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  • TRAM breast reconstruction

    The TRAM (transverse rectus abdominis muscle) flap procedure uses tissue and muscle from the tummy (lower abdominal wall) to create the new breast. The tissue from this area is often enough to shape the breast, without the need for an implant. This procedure takes a flap of skin, fat, blood vessels, and at least one abdominal muscle from the belly (abdomen) and moves it to the chest. A TRAM flap can decrease strength in your belly, and may not be possible for women who have had abdominal tissue removed during previous surgeries. The procedure also results in a tightening of the lower belly, or a “tummy tuck.

  • Pedicle flap: This type leaves the flap attached to its original blood supply and tunnels it under the skin to the breast area.
  • Free flap: With this type, the surgeon cuts the flap of skin, fat, blood vessels, and muscle away from its original location and then moves it to the chest, where they attach it to blood vessels in the chest. This requires the use of a microscope (microsurgery) to help connect the tiny blood vessels. This procedure takes longer than a pedicle flap and is not done as often. However, some doctors believe that it results in a more natural shape.
  • DIEP breast reconstruction

    A newer type of flap procedure, a DIEP (deep inferior epigastric artery perforator) flap uses fat and skin from the tummy (lower abdominal wall) to create the breast, but does not use the muscle. When skin and fat in the lower belly (abdomen) is removed, it results in a “tummy tuck.” This is a free flap method, meaning that the tissue is completely cut away from the tummy and then moved to the chest area, where it is connected to the blood vessels. This requires the use of a microscope (microsurgery) to help connect the tiny blood vessels. The procedure takes longer than the TRAM pedicle flap discussed above.

  • Latissimus breast reconstruction

    A latissimus dorsi flap procedure moves muscle, skin, fat, and blood vessels from your upper back to your chest. It is tunneled under the skin to create a pocket for an implant (used for extra fullness in the reconstructed breast).


  • Nipple reconstruction

    During a mastectomy, the nipple and areola are removed. Therefore, nipple and areola reconstruction represents the final stage of a complete breast reconstruction.

    Nipple and areola reconstruction is performed at a time when you and your surgeon are both happy with the final shape and size of the reconstructed breast. Depending on the type of nipple and areola reconstruction performed, this may be done either in the operating room or as an outpatient procedure in the surgeon’s office or minor procedures room. This procedure may be performed under local or general (fully asleep) anesthesia.

    Your surgeon may reconstruct your nipple by using a flap or a graft. Flaps are pieces of tissue that are moved from one location to another with their own blood supply intact. Grafts are pieces of tissue that are completely removed from their own blood supply and rely on the ingrowth of a new blood supply at the new site.

  • Flap reconstructions

    Your surgeon can use nearby tissue as a flap to reconstruct the nipple. The skin and some subcutaneous (just under the skin) fat is gathered from areas surrounding the new nipple location and then stitched together to create a new nipple.

  • Graft reconstructions

    The location of the new areola is marked and the skin in that area is removed. Your surgeon then cuts a split-thickness skin graft (contains multiple layers of the skin, including the epidermis and part of the dermis) from the donor skin site. The most common donor sites include the upper inner thigh and the inner gluteal (buttocks) crease, as these areas tend to provide an acceptable color match. In some patients who have breast reduction surgery to the natural breast, can use a portion of that breast’s areola. The graft is then stitched in place and the donor site is closed..