Table 5.

Common types of autologous (tissue-based) breast reconstruction

TYPESDEFINITIONIDEAL CANDIDATE
Pedicled flap

  • Pedicled TRAM

  • Rectus abdominis muscle

  • Soft tissue from lower abdomen similar in colour, texture, and longevity

  • Underlying rectus abdominis muscle is separated from its attachment to the pubis and flipped up onto the breast area along with the overlying skin and subcutaneous tissues

  • Healthy amount of excess abdominal tissue (not obese)

  • Unilateral

  • Latissimus dorsi

  • Versatile flap from back

  • Can be used with muscle alone or with overlying skin

  • Small amount of bulk

  • Thin patient (inadequate abdominal tissue)

  • Generally has significant skin damage from radiotherapy

Free flap

  • DIEP

  • Same tissue as pedicled TRAM but without sacrifice of underlying rectus muscle

  • Vessels dissected from muscle and microvascular anastomosis created to recipient vessels in chest

  • Healthy patients

  • Bilateral cases

  • Desire to harvest larger amounts of tissue

  • SGAP

  • Skin and fat from upper buttock

  • Reserved for unique cases (ie, inadequate abdominal tissue or previous failed abdominal tissue reconstruction)

  • TUG

  • Skin, fat, and small muscle from upper inner thigh

  • DIEP—deep inferior epigastric artery perforator, SGAP—superior gluteal artery perforator, TRAM—transverse rectus abdominis myocutaneous, TUG—transverse upper gracilis.