Advanced Breast Reconstruction Surgery

In natural tissue breast flap reconstruction, plastic surgeons will reconstruct the breast using your own tissue from another location on your body (also known as a flap). It could come from your abdomen, back, thighs, or buttocks. Using your own tissue (autologous tissue) can give your breasts a natural look and feel, and increase the likelihood that your body will adapt to the newly placed tissue more easily.

Staged Surgery

Although flap surgery can be done at the time of the mastectomy, often it will be done in stages. A tissue expander may be placed at the time of the mastectomy to preserve the space for later reconstruction with your own tissue.

There are many reasons to perform the surgery in stages, including the need for additional cancer treatments such as radiation and chemotherapy. Talk with one of our expert surgeons about which choice would be right or you.

If you had a previous implant-based reconstruction and are having any issues or concerns, you may be a candidate for natural tissue implant reconstruction. This would entail removing any implants and surrounding scar tissue, and replacing with a natural tissue flap. There is no time limit from when you had your initial implant done and when this implant can be done.

Surgical Procedures We Perform

The surgeons at Robert Wood Johnson University Hospital (RWJUH) are experienced in the latest techniques for natural tissue reconstruction. Some of the most common ones they perform include:

• DIEP - Deep inferior epigastric perforator flap surgery
• PAP - Profunda artery perforator flap surgery
• TUG - Transverse upper gracilis flap surgery
• GAP - Gluteal artery perforator flap surgery

These procedures are not always available at hospitals because of the complex microsurgical techniques involved. RWJUH surgeons are trained and skilled in these advanced procedures.

What Is DIEP Flap Reconstruction?

In deep inferior epigastric perforator (DIEP) flap reconstruction, a surgeon will transfer fat, skin, and blood vessels from the wall of the lower belly to your chest to rebuild your breast. First, the surgeon will perform a “tummy tuck” and remove the necessary tissue, then use it to create your new breast shape.

Using complex microsurgery, the surgeon will reattach blood vessels (including the deep inferior epigastric perforator artery) to improve blood flow and speed recovery. This procedure can result in less pain and fewer complications than the more traditional transverse rectus abdominis myocutaneous (TRAM) flap surgery, which uses muscles from the abdomen as well.

What is PAP Flap Reconstruction?

PAP flap surgery uses the profunda artery from your thigh as well as skin and fat from the back of your thigh to create a new breast. People who do not have enough tissue in their lower abdomen to create new breasts may be good candidates for PAP flap surgery.

What is TUG Flap Reconstruction?

TUG surgery uses a flap of skin, fat, gracilis muscle, and blood vessels from your upper thigh to reconstruct the breast. People who do not have enough tissue in their lower abdomen to create new breasts may be good candidates for TUG flap surgery.

What is GAP Flap Reconstruction?

Gluteal artery perforator (GAP) surgery uses a flap of skin as well as fat and blood vessels from your hips and buttocks and possibly the upper thighs to create your new breast. This will tighten the shape of the hip and buttock area. People who do not have enough tissue in their lower abdomen to create new breasts may be good candidates for GAP flap surgery.

Stacked Flap Surgery

If you don’t have enough tissue to create the breast from one area of your body, flaps of tissue may be taken from more than one area at a time and "stacked" to achieve the desired breast shape. For example, if you don’t have enough tissue in your abdomen for reconstruction using DIEP flaps alone, PAP flap surgery may be done in addition.