue resection (transverse) and the muscle used to provide blood supply to that tissue.  Pedicled describes the way in which the tissue is transferred, namely with the muscle still attached to its underlying blood supply.  With this technique the entirety, or majority, of one or both muscles is required to keep the skin and fat used for the reconstruction alive.  The effect of removing these muscles on the strength of the abdominal wall can be significant.  Newer techniques seek to transfer the same optimal tissue without the need for such muscle sacrifice.

The Deep Inferior Epigastric Perforator (DIEP) or muscle sparing (MS) free TRAM flap are techniques for transferring the same abdominal tissue used in a traditional pedicled TRAM flap with either a small portion of rectus abdominius muscle (MS TRAM) or no muscle at all (DIEP). This technique results in increased reliability of the transferred tissue and decreased negative effects on the abdominal wall.  This procedure involves complete removal of the abdominal tissue with its blood supply intact and transfer to the mastectomy defect where its blood supply is reconnected to vessels in the chest.  Once survival of the tissue is assured the patient can enjoy a permanent reconstructive solution that has the capacity to grow and shrink with them.

Ideal candidates for this procedure are those with excess abdominal tissue below the belly button who are willing to accept the increased initial hospital stay and recovery necessary to ensure optimal safety and success.  Following successful transfer of tissue patients may notice areas of irregularity or imperfection in their reconstructed breast.  This is typically a result of attempting to fully reconstruct breast tissue with abdominal tissue that will by nature be different from the unique anatomy inherent to each and every person.  These imperfections can be improved and possibly eliminated using additional techniques.  Patients frequently do require one to two revision procedure, which can be performed on an outpatient basis, ranging from surgical reshaping of the transferred tissue to fat grafting (insert hyperlink).

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