A “flap” refers to the transfer of tissue from one part of the body to another. There are two main types of flaps in breast reconstruction, pedicled flaps and free flaps. A pedicled flap remains attached to its native blood supply whereas a free flap is disconnected from its original blood supply and transferred to another part of the body where the blood vessels are connected to a new blood supply.
There are two main types of pedicled flaps that are used for breast reconstruction, the latissmus dorsi flap (LD flap) and tranverse rectus abdominis muscle flap (TRAM flap). Both of these flaps utilize the muscle and overlying fat and skin to create the new breast.
In the LD flap, the latissismus dorsi muscle is utilized which is located in the mid/lower back. It is the muscle utilized in “pull downs.” Most women will not notice any long term weakness with using this muscle for breast reconstruction because there are other muscles in the shoulder that are able to compensate, but people who perform activities such as swimming or cross country skiing may want to consider alternative methods of reconstruction. The scar from the LD flap can be placed in a horizontal line (hiding it in the bra strap line) or obliquely across the mid back.
In the TRAM flap, the rectus abdominis muscle (the six pack muscle on the abdomen) is utilized. It is possible to have some weakness with activities that require use of these muscles. Additionally, bulging of the abdominal wall or hernias are a potential complication. Sometimes a piece of mesh is placed to help prevent abdominal bulging or hernias. The scar lies transversely in the lower abdomen where it is usually easily hidden by underwear.
Tissue expanders or implants can also be placed in conjunction with pedicled flaps to give a patient additional volume. Pedicled flaps are usually utilized as a salvage procedure when there are complications from an earlier reconstruction or when a large amount of skin has to be resected during the mastectomy. Sometimes they are used when patients would like a reconstruction using only their own tissue but do not wish to undergo a free flap.
The surgery for an LD or TRAM flap usually takes about 3 hours to perform. Usually patients are in the hospital for 1-2 nights after an LD or TRAM flap.
Free Flap Reconstruction
Dr. Elswick does not perform free flap reconstruction.