Flap reconstruction surgery using your own tissue
About flap reconstruction
Flap reconstruction is a type of breast reconstruction that uses your own tissue from somewhere else on your body. It is more complex than reconstruction using implants. It involves moving a flap of skin, fat and sometimes muscle from another part of your body to your chest wall. This creates a breast shape. The flap is taken from a part of your body called the donor site.
Most flap reconstructions use tissue from the tummy (abdomen). But surgeons can also use tissue from the:
You may have a flap reconstruction if enough tissue can be taken from the donor site. It is often used in delayed reconstruction. It may also be an option if you are having radiotherapy. It is a longer operation than an implant-only reconstruction and has a longer recovery time.
Types of flap surgery
The reconstructed breasts need a good blood supply to keep them healthy. There are 2 ways a surgeon can do flap surgery.
Free flap reconstruction
With a free flap reconstruction, the surgeon takes a flap of tissue from another part of your body. They remove it from its blood supply and move it to your chest. They then connect it to a new blood supply.
This is complex surgery. It is only done by plastic surgeons in specialist hospitals.
- Most breast reconstructions using tissue from the tummy are free flap reconstructions.
- All reconstructions using tissue from the buttock or thigh are free flap reconstructions.
Pedicled flap reconstruction
With a pedicled flap reconstruction, the surgeon takes a flap of tissue from your back or tummy. They keep it connected to its original blood supply. They then tunnel the tissue with its blood supply under your skin and out onto your chest.
- Reconstructions using tissue from the back are usually pedicled flap reconstructions.
- Some reconstructions using tissue from the tummy or lower back are pedicled flap reconstructions. This is less common.
Who is it suitable for?
Reconstruction using your own tissue may be suitable if you:
- do not want breast implants
- have had or need radiotherapy as part of your treatment
- want your breasts to have a more natural shape and feel
- cannot have implants or tissue expansion because the chest skin and muscle are too tight
- have large breasts or breasts with a natural droop and do not want your breasts to be smaller.
There may be increased risks with flap reconstructions if you:
These risks are more common with free flap operations.
What are the benefits?
- It gives a more natural shape, movement and feel to the reconstructed breast.
- It is suitable for all breast shapes.
- It can create a breast with a more natural droop.
- The reconstructed breast will change as your body changes over time. It may put on weight or lose weight as you do.
- This means the reconstructed breast is more likely to look similar to the other breast over time.
- You may also be less likely to need maintenance breast surgery in the future.
- You can usually avoid having an implant.
What are the limitations?
- You will have a scar on the part of your body the flaps are taken from.
- You may have a patch or circle of skin on the reconstructed breasts. This skin comes from a different part of your body. Because of this, it may be a different texture and colour from the breast skin. Your breast surgeon will be able to give you more information about this.
- It involves having surgery to another part of your body to remove the flap.
- You may have a longer operation, hospital stay and recovery.
- Reconstructed breasts have less sensation than natural breasts. They usually feel numb.
What are the risks?
With any operation, there are risks, such as infection. There are also some specific risks with this type of reconstruction.
Problems with blood supply to the flap
Your surgeon and nurses will check the reconstructed breasts regularly for a few days after the operation. This is to make sure they have a good blood supply. Most operations are successful. But when a flap of tissue is used for breast reconstruction, there is a small risk that all or part of the flap will not have a good enough blood supply.
If there are any signs of a poor blood supply in the first few days after the operation, you may need another operation. This allows the surgeon to check the blood supply. If there is not a good enough blood supply, the tissue flap may fail. You may then need another operation to remove the affected tissue. Your surgeon can explain more about this risk.
Fat necrosis
Fat necrosis is an area of damaged fat cells. It can cause a firm lump in the reconstructed breast. It can happen when fatty tissue does not have a good enough blood supply.
The body can usually absorb small areas of fat necrosis over time. But some people need surgery or liposuction to remove a larger area of fat necrosis. This will improve the appearance of the breast, but it can leave a dent. This can be improved with lipomodelling (fat transfer).
If you feel a lump in your reconstructed breast, you should always get it checked.
About our information
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References
Below is a sample of the sources used in our breast reconstruction information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk
European Journal of Surgical Oncology. Oncoplastic breast surgery: A guide to good practice A. Gilmour et al. Published 5th May 2021. associationofbreastsurgery.org.uk/media/359061/abs-oncoplastic-guidelines-2021.pdf (accessed April 2023)
National Institute for Health and Care Excellence (NICE). Early and locally advanced breast cancer: diagnosis and management. Guidelines. July 2018. Last updated: April 2023. Available from: www.nice.org.uk/guidance/ng101 (accessed April 2023)
European Society for Medical Oncology (ESMO) Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow up. Last updated 2019. Annals of Oncology 30: 1194–1220, 2019. Available from: www.annalsofoncology.org/article/S0923-7534(19)31287-6/pdf (accessed April 2023)
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Reviewers
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Professor Mike Dixon, Professor of Surgery and Consultant Breast Surgeon.
Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.
The language we use
We want everyone affected by cancer to feel our information is written for them.
We want our information to be as clear as possible. To do this, we try to:
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We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.
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