Flap surgery - breast reconstruction using your own tissue
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:
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.
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
- 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.
- 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.
Loss of part or all of the reconstructed breast
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.
Below is a sample of the sources used in our breast cancer information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
European Society for Medical Oncology. Primary breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Annals of oncology 26 (supplement 5): v8–v30. 2015.
Morrow M, et al. Chapter 79: malignant tumors of the breast. DeVita, Hellman and Rosenberg’s cancer: principals and practice of oncology (10th edition). Lippincott Williams and Wilkins. 2014.
National Institute for Health and Care Excellence (NICE). Early and locally advanced breast cancer: diagnosis and management. July 2018.
Scottish Intercollegiate Guidelines Network. SIGN 134. Treatment of primary breast cancer: a national clinical guideline. September 2013.
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Rebecca Roylance, Consultant Medical Oncologist.
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