When you’re facing breast reconstruction surgery after mastectomy, there are usually two main options for how to construct new breasts: reconstruction with implants or reconstruction with your own tissue (natural tissue flap reconstruction). Within those broad reconstruction categories, there are additional choices to be made, but the first one is often the hardest and most critical. It will inform what comes next and can even impact which plastic surgeon you choose. Not all plastic surgeons perform natural tissue procedures. Recovery and long-term considerations also change. Natural tissue procedures are typically more complex. As you research, you may find yourself asking, what actually happens during a natural tissue breast reconstruction? Why would someone make this choice?
If it feels overwhelming to have yet another set of decisions to make, that’s OK. Whether you received a diagnosis or chose risk-reducing mastectomies, you have likely been through what feels like millions of doctor’s appointments, and sleepless nights spent down Google rabbit holes. Take a deep breath, and remember that all this new information is best taken in one piece at a time.
Read on for high-level information on what happens during a natural tissue flap procedure. We’ll go over the basics of what this form of reconstruction looks like, talk about why you might choose this option over implants, and go over the surgical process and potential risks.
What is natural tissue flap breast reconstruction, and why does it have so many names?
Natural tissue flap breast reconstruction is a type of breast reconstruction that uses your own tissue (skin and fat) to create a new breast. It is also called autologous reconstruction, flap reconstruction, and natural tissue reconstruction. These are all terms for the same thing.
During the procedure, a plastic surgeon takes tissue from your abdomen, thigh, back, or buttock and transfers it to the chest. This technique essentially allows you to donate tissue from another part of your body to create a new breast. That’s why the area the tissue comes from is called a donor site. That is also where the names get more complicated.
Individual natural tissue procedures have their own names. While autologous reconstruction refers to a broad reconstruction category, you may hear terms like “DIEP” and “TUG” in the breast reconstruction community. Those are specific types of natural tissue reconstruction. Flap procedures are named for the specific muscles and blood vessels in the donor site from which they come. Surgeons and patients use acronyms to avoid additional confusion.
What happens during natural tissue breast reconstruction surgery?
During the procedure, your surgical team will prepare both the donor site (the place where the tissue will come from) and the chest (where the tissue will become a new breast).
First, the flap is removed from the donor site. This step is called flap elevation. The tissue and blood vessels are carefully separated and prepared for transfer. Blood vessels in the chest are also prepared so they can be connected to the flap. Then, your plastic surgeon transfers (moves) the donor site tissue flap to your chest.
Once the flap is transferred, your plastic surgeon connects the blood vessels from the flap to the blood vessels in the chest to restore blood flow. Finally, they shape the donor tissue into a breast and secure it with sutures.
Where does donor tissue come from?
This tissue used in autologous breast reconstruction comes from the abdomen, thighs, back, buttocks, or some combination therein.
In general, abdominal-based flaps are the most common option because many patients have enough abdominal tissue to reconstruct one or both breasts. Abdominal tissue also reshapes well, and the abdominal donor site is relatively close to the chest, which means minimal repositioning in the operating room. Thigh flaps are often the next choice when the abdomen is not a good donor site. Back and buttock flaps are used less often, but they can be a good option in specific situations. Sometimes, your plastic surgeon will use a combination of donor sites, but that is unusual.
What are the benefits of natural reconstruction over implant reconstruction?
For some patients, flap reconstruction feels more like a natural breast, since it uses your own body part to create a reconstructed breast. It tends to be softer and warmer than implant reconstruction, which contributes to that feeling. Since there are no implants, there is no risk of implant movement (animation) or capsular contracture, and there is no long-term maintenance associated with the reconstruction.
That said, the best choice depends on your body, your treatment plan, and your personal preferences.
What are the downsides of natural reconstruction with flap surgery over implant reconstruction?
Like all types of breast reconstruction, natural tissue reconstruction may require multiple procedures. These are called stages and can include procedures like fat grafting. Later stage procedures are sometimes called revisions or secondary procedures. Natural tissue reconstruction often necessitates more procedures than implant-based reconstruction. Flap revision surgery can be done after the reconstructed breast has healed.
Compared to implant reconstruction, flap surgery is usually a longer, more complex operation and recovery. Because tissue is taken from another part of the body, it also creates a second surgical site that will need to heal. However, implants require maintenance down the line that natural tissue reconstruction does not.
