Autologous Breast Reconstruction

One popular option for breast reconstruction involves the use of a patient’s own tissues to recreate the breast completely following mastectomy. 

Known as autologous tissue reconstructions, these procedures have the ability to provide patients with permanently reconstructed breasts. And, as compared to implant-based techniques, these procedures avoid potential implant-related complications in the long term. This method of breast reconstruction has been used in one form or another for nearly a century but has excelled recently with the advent of, and improvement in, microsurgical technique.

Autologous breast reconstruction is typically performed using patient’s excess abdominal tissue to recreate tissue lost as a result of mastectomy. This is done by using a patient's abdominal tissue in a technique known as the pedicled TRAM flap. TRAM stands for transverse rectus abdominus myocutaneous and signifies the direction of tissue resection (transverse) and the muscle that provides the blood supply to that tissue. Pedicled describes the way the tissue is transferred, namely with the muscle still attached to its underlying blood supply. During this procedure, the entirety, or majority, of the muscle(s) is transferred along with the desired skin and fat in order to keep the reconstruction alive. Though a very reliable technique, 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 abdominus muscle (MS TRAM) or no muscle at all (DIEP). These techniques results in increased reliability of the transferred tissue and decreased negative effects on the abdominal wall by completely removing the abdominal tissue from the belly button to the groin crease with blood supply intact. The tissue is then transferred to the mastectomy defect where its blood supply is reconnected to vessels in the chest. Once tissue survival is assured, the patient can enjoy a permanent reconstructive solution.

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 the 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 be different from the unique anatomy inherent to every person. These imperfections can be improved and possibly eliminated using additional techniques. Patients frequently benefit from one to two revision procedures, which can be performed on an outpatient basis, ranging from surgical reshaping of the transferred tissue to fat grafting.