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Microsurgery and Perforator Surgery

These techniques involve using an operating microscope to connect blood vessels to give living tissue the blood flow it needs to survive.


Microsurgery and perforator surgery are techniques that allow highly skilled plastic surgeons to connect small blood vessels to establish blood flow to living tissue. Microsurgery is a specialized technique that requires additional training. It gives surgeons the ability to transplant a flap of tissue, called a free flap, from one part of the body to another.

Perforator surgery allows surgeons to transfer free flaps of skin and fat while preserving muscle. Surgeons can carefully select the best perforator vessels to feed a given flap, transfer it to the area of the mastectomy, and connect it to the blood vessels in that rea using microsurgical techniques.

Types of Microsurgery and Perforator procedures

Most current natural tissue breast reconstruction procedures depend on microsurgery or perforator surgery. Examples include:

DIEP flap

This type of breast reconstruction involves elevating a flap of skin and fat from the lower abdomen and transplanting it to the chest wall, leaving the abdominal muscles in place and intact.

TUG/PAP flap

This type of breast reconstruction involves bringing excess tissue from the inner thighs to the chest wall to create a breast.

LTP flap

This type of breast reconstruction uses excess tissue from the outer thighs to create a breast.

Procedure details:

  • A surgeon may use a CT angiogram to help identify perforator blood vessels before surgery
  • During the procedure, a flap of skin and fat is elevated while preserving muscle
  • Perforator vessels are separated from the underlying muscle using careful microsurgical technique
  • The flap is transferred to the chest wall
  • A surgeon uses an operating microscope to connect flap blood vessels to blood vessels in the chest
  • The area from which the flap was taken (donor site) is repaired. This repair often improves the contour in that area