Breast Reconstruction with Abdominal Tissue (The James)

Breast Reconstruction with Abdominal Tissue (The James)

 

The goal of any breast reconstruction surgery is to help you feel comfortable with the shape of your breasts in clothing. One type of breast reconstruction surgery uses an abdominal tissue flap to make a new breast. A flap is a piece of tissue (skin, muscle, and/or fat) that is moved from one area of your body to another. There are different ways that this flap surgery is done. Your doctor will talk with you about the type of flap surgery that may work for you.

This handout will describe the different types of flaps that use abdominal tissue for breast reconstruction.

 

What are the types of abdominal tissue flaps?

There are 2 basic ways to move tissue from your abdomen (belly) to your chest for breast reconstruction:

  • Microvascular flap
  • Non-microvascular flap

The microvascular flap is also called free flap. This procedure moves tissue, that includes skin, fat or muscle from your abdomen to your chest. The tiny blood vessels that supply blood to these tissues are also moved and reattached by your surgeon using a microscope. This is why it is called a microvascular flap. 

The non-microvascular flap also called a pedicled flap, does not move or cut your blood vessels. In this surgery, one end of your muscle stays attached to your rib cage. Your surgeon will tunnel fat and the free end of your muscle under your skin to the area of your breast. 

 

Types of Microvascular Free Flaps:

Transverse Rectus Abdominis Musculocutaneous (TRAM) refers to the six-pack muscle in your abdomen (belly) that is used in breast reconstruction flap surgery. The type and amount of muscle tissue used may be different. The type of flap you will have may not be decided until during your surgery.

  • Free TRAM Flap:

Most of your six-pack muscle, along with skin, fat and blood supply are cut from your abdomen and moved to your chest to make a breast. The muscle flap  keeps its own blood supply. This helps feed the tissue that makes your new breast.

  • Muscle-Sparing Free TRAM Flap:

A small amount of muscle, along with some skin and fat are cut from your abdomen and are moved to your chest to make a breast. Only a small portion of your muscle is used in order to keep the blood supply to your skin and fat. This helps feed the tissue that makes your new breast.

  • DIEP (deep inferior epigastric artery) Flap:

No muscle is removed during this surgery. Only the fat, skin and the blood supply are moved to the chest to make a breast. 

  • SIEA (superficial inferior epigastric artery) Flap:

Like the DIEP flap, fat, skin and blood vessels are cut from your abdomen and moved to your chest to make a new breast. No muscle is removed during this surgery.

 

Types of Non-Microvascular Flaps:

  • The Pedicled TRAM Flap:

Your abdominal muscle, lower abdominal skin and other tissue are tunneled under your skin and move to your chest to make a breast. The muscle flap keeps its own blood supply. This helps feed the tissue that makes your new breast. 

 

How long will the surgery take?

Microvascular surgery on one breast takes about 8 hours. Non-microvascular surgery on one breast  takes about 4 to 6 hours. The length of your surgery will depend on whether your surgery includes 1 or 2 breasts.

 

How long will I be in the hospital?

You will be in the hospital 3 to 5 days after your surgery.

 

Where will my scars be?

You will have a scar on your belly and one on the breast where your flap was made. Your plastic surgeon will make an incision (cut) around your belly button and from hip to hip below your belly button. Your surgeon will use your mastectomy incision to insert the abdominal flap.

 

What are the risks?

The most common risks with breast reconstruction with abdominal tissue include:

  • Short-term risks
    • Partial or total flap loss – the flap tissue dies after it has been moved to your chest and will need to be removed. If there are signs of partial or total flap loss, your doctor will do  surgery right away to try to save the tissue.
    • Infection and fluid build-up in your abdominal area. If you have an infection, your doctor will order antibiotics. If you have fluid build-up, your doctor will drain the fluid with a needle.
  • Long-term risks
    • Problems with your abdominal wall, such as bulging and hernias.
    • Weakness and pain
    • Asymmetry – the size, shape or level of your breasts look uneven.

There are risks with any operation. Talk to your doctor about any questions you may have with this type of surgery.

 

What type of support will I need at home?

  • You will need to have a family member or friend drive you home after your surgery and hospital stay. They should stay with you at least 24 hours after you are home to make sure you are recovering well.
  • After your surgery, you will not be able to lift, push or pull anything over 3 pounds. You will need help doing laundry, cooking and other housework.
  • You need to wait until your drains are removed and your doctor says it is okay for you to drive. You will also not be able to drive while you are taking opioid pain medicines.

 

 

© June 9, 2022. The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.

This handout is for informational purposes only. Talk with your doctor or health care team if you have any questions about your care.