Breast reconstruction with autologous tissue method (from our own body) is the most modern and most complex technique in the field of breast reconstruction after mastectomy.
This method provides breast reconstruction without the use of silicone implants.
The most common method of breast reconstruction with autologous tissues is the one in which we remove tissue and muscle from the tummy (the lower abdominal wall) and transfer it to the chest where we create the new symmetrical and healthy breast (TRAM: transverse rectus abdominis muscle).
There are three different types of TRAM methods:
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A pedicle TRAM flap.
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A free TRAM.
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The DIEP (deep inferior epigastric perforator) flap.
It has to be mentioned that the planning and results are similar in all the techniques. The differences among them are detected in the technical surgical details and surgical handling of the donor area in order for the patient to have the slightest possible burden on abdominal wall after taking the flap.
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In cases of a non-skin sparing mastectomy we perform a pedicle TRAM flap. In this method we transfer tissue from the lower abdominal area (skin and fat) and place it to the mastectomy area where we have the formation of the new breast.
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In cases of skin sparing mastectomy we use only the fat tissues of the abdominal area- since the skin is in place- providing a totally natural result.
In this method the receiving of fat and skin of the lower abdomen is based on the perfusion of the rectus abdominis muscle which is attached to the lower section of the flap and is transferred as a stem.
The method gives a natural result without the use implants. The main disadvantage of this method is the loss of abdominal rectus muscle of the abdominal wall which can cause the weakening of the anterior abdominal wall and the development of postoperative hernia.
Usually, when the procedure of the TRAM flap is performed, a grid is used is used to reinforce the abdominal wall.
The surgery
It is performed under general anesthesia, and if we need to simulate the other breast, we perform abdominoplasty at the same time.
The duration of the operation is longer than the other methods because two extra surgical operations are performed, the patient remains hospitalized 5 to 6 days.
The patient returns to daily activities after 15 days.
In conclusion
It concerns women with abdomen looseness and provides breast reconstruction without the use of silicone implants and abdominoplasty at the same time.
The results are long lasting, we avoid the complications of implants (capsule formation, infections) and no other surgical operation is of need.
It is a method recommended and used in many countries of Europe and North America.
Free Tram Sparing, Diep
Both methods involve breast reconstruction carried out with the use of the modern microsurgical technique.
Mainly both techniques are similar in planning and in the postoperative results.In Free Tram sparing only a very small part of the rectus abdominis muscle is used without causing any functional issues or weakening the anterior abdominal wall.
In DIEP method we do not receive any part of the rectum abdominis muscle except from the vessels which are attached on the belly flap.
The result of this method does not effect the functionality of the anterior abdominal wall.
The free tissue transfer from the abdominal area for a breast reconstruction cannot be performed at all hospitals and by all plastic surgeons.
It is performed in a specialized hospital for breast reconstruction as well as by specialized plastic surgeons who are experts in breast reconstruction with microsurgical techniques.
The surgery
The surgery is performed in a specialized hospital that has facilities for the performance of microsurgical operations.
The surgery has a longer duration than the other breast reconstruction surgeries, but this is difficult for the patient to see.
Taking flap and performing revascularization are made by the use of a microscope.
The surgery is combined with an abdominoplasty and if the assimilation of the other breast is necessary.
The patient remains in hospital for 6-7 days and returns to daily activities after 2 weeks.
Recovery after a free tissue transfer from the buttocks S- GAP
It is a reconstructive method in which a part of the gluteal area is used as a donor instead of the abdominal area.
Breast reconstruction is performed by gluteal tissue transfer where we have free transfer and microvascular anastomosis of the flap.
After flap removal there is a scar in the gluteal area which is quite visible and that is the reason that the specific method is not widely used.
In conclusion
It is the most modern breast reconstruction method with a long lasting and beautiful aesthetic result.
The main disadvantage of the method is the high cost and long operative and hospitalization time.
Nevertheless, free tissue transfer from the abdomen (DIEP) is the procedure of choice in many breast reconstruction centers in Europe, North America and at our clinic the Metropolitan Hospital.
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