For many women receiving surgery for breast cancer[MB1] , breast reconstruction is an option. Flap procedures (also known as autologous tissue reconstruction) are a type of breast reconstruction [MB2] that uses the patient’s own tissues to help rebuild the breast. The most common types of flap procedures are a transverse rectus abdominus muscle (TRAM) flap, deep inferior epigastric perforator (DIEP) flap, latissimus dorsi flap, gluteal artery perforator (GAP) flap (also known as gluteal free flap), and transverse upper gracilis (TUG) flap. TRAM and DIEP flaps use tissues from the stomach, latissimus dorsi flaps use tissues from the upper back, GAP flaps use tissues from the buttocks, and TUG flaps use tissues from the inner thigh.[1]

            During a TRAM flap procedure, the fat, skin, blood vessels, and at least one muscle is taken from the stomach. This can function as a tummy tuck by removing fat from the stomach, but it can also decrease the strength of the muscles in the stomach. A TRAM flap procedure may not be possible for very thin women or women who have had stomach tissue removed in the past. A pedicle TRAM flap leaves the flap attached to its original blood supply and connects it under the skin to the chest, while a free TRAM flap completely removes the blood vessels and reattaches them to blood vessels in the chest. Pedicle TRAM flaps have an increased risk of hernia and/or bulging, while the main risk with free TRAM flaps is blood vessels getting clogged and the flap not working. However, free TRAM flaps tend to get better blood supply than pedicle TRAM flaps, and the donor site typically has a better cosmetic appearance. The free TRAM flap procedure takes longer than the pedicle TRAM flap procedure because the surgeon must go in with a microscope and connect the tiny blood vessels.[1]   

            A DIEP flap uses the same skin and fat used in a TRAM flap procedure but does not remove any muscle. This procedure uses a free flap technique and has less of a change of hernia and/or bulging because no muscle is removed. Superficial inferior epigastric artery (SIEA) flap is a similar procedure that uses the same tissues as a DIEP flap but different blood vessels. A latissimus dorsi flap is typically used in combination with a breast implant. This procedure uses a pedicle flap to attach the fat, skin, blood vessels, and muscles from the upper back to the chest. This procedure can add additional coverage to an implant, making the breast look more natural. A latissimus dorsi flap is sometimes used without an implant as well. In rare cases, women who have this procedure may experience back, arm, or shoulder weakness.[1]

GAP flaps and TUG flaps are typically options for women who cannot or do not want to get tissue removed from their stomach, but these procedures are not offered at all surgical centers. A GAP flap uses a free flap technique to remove fat, skin, and blood vessels from the buttocks and reattach at the chest. No muscle is removed during a GAP flap procedure. A TUG flap also uses a free flap technique by removing fat, skin, blood vessels, and muscle from the area between the bottom fold of the buttocks and the inner thigh and reattaching at the chest. Profunda artery perforator (PAP) flap is a similar procedure to a TUG flap except no muscle is removed. Women with larger thighs that touch together are better candidates for TUG and PAP flap procedures because there is more tissue to be used. For women with larger breasts, an implant may need to be used in addition to these procedures to match the size of the reconstructed breast to the opposite breast. The location of the donor site can cause minor problems with healing that can be easily treated.[1]

 [MB1]Link to ‘surgery’ article

 [MB2]Link to ‘types of breast reconstruction’ article

References

1.     Breast Reconstruction Using Your Own Tissues (Flap Procedures) https://www.cancer.org/cancer/breast-cancer/reconstruction-surgery/breast-reconstruction-options/breast-reconstruction-using-your-own-tissues-flap-procedures.html (accessed Jun 28, 2021).