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Autologous breast reconstruction
Autologous breast reconstruction uses the woman’s own body tissues (fat and muscle) that are collected from other parts of her body to create a new breast. The reconstructed breast has a more natural feel than a breast implant.
There are different types of tissue techniques used for autologous breast reconstruction.
The TRAM flap is the most common technique used for breast reconstruction. It uses muscle (transverse rectus abdominis muscle or TRAM), fat and skin tissue from a woman’s abdomen to reconstruct the breast.
During the surgery, the tissue flap may either be:
- completely removed from the abdomen and formed into a breast mound
- left attached to its blood supply and moved underneath the skin up to the chest wall
A LATS flap uses muscle (latissimus dorsi), fat and skin from the back. The flap is moved under the skin to the mastectomy site and remains attached to its original blood supply. An implant is also used for women who need a larger breast.
This technique also adds fullness to the lower part of the breast, which helps to create a natural looking breast.
DIEP stands for deep inferior epigastric artery perforator. With a DIEP flap, skin, fat and blood vessels (but not muscle) are removed from the abdomen and placed under the skin on the chest to form a breast.
Because the muscle in the abdomen is left in place with the DIEP flap method, there is less potential for weakening of the abdominal muscles than when muscle is removed during a TRAM flap.
A free flap procedure uses skin, fat, muscle and blood vessels from one area of the body, such as the abdomen (TRAM flap) or from the buttocks (gluteal free flap). These tissues are placed under the skin on the chest to create a breast.
The free flap method is not used very often and needs a plastic (reconstructive) surgeon skilled in microsurgery to reconnect tiny blood vessels to the flap in the new breast location.
Side effects can occur with any type of autologous breast reconstruction, but not everyone has them or experiences them in the same way. The side effects are similar for the different types of flap surgeries. Side effects of autologous breast reconstruction will depend mainly on the:
- type of surgery
- site of the donor tissue
- woman’s overall health
- Women who are diabetic or obese may have more side effects.
- breast size
- Women with larger breasts may have more side effects.
- effect of other cancer treatment
- There may be a higher number of complications in women who have had radiation therapy to the chest.
It is strongly recommended that women who smoke stop at least 3 months before and 1 month after having an autologous breast reconstruction. Smoking affects blood flow to the skin and underlying tissues, which can lead to infection, delayed healing and increase the risk of dead tissue in the flap (flap necrosis). Many surgeons will not offer reconstruction to women who do not quit smoking.
Side effects can happen any time during autologous breast reconstruction. Some may happen during, immediately after, or a few days or weeks after surgery. Most side effects go away after surgery. Late side effects can occur months or years after surgery. Some side effects may last a long time or be permanent.
It is important to report side effects to the healthcare team.
Some potential side effects of autologous breast reconstruction include:
- infection and bleeding after surgery
- scars on the abdomen, back and reconstructed breast
- Scars will fade over time but may never completely go away.
- buildup of fluid (seroma) where the tissue was removed
- dead tissue (flap necrosis)
- Muscle, skin or fat tissue may not survive if there is a poor blood supply to the reconstructed breast.
- Depending on how bad the circulation problem is, it may take a long time for the reconstructed breast to heal or the reconstructed tissue may have to be removed.
- uneven breast size and appearance
- possible weakness (hernia) of the abdominal wall (particularly with TRAM flap)
- skin used in a reconstruction may have a different colour and texture than skin in the breast area (particularly with LATS flap)
- less muscle strength in the back on the side of the donor site (with LATS flap)
Women who have autologous breast reconstruction surgery should talk to their doctor about a follow-up plan that suits their individual situation.
- Women need to continue to have regular mammography on the other (unaffected) breast.
- Women who have autologous breast reconstruction do not need to have regular mammography done on the reconstructed breast because the breast no longer contains breast tissue.
- clinical breast exam (CBE)
- CBE may be done on both breasts during checkups.
- knowing your breasts
- Women should become familiar with both their natural breast and reconstructed breast, and learn what is normal for both. Ask the surgeon about how to check the reconstructed breast.
Establishing a national caregivers strategy
The Canadian Cancer Society is actively lobbying the federal government to establish a national caregivers strategy to ensure there is more financial support for this important group of people.