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Summary: Flap breast reconstruction remains one of the top choices for an improved breast appearance following breast cancer treatment. By using tissue from the patient’s body rather than implants alone, the reconstructed breast looks and feels a lot like a natural breast. However, breast reconstruction is a complex, involved surgery that needs the skill of an experienced plastic surgeon for the best results. Here’s a closer look at the process.

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By Dr. Elisabeth Potter

An Explanation of Flap Reconstruction

When performing a flap reconstruction, your surgeon transfers tissue from one area of the body to the breast, reshaping it into a breast mound. There are a few different options when it comes to flap reconstruction:

  • DIEP Flap Reconstruction: Deep inferior epigastric perforator (DIEP) flap reconstruction uses skin and tissue from the abdomen to form a new breast. The donor tissue is entirely separated from the abdomen, and the blood vessels are reattached using advanced microsurgery techniques to ensure a healthy blood supply to the transplanted tissue. A variation of this is superficial inferior epigastric artery (SIEA) flap reconstruction. Although similar to DIEP flap reconstruction in the sense that tissue from the lower abdomen is used, SIEA flap reconstruction uses blood vessels just below the skin rather than those located in the abdominal musculature. This option is limited by a woman’s anatomy, and may not be possible in every patient.
  • MS TRAM Flap Reconstruction: Muscle-sparing transverse rectus abdominis myocutaneous (MS TRAM) flap reconstruction also uses skin and tissue from the abdomen, but includes the removal of a small amount of muscle as well. This can result in a loss of some amount of abdominal strength, which is why DIEP flap reconstruction is often preferable.
  • MS Lat Flap Reconstruction: Muscle-sparing latissimus dorsi myocutaneous (MS Lat) flap reconstruction uses tissue and a small amount of muscle from the upper back to recreate the breast mound. This option is most often reserved for women with insufficient abdominal tissue to use for reconstruction. Although there may be some muscle weakness after surgery, it’s typically not noticeable unless participating in extreme sports like rock climbing.
  • TAP Flap Reconstruction: Thoracodorsal artery perforator (TAP) flap reconstruction (sometimes also called TDAP flap reconstruction) rotates a tissue flap from the upper back to the chest wall, without taking any muscle. The existing blood vessels are left in place rather than reattached later. Since there is only a small amount of available tissue in this donor area, TAP flap reconstruction is often used for restoring breast contours following a lumpectomy, or in combination with a small implant or another type of flap reconstruction.

What Makes DIEP Preferable?

DIEP flap breast reconstruction surgery has several advantages over other forms of flap reconstruction, as well as implant-based reconstruction.

First, because DIEP flap reconstruction does not take any muscle from the abdomen, there is a reduced chance of resulting hernia or abdominal weakness. A hernia could require a second surgery to repair, while muscle weakness can interfere with a patient’s daily activities once she is fully healed. Another benefit is that the incision used to collect the donor tissue can be placed quite low on the abdomen, similar to a scar from a tummy tuck that can be hidden by a bikini bottom.

Because no muscle is removed, women often find they have a faster and more comfortable recovery. In some cases, the reconstructive surgery can take place at the same time as the mastectomy itself, bypassing the need for a second surgery. Compared to implant-based reconstruction, flap reconstruction has the primary advantage of lifetime results, plus the look and feel of actual breast tissue.

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