The DIEP flap is the most advanced form of breast reconstruction available today because it completely preserves the patient's muscles.
The DIEP flap uses the patient's own abdominal skin and fat to reconstruct a natural, warm, soft breast after mastectomy. Unlike the TRAM flap, the DIEP preserves all the abdominal muscles. Only abdominal skin and fat are removed similar to a "tummy tuck". Saving the abdominal muscles means patients experience less pain, enjoy a faster recovery, maintain their core strength long-term, and have a lower risk of complications. Learn more about DIEP flap reconstruction here.
The SIEA flap (also known as the SIEP flap) is very similar to the DIEP flap procedure. Both techniques use the lower abdominal skin and fatty tissue to reconstruct a natural, soft breast following mastectomy.
The main difference between the SIEA flap and the DIEP flap is the artery used to supply blood flow to the new breast. The SIEA blood vessels are found in the fatty tissue just below skin whereas the DIEP blood vessels run below and within the abdominal muscle. While the surgical preparation is slightly different, both procedures spare the abdominal muscles completely and only use the patient's skin and fat to reconstruct a warm, soft, "natural" breast. Learn more about SIEA flap surgery here.
The TUG and VUG flap procedures use tissue from the inner portion of the upper thigh (just under the groin crease) to reconstruct a "natural", warm, soft breast.
The TUG/VUG flap is a very good option for women who have small to medium sized breasts, want to avoid an abdominal scar, or are not candidates for DIEP or SIEA flap breast reconstruction (e.g. have had previous abdominoplasty or do not have enough lower abdominal tissue). Learn more about the TUG and VUG flap procedures here.
Some patients are candidates for direct-to-implant reconstruction (also known as single-stage or "Alloderm one-step") whereby the permanent implant is inserted at the same time as the mastectomy.
The patient avoids the use of an expander and the whole expansion process. The breast implant is usually completely covered by the pectoralis muscle and a type of cadaveric acellular dermal matrix (ADM) such as Alloderm. In some instances, the implant may be placed on top of the muscle and covered by ADM. Learn more about direct to implant reconstruction here.
The most common method of breast reconstruction currently performed in the US uses tissue expanders and breast implants, usually with an ADM (acellular dermal matrix) like Alloderm. This is usually performed as a multiple-step procedure starting with tissue expanders. Learn more about tissue expander breast reconstruction here.
Fat grafting is a fairly new technique in breast surgery. Fat is liposuctioned from one part of the patient's body, purified and then injected into the breast.
Fat grafting is used in conjunction with other breast reconstruction techniques to optimize breast contour and improve the final cosmetic results after both implant-based and autologous (flap) reconstruction.
There are several fat grafting techniques that are used by plastic surgeons. There is no "set way" that has been shown to be the best in terms of long-term results. However, studies have shown that regardless of the technique used, the collection and transplantation of the fat cells must be optimized to obtain the best long-lasting results. Learn more about fat grafting here.
Latissimus flap breast reconstruction uses skin, fat and all or part of the latissimus dorsi muscle from the back, beneath the shoulder blade area. The tissue ("flap") is brought around to the chest to create a new breast. Learn more about latissimus flap reconstruction here.
Women who do not have an adequate amount of abdominal tissue for DIEP or SIEA flap reconstruction may be eligible for GAP (gluteal artery perforator) flap breast reconstruction. This procedure uses excess skin and fat from the gluteal (buttock) region and leaves all the gluteal muscle behind. Sparing the buttock muscle preserves function and makes recovery easier. Learn more about GAP flap reconstruction here.