Also called Autologous Tissue Reconstruction, flap reconstruction is a procedure that takes healthy tissue, taken from skin, fat or muscle, from one part of your body to another. Flap means that healthy tissue is rotated into the wound either regionally locally or remotely (free flap, microsurgery).
With flap reconstruction, full-thickness tissue is being used as opposed to a skin graft. Local tissue can be moved into the wound to optimize function and appearance. Flap reconstruction is most used to help women who have had breast tissue removed or a mastectomy but can help with the reconstruction of extremities, torso, nerves and facial features. There are several options and types of flap reconstruction or surgery.
Who is a candidate for flap reconstruction?
Candidates for flap reconstruction include patients who:
- Have undergone a mastectomy after breast cancer
- Need structures of their face or facial feature rebuilt
- Have had Mohs surgery
- And more
What can you expect from flap reconstruction at BRCA?
At BRCA, our surgeons work closely with patients to develop a care plan that begins during the acute phase of their care, reducing delays in reconstruction and improving outcomes. By choosing flap reconstruction, patients can expect a more natural appearance and feel, and a lower risk of tissue rejection and other complications.
Types of flap reconstruction:
DIEP (deep inferior epigastric perforator) is a procedure to reconstruct the breast using skin, fat, and blood vessels of the lower abdomen. Muscle is not removed like in a TRAM flap. Instead, a microscope is used to connect the blood supply of the tissue removed from the abdomen to the chest blood vessels. Because the tissue is completely detached from the belly and transferred to the chest area, this is known as a free flap. DIEP flap reconstruction can be used for immediate or delayed reconstruction.
Latissimus muscle flap
Latissimus muscle flap breast reconstruction has been available since the 1970s. The latissimus dorsi muscle is the muscle that lies in your back. If you stand against a wall and push with your hands, you can contract this muscle. An expander or sometimes a permanent implant is almost always required with this type of reconstruction. This is an excellent type of reconstruction for patients who continue to smoke or who are overweight and have a droopy opposite breast.
Perforator flaps represent the newest advance in breast reconstruction. These flaps are based on a single blood vessel and do not require the removal of a muscle to supply the skin and fat. Instead, microsurgical techniques are needed to connect the very small blood vessels of the flap to blood vessels in the axilla or usually ribs. This technique usually takes longer than other techniques. Any patient who is a candidate for tissue reconstruction is a candidate for perforator flap reconstruction.
The TRAM (transverse rectus abdominis flap) has been the mainstay of breast reconstruction since the 1980s. It involves using abdominal tissue (skin and fat; same as removed in a tummy tuck) based on the rectus abdominus muscle (pedicled TRAM). Variations of the tram flap include the “Free” tram, which involves using only a small part of the rectus muscle- “muscle-sparing”- to provide the same tissue but minimize the impact on the abdomen.