After a mastectomy for breast cancer, you may choose to have your breasts reconstructed. Free-flap breast reconstruction uses your body's skin, fat and blood vessels to recreate your breasts. This complex microsurgery procedure is also called autologous tissue reconstruction.
Penn Medicine is the nation's leader in free-flap surgery for breast reconstruction, performing more procedures than any other health care system in the United States. We also developed an innovative, minimally invasive type of free-flap procedure that can cause less pain and faster recovery.
Free-Flap Surgery for Breast Reconstruction: The Penn Medicine Difference
If you choose free-flap breast reconstruction after mastectomy, you can count on Penn for:
- Education for informed choices: We educate you about autologous tissue reconstruction and its advantages and disadvantages according to your situation. You can also talk with other patients who have had breast reconstruction in our Peer-to-Peer Telephone Program.
- Revolutionary procedure: One of our plastic surgeons developed a new breast reconstruction technique called minimally invasive deep inferior epigastric perforator (mi-DIEP) flap. This procedure uses tiny incisions, often resulting in less pain and faster recovery.
- Unmatched microsurgery experience: Penn performs more microsurgery free-flap breast reconstruction procedures than any other program in the nation. Our experience and expertise mean you are in good hands for the best possible results.
Types of Flap Breast Reconstruction Using Your Own Tissues
Penn is the nation's leader in microsurgery, a complex procedure that uses autologous (your body's own) tissue for reconstructing breasts. In free-flap surgery, your surgeon frees tissue from its original location and blood supply and then transfers and connects it to the blood supply in the chest. We are experts in all types of free-flap breast reconstruction, including:
Free-Flap Reconstruction from the Lower Abdomen
In this procedure, your surgeon takes belly fat and blood vessels to reconstruct your breast. Types of free-flap reconstruction using abdominal tissue include:
- Free transverse rectus abdominis myocutaneous (TRAM) flap surgery: In this procedure your surgeon transfers skin, fat, blood vessels and a small piece of muscle to the breast area.
- Deep inferior epigastric perforator (DIEP) flap surgery: Your surgeon creates an incision in the abdominal muscle to take fat and blood vessels (but not muscle) from the lower abdomen.
- Minimally invasive deep inferior epigastric perforator (mi-DIEP) flap surgery: A Penn surgeon developed this innovative procedure that uses tiny laparoscopic incisions in the abdominal muscle to reach belly fat and blood vessels underneath. Small incisions can mean less pain, less need for narcotic drugs to manage pain and a faster recovery.
- Superficial inferior epigastric artery (SIEA) flap surgery: Your surgeon takes skin, blood vessels and fat from the top of the muscle and makes no incisions to the muscle.
Free-Flap Reconstruction from Other Areas of the Body
Penn surgeons are also experienced at transferring tissues from the buttocks or inner thigh. Procedures include:
- Superior gluteal artery perforator (S-GAP) flap surgery: This surgery takes tissues from the upper portion of your buttocks.
- Inferior gluteal artery perforator (I-GAP) flap surgery: This procedure uses the lower portion of your buttocks.
- Profunda artery perforator (PAP) flap surgery: This procedure uses a blood vessel, skin and fat from the back of the inner thigh.
- Transverse upper gracilis (TUG) or transverse myocutaneous gracilis (TMG) flap surgery: This surgery transfers tissue from the upper portion of your thighs.
Advantages of Free-Flap Breast Reconstruction
Breast reconstruction using your own body tissue has many advantages, including:
- A natural-looking result with tissue that changes as your body changes
- A pleasing cosmetic outcome — your surgeon may take tissue from the abdomen, buttocks, inner thigh or back
- Better tolerance of radiation for breast cancer, if you need that type of treatment
- No future surgeries to replace the breast reconstruction material. Breast implants with silicone or saline require periodic replacement.
Disadvantages of Free-Flap Breast Reconstruction
Some disadvantages of free-flap breast reconstruction include:
- A breast size that depends on the amount of fat tissue you have. Conversely, artificial implants have many predictable sizes and shapes.
- Longer time in surgery and recovery than with implant reconstruction
- Potential risk of a hernia
- Multiple incision sites and multiple scars since this procedure surgically removes tissue from another area of the body
If free-flap breast reconstruction is not right for you, learn about other breast reconstruction options offered by experienced plastic surgeons at Penn Medicine.
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