Flap breast reconstruction: the complete guide to using your own tissue

Flap breast reconstruction rebuilds a breast using your own tissue instead of, or as well as, an implant. A surgeon moves skin, fat and sometimes muscle from another part of your body, called the donor site, to your chest, and shapes it into a breast. The tissue must keep a blood supply to survive. In a pedicled flap, the tissue stays attached to its original blood vessels and is tunnelled under the skin to the chest, as with the back muscle flap. In a free flap, the tissue is fully detached and its tiny vessels are joined to vessels in the chest under a microscope. The most common donor site is the lower tummy, used for DIEP and TRAM flaps. When the tummy is not suitable, tissue can come from the buttock, the inner or back of the thigh, or the back. Own-tissue reconstruction usually feels soft and warm, changes with your weight and often lasts for life without the need to replace an implant. It also tends to cope better with radiotherapy. The costs are longer surgery, a second scar at the donor site, a longer recovery and a small risk that the flap loses its blood supply. Choosing a flap depends on your body shape, your cancer treatment, your general health, your wishes for future pregnancy and activity, and the skills available. Many women also choose no reconstruction at all, and that is an equally valid decision.

Your own tissue, moved

Skin and fat, and sometimes muscle, are shifted to the chest to form a breast.

Several donor sites exist

The tummy is most common, with the back, thighs and buttocks as alternatives.

More surgery, longer lasting

Recovery is longer than with implants, but the result usually lasts.

Flap surgery can give a result many women are very happy with, but it is demanding, and it is worth going in with clear expectations.

It is a long operation

Free flaps often take several hours or most of a day, with a hospital stay of a few days.

Two areas have to heal

You recover from both the chest and the donor site, and the donor scar is permanent.

Complications do happen

These include wound problems, fluid collections, firm fat lumps, tummy bulging and, rarely, loss of the whole flap.

The final shape takes time

Swelling settles over months, and further smaller procedures are often part of the plan.

What this page cannot tell you

It cannot tell you which flap, if any, suits your body and treatment. A reconstructive surgeon who examines you and knows your cancer plan can.

Recovery varies with the flap type, but the general pattern is similar for most women.

In hospital

Nurses check the flap often, looking at its colour and warmth and sometimes listening to blood flow with a small probe. You will have drains and be encouraged to walk early to lower the risk of clots.

At home

You will need help with household tasks for several weeks. Avoid heavy lifting, and look after both wounds as your team advises.

Later on

Most women return to most activities within about two months, though full strength and the final breast shape can take many months.