Breast reconstruction using free-flaps - after risk-reducing mastectomy

In a free-flap reconstruction, the skin and fat is completely removed from the original area and reconnected to a new blood supply using microsurgery. This involves rejoining arteries and veins that are only 2–3mm in diameter, using an operating microscope. Blood vessels from the armpit, or near the breast bone (sternum) are used to create a new blood supply for the tissue that has been moved to the breast.

A number of different types of free flap can be used for breast reconstruction. This is very specialised surgery and is done by plastic surgeons. These operations usually take about 6–8 hours.

Free TRAM flap Back to top

This uses the same skin and fat from the lower abdomen as the pedicle TRAM flap|, but less of the muscle is taken. Once the blood vessels are joined up, the blood supply is better than the pedicle TRAM flap because the blood doesn’t have so far to flow in and out of the new breast. It’s possible to make a larger breast using this technique and the appearance is usually very good. However, some muscle is still taken from the abdominal wall and it is still necessary to repair it with mesh to prevent hernias and bulges.

Both breasts have been reconstructed using free TRAM flap
and nipple reconstruction

As with the pedicled flap, a free TRAM flap may not be a suitable operation for women who are diabetic, heavy smokers or very overweight. It may also not be suitable for women who have previously had certain types of abdominal surgery.

Free TUG flap Back to top

TUG stands for transverse upper gracilis. This is a relatively new operation suitable for women who are slim and who desire small breasts. It uses tissue from the upper inner thigh, including some of the gracilis muscle. The tissue is removed and attached to the breast area using microsurgery. The scar is quite long but it is well hidden as it as at the top of the leg. Sometimes there can be a problem with fluid building up in the wound area (seroma|).