About flap reconstruction

Flap reconstruction is a type of breast reconstruction that uses your own tissue. It is more complex than implant reconstruction. It involves moving a flap of skin, fat and sometimes muscle from another part of your body to your chest wall. This creates a breast shape. The flap is taken from a part of your body called the donor site.

Most flap reconstructions use tissue from the tummy (abdomen). But surgeons can also use tissue from the:

Blood supply

The reconstructed breast needs a good blood supply to keep it healthy. There are two ways a surgeon can do this.

Free flap reconstruction

With a free flap reconstruction, the surgeon takes a flap of tissue from another part of your body. They disconnect it from its blood supply. They then move the flap of tissue to your chest and connect it to a new blood supply there.

It is complex surgery. It is only done by plastic surgeons in specialist units.

  • Most breast reconstructions using tissue from the tummy are free flap reconstructions.
  • All reconstructions using tissue from the buttock or thigh are free flap reconstructions.

Pedicled flap reconstruction

With a pedicled flap reconstruction, the surgeon takes a flap of tissue from your back or tummy. They keep it connected to its original blood supply. They then tunnel the tissue and its blood supply under your skin and out onto your chest.

  • All reconstructions using tissue from the back are pedicled flap reconstructions.
  • Some reconstructions using tissue from the tummy are pedicled flap reconstructions.

Who might it be suitable for?

Reconstruction using your own tissue may be suitable if you:

  • do not want a breast implant
  • have had or need radiotherapy as part of your treatment
  • want your breast to have a more natural shape and feel
  • cannot have an implant or tissue expansion because the chest skin and muscle are too tight
  • have large or droopy breasts and do not want your breasts to be smaller.

Flap reconstructions, especially free flap operations, may not be suitable if you:

  • have health problems such as diabetes
  • are very overweight
  • smoke.

What are the benefits?

  • It gives a more natural shape, movement and feel to the reconstructed breast.
  • It is suitable for all breast shapes.
  • It can create a breast with a more natural droop.
  • The reconstructed breast will change as your body changes over time. It may put on weight or lose weight as you do.
  • The reconstructed breast is more likely to look the same as your other breast over time. This means you are less likely to have to consider further maintenance breast surgery in the future.
  • You can often avoid having an implant.

What are the limitations?

  • You will have a scar on the part of your body that the tissue flap is taken from.
  • You may have a patch of skin or circle of skin on the reconstructed breasts. This patch of skin comes from a different part of your body. Because of this, it may be a different texture and colour from the breast skin. Your breast surgeon will be able to give you more information about this.
  • It involves having surgery to another part of your body to remove the skin flap.
  • You will have a longer operation, hospital stay and recovery.
  • Reconstructed breasts have less sensation than the original breasts. They may feel numb.

What are the risks?

With any operation, there are risks, such as infection. There are also some specific risks with this type of reconstruction.

Second operation

Your surgeon and nurses will check the reconstructed breast for a few days after the operation. They will want to be sure that the breast has a good blood supply. If there are any signs of a problem during this time, you may need another operation so they can check it. This is to make sure the reconstructed breast tissue stays healthy and heals well.

Loss of part or all of the reconstructed breast

Most operations are successful. But occasionally some or all of the tissue dies soon after the operation. This can happen if the reconstructed breast does not have a good blood supply. If this happens, you may not be happy with the appearance of your breast. If you want to improve the appearance of your breast, you may need another operation.

Fat necrosis

Fat necrosis can cause a firm lump in the reconstructed breast. It can happen when fatty tissue does not have a good enough blood supply.

Small areas of fat necrosis can often be absorbed by the body over time. But some women need surgery or liposuction to remove the area of fat necrosis. This will improve the appearance of the breast. But it can leave a dent in the reconstructed breast. The appearance can be improved by injecting fat into your breast (lipomodelling).

If you feel a lump in your reconstructed breast, you should always get it checked.

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