After 32 remarkable years in surgery and patient advocacy, Dr. Pisano and Dr. Ledoux will be retiring from surgery. Dr. Pisano will become CEO of PRMA in 2027. Book your procedure before their availabilities close in December 2026.
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Tissue-Based Reconstruction

What is Tissue-Based Reconstruction?

Tissue-based breast reconstruction, also known as natural breast reconstruction, is a surgical method that rebuilds the breast using a woman’s own tissue, usually taken from areas like the abdomen, thighs, or buttocks. Unlike implant-based reconstruction, this approach uses living fat, skin, and sometimes muscle to create a soft, natural-looking breast that’s part of your own body.

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Flap Surgery for Breast Reconstruction: Understanding Your Options

One of the most advanced forms of natural, tissue-based reconstruction is the DIEP flap reconstruction, which uses skin and fat from the lower abdomen while preserving the abdominal muscles. 

While all DIEP flaps are tissue-based, not all tissue-based reconstructions are DIEP. Other flap types include abdominal-based, thigh flaps, latissimus dorsi flap, and GAP flap, each using different donor sites to accommodate a woman’s unique anatomy and needs.

Abdominal-Based Flaps (DIEP, SIEA, TRAM)

These techniques use skin and fat from the lower abdomen to reconstruct the breast. The DIEP flap is the most advanced, preserving the abdominal muscles while transferring only skin and fat for a natural look and feel. The SIEA flap is similar but uses different blood vessels, which is ideal for select candidates. The TRAM flap includes muscle and is less commonly used today due to a longer recovery and greater physical impact. All options can also help contour the abdomen, similar to a tummy tuck.
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Thigh Flaps (PAP, TUG, VUG, LTP)

Thigh-based flaps, like PAP, TUG, and VUG, use tissue from the upper inner or back of the thigh to rebuild the breast. These are ideal for thinner women who don’t have enough abdominal tissue. The result is a natural breast shape using your own body, with the added benefit of inner thigh contouring. Thigh flaps also preserve muscle and allow for discreet donor site scars.
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Latissimus Dorsi Flap

This procedure uses muscle, skin, and fat from the upper back to reconstruct the breast. It’s often combined with a small implant, especially in women with limited donor tissue elsewhere. While not as common as abdominal or thigh flaps, it can be a good option in certain cases, such as in revision or salvage scenarios, and the back incision is well-hidden in most clothing and swimsuits.
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GAP Flap

The GAP (Gluteal Artery Perforator) flap uses fat and skin from the upper or lower buttocks to recreate the breast without removing muscle. This surgery is a great option for patients who can’t use their abdomen or thighs, and offers long-term, natural-looking results. It requires advanced microsurgical expertise and leaves scars in the gluteal crease, typically hidden by undergarments.
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Surgery Options for Natural Breast Reconstruction

Abdominal-Based Flaps

High Def DIEP Flap
SIEA
TRAM

Thigh Flaps

PAP
TUG
VUG
LTP

Latissimus Dorsi Flap

With Implant
Extended, Without Implant
Muscle-Sparing
Revision Reconstruction

GAP Flap

sGAP
iGAP

The Nation’s Destination for Sensation Restoration

PRMA has transformed breast reconstruction with their revolutionary TruSense® procedure, a proprietary technique that restores breast sensation in qualified patients, giving back not just form, but feeling.
About TruSense®

Why Choose PRMA

With over 16,000 successful breast reconstructions, including 12,500 natural tissue flap procedures, PRMA isn’t just a global leader in breast reconstruction; we’re the pioneers behind groundbreaking techniques that continue to elevate the standard of post-mastectomy care for patients nationwide.

 

What Sets PRMA Apart: 

  • TruSense® Sensation Restoration: a proprietary technique developed by PRMA to help women regain breast sensation after reconstruction.
  • High Def DIEP®: An advanced microsurgical approach that delivers more natural-looking results with refined contouring.
  • Dual-Surgeon Advantage: Every flap procedure is performed by two microsurgeons, enhancing safety, precision, and outcomes.
  • Implant-to-Flap Expertise: Nationally recognized for successfully converting failed implant reconstructions into natural tissue solutions.
  • Comprehensive Patient Support: From dedicated liaisons to the Breast Advocate® App, patients are guided with compassion and clarity at every step.
  • Advanced Lymphedema Surgery: Offers leading-edge treatments for lymphedema and post-mastectomy pain syndrome.
  • Texas-Based, National Reach: Patients from across the U.S. choose PRMA for its affordability, insurance-friendliness, and seamless travel support.
  • Trusted Experience: With 30+ years of innovation and over 15,000 reconstructions, PRMA is one of the most experienced centers in the world.
  • Empowerment Through Education: PRMA makes complex decisions easier by educating patients on all their options, including rarely-discussed sensation restoration.
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Refer a Patient – Nationwide

When your patients need advanced care, PRMA is the partner you can trust. Our team is a referral destination nationwide for advanced breast reconstruction, sensation restoration, lymphedema surgery, and more, offering seamless coordination, groundbreaking techniques, and outcomes that consistently elevate patient satisfaction.
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