What are the Options for Breast Reconstruction Using Tissue from the Abdominal Wall?

  • Women seeking options for breast reconstruction for mastectomy should be offered the option of using tissue from the abdominal wall for unilateral or bilateral breast reconstruction. For patients desiring a more natural reconstruction, with the best cosmetic appearance and texture, the abdomen is a very good option.

    Many women develop excess skin and fat on their lower abdomen as they age and after pregnancy. In this region of redundant tissue the vascular anatomy is well described and skin and fat with or without muscle can be harvested and transferred to reconstruct the breast. The different options offered to patients are based on different methods of dissecting and transferring this tissue based on abdominal wall anatomy. When a block of tissue on the lower abdomen is surgically created based on a defined blood supply it is termed a “flap.” Transferring this flap from the abdomen to the mastectomy site is performed either by cutting the blood supply and reattaching it to blood vessels on the chest wall using a microscope (free flap) or by leaving the blood supply intact and tunneling the flap under the upper abdominal wall to the mastectomy defect (pedicled flap). With this in mind, the possible options for breast reconstruction using the lower abdomen include:

    1. Pedicled T.R.A.M (Transverse Rectus Abdominus Myocutaneous) Flap. In this option, the blood supply is left intact and the lower abdominal tissue is tunneled under the upper abdominal skin to the mastectomy site.
    2. Free muscle sparing TRAM. The major blood supply leading to the flap is cut, a portion of the abdominal muscle is taken with the flap and carried to the chest wall where the blood vessels are reattached using a microscope to
      the blood vessels existing in the mastectomy site.
    3. Free D.I.E.P. (Deep Inferior Epigastric Perforator) flap. The Major blood supply leading to the flap is cut but the blood vessels leading to the abdominal skin and fat are carefully dissected through the muscle. The muscle is left on the abdomen while the flap is carried to the mastectomy site and the blood vessels reattached.
    4. Free S.I.E.A. (Superficial Inferior Epigastric Artery perforator) flap. A different blood supply leading to the lower abdominal wall is used to supply the flap, the “superficial system”. No muscle is harvested and recovery is faster. Not all patients can have this procedure due to significant variability of the superficial blood supply in patients.

    The best results will come from an experienced surgeon. Surgeons trained in microvascular surgery are especially adept at reconnecting blood vessels and routinely perform the free muscle sparing TRAM, free DIEP flap, and free SIEA flaps. These flaps have been shown to preserve abdominal wall function and can create exceptional natural results.