This strategy of reconstruction uses the patient’s own tissues to shape a breast mound.
There are several advantages, which make autologous reconstruction the method of choice in a variety of situations.
Breast reconstruction to correct the deformities arising from breast cancer treatments (mastectomy, quadrantectomy) is a frequent request, given that one out of eight women in the US are expected to develop breast cancer over their life time.
At Trinidad Institute of Plastic Surgery we favor the use of the patient’s own tissues to shape a new breast mound (autologous breast reconstruction). This approach to breast reconstruction has several advantages.
The use of an implant and associated complications can generally be avoided. Thus the reconstructed breast feels like tissue and not like an implant. It responds to changes of aging and weight fluctuations more in synchrony with the unaffected opposite breast. Intraoperative shaping is very flexible helping with the achievement of a natural result, which maintains its positive qualities over time. Autologously reconstructed breasts are generally more tolerant to the effects of irradiation than expanders and implants, although the quality of the result certainly suffers, underlining the importance of proper sequencing of the multiple elements of breast cancer treatment.
Several choices of donor tissue sites are available allowing to match the technique to the patient. Tissue from the back can be used in the form of the latissimus dorsi (LD) flap with the mucscle included or the thoracodorsal artery perforator flap (TDAP). The “gold standard” of autologous reconstruction remains the transverse rectus abdominis (TRAM) flap from the lower abdomen. When transferred as a microsurgical free flap (fTRAM), a more benign donor defect in the abdominal wall results. This effect is even more pronounced when using the perforator variety of the fTRAM, the so called deep inferior epigastric perforator (DIEP) flap. Its dissection requires considerable microsurgical expertise. Other advanced microsurgical techniques use redundant tissue from the buttocks or inner thigh (free superior and inferior gluteal artery perforator flap, free gracilis flap).
Not every patient is an ideal candidate for autologous reconstruction as some underlying medical conditions do result in a disproportionate risk.