The most attractive and most natural method of breast reconstruction is that using the body's own endogenous tissue. Its greatest advantage is that grafting of foreign material, such as a breast implant, can be avoided. Microsurgical techniques allow reconstruction of the breast with endogenous tissue derived from various regions of the body:
Breast Reconstruction using abdominal tissue (DIEP, TRAM)
In our clinic this surgical method is the most common for reconstruction of the breast, for this type of reconstruction achieves the most natural result. It is based on the concept that like is replaced as like as possible. It follows that abdominal skin and adipose tissue correspond most closely to breast tissue. Of course, a prerequisite is the presence of an adequate amount of abdominal tissue. With the standard technique used, the fatty tissue of the abdomen is freely transplanted i.e. a portion of skin and adipose tissue together with its vascular supply is excised and then, with the aid of a microscope, connected microsurgically to the recipient vasculature in the chest.
For better visualization of the small vessels we often perform a preoperative computer-assisted tomography (CT) with contrast. This allows early preoperative selection of the preferred vessels, simplifies intraoperative search and ultimately patient safety. To achieve the best possible esthetic result, incision sites and measurements of critical landmarks are charted on each patient.
Breast reconstruction with thigh (femoral) tissue (TMG, PAP)
The so-called transversal myocutaneous gracilis muscle flap (TMG) consists of a portion of the upper thigh musculature including overlying skin and fat tissue. This method also provides a very natural-looking result with an inconspicuous scar positioned in a natural body fold (inner thigh/groin fold). The operation is best suited for slender patients with small breasts. As with the DIEP flaps, the vascular supply of the flap is harvested, then transplanted together with the entire muscle-skin-fat island and sutured to the recipient vessels under microscopic magnification. The anatomy of the three components (muscle, skin, and fat) allows the individual adjustment of the flap to the contralateral side and configuration of the flap into an autologous implant. It is also possible, when needed because of the illness, to build up both breasts simultaneously in an operation using this technique.
Sometimes it is also possible to prepare a skin-and-fat flap with including muscle tissue (PAP). For patients, a great advantage of this method consists in the unobtrusive placement of the scar and the simultaneous tightening of the upper thigh, similar to an inner thigh lift. There is no expected limitation of inner thigh function since there are a number of other muscles in this area. Occasionally there will be sensory disturbance of the dorsal upper thigh for a few months. After six months, tissue healing is complete. In most cases, the tissue then reaches a definitive contour, so that corrective procedures such as mastopexy to match the contralateral breast, or nipple reconstruction can be performed.
The operation takes place under general anesthesia. Hospital stay is around six to ten days. Risks and complications are similar to those of other types of breast reconstruction (see DIEP) with free flaps. Occasionally impaired wound healing can occur at the harvest site. Patients should not perform extensive spreading of the leg during the first five days, so that wound healing will be cosmetically attractive and stable. Prolonged sitting should also be avoided during the first two weeks. Compression hose and support bra should be worn for approximately two to three months.
Breast reconstruction using gluteal tissue (SGAP, IGAP, FCI)
Another alternative is the use of gluteal tissue. During buildup with gluteal tissue, skin and fat are harvested from the upper buttock/hip region. This tissue is perfused by the superior (SGAP: Superior Gluteal Artery Perforator), or inferior (IGAP: Inferior Gluteal Artery Perforator), gluteal artery. A further option is the so-called fasciocutaneous infragluteal flap (FCI). Gluteal tissue is somewhat more difficult to transplant, but constitutes an alternative when there is too little abdominal fatty tissue, or when vascular supply is absent due to previous surgeries. Here, a second operation may be required to match the contralateral buttock.
Follow-up care is at first more comprehensive. Patients will spend from seven to ten days in hospital. Also, a supportive brassiere must be worn for about three months. In addition, sedentary restriction should be observed for approximately three weeks in order to facilitate proper wound healing of the buttocks/gluteal region.