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Reconstructing the Breast: Free Flap Breast Reconstruction Surgery

Landon Plastic Surgery

Breast reconstruction with flap surgery can help restore the contour of breasts to recreate the silhouette of natural breasts. Breast reconstruction with flap surgery is the most complex alternative of breast reconstruction options. The surgeon will transfer muscle, skin, fat and blood vessels from one part of the body to the breast area to recreate the breast. Skin and tissue may be augmented to enlarge the breast size.

Free flap surgery is a type of surgical method for breast reconstruction. In this case, the surgeon will disconnect the tissue being transferred completely from the blood supply before reattaching it to blood vessels in the chest. Free flap surgery will typically take longer than the alternative, pedicle flap surgery, due to the reattaching process.

Types of free flap surgeries:

  • TRAM flap (abdomen) – Tissue and fat is removed from the abdomen in a procedure called transverse rectus abdominis muscle (TRAM) flap. It can be transferred as a free flap or pedicle flap. As a muscle-sparing free flap, the surgeon will take a portion the abdomen, which will help the patient retain abdominal strength afterwards.  
  • DIEP flap (abdomen) – A newer alternative to the TRAM flap, deep inferior epigastric perforator (DIEP) flap will transfer only skin and fat. Minimum muscle tissue will be taken.
  • SIEA flap (abdomen) – A less invasive variation of the DIEP flap, superficial inferior epigastric artery (SIEA) relies on blood vessels that aren’t as deep in the abdomen. Not all women’s blood vessels will be adequate for this surgery.
  • Latissimus dorsi flap (back) – Skin, fat and muscle from the upper back are tunneled under the skin to the chest. This procedure may be used to to create small or medium-sized breasts or pockets for breast implants.
  • Gluteal flap (buttocks) – Tissue from the buttocks are transplanted to the chest area. This procedure is solely a free flap procedure.
  • TUG (inner thigh) – A relatively new procedure, the transverse upper gracilis (TUG) flap uses muscle and fatty tissue from the inner thigh and bottom of the buttocks.


The patient may be tired and sore after the surgery, and the doctor may prescribe medication to help the patient relieve pain. Drainage tubes may be placed at the surgical site to help eliminate excess fluids that collect at the affected area. There will also be stitches, but they may not need to be removed if they are absorbable. Wearing a support bra or elastic bandage may help lessen swelling and support the healing breast. Normal activities may be resumed as soon as six weeks after the surgery. The doctor will let the patient know if there are specifications on actions that should be limited. For example, lifting heavy objects or cardio may be restricted. In the long term, scarring will be permanent, but the scars will fade over time, depending on each patient’s skin type.

Works Consulted

Deutsch, Mark F., M.D. “Free Flap Breast Reconstruction.” MedScape. WebMD, 01 June 2016.

Web. 21 Mar. 2017.

Mayo Clinic Staff. “What You Can Expect.” Mayo Clinic. Mayo Foundation for Medical Education

and Research, 03 Dec. 2016. Web. 21 Mar. 2017.