Services at Banner MD Anderson Cancer Center  

Reconstruction Using Abdominal Tissue

 

Breast reconstruction using tissue from the abdomen (stomach) to re-create a breast mound provides the most natural result of any technique. The choice of tissue to be moved from your stomach to your chest to re-create a breast mound will vary, depending on the blood vessels that supply the tissue of your abdomen and the skills of your surgeon.

Understanding the different types of flaps taken from your abdomen can be confusing. Looking at the makeup of your abdomen can be helpful. Your abdominal wall is made up of multiple layers, with the skin being the outermost layer. Under the skin is a layer of fat. This is followed by a layer of tissue known as fascia, which is sturdy and helps prevent your intestines from bulging out. Under the fascia is a layer of muscle known as the rectus abdominis muscle (your “6-pack” muscle).

Two blood vessels supply this muscle: the deep superior epigastric artery and vein, and the deep inferior epigastric artery and vein. The deep inferior epigastric artery and vein has smaller blood vessels that come off and travel back through the rectus abdominis muscle to supply the fatty layer and overlying skin. These smaller blood vessels are called “perforators.” Another set of blood vessels known as the superficial inferior epigastric artery and vein also help supply blood flow to the fatty tissue and skin. These blood vessels lie on top of the fascia layer.

The tissue taken from your abdomen can consist of all of these layers of the abdomen or only a few. Also, the tissue may be rotated to your chest on its blood supply (called a “pedicled” flap) or disconnected from its blood supply and connected to a new blood supply in your chest (called a “free” flap).

Advantages of reconstruction with abdominal flap:

  • Natural breast shape, consistency and behavior
  • Improved abdominal shape
  • No breast implant required

Disadvantages of reconstruction with abdominal flap:

  • Longer surgery
  • Requires a surgeon trained in microsurgery techniques
  • Additional scarring on stomach
  • Longer hospitalization and recovery

The different types of flaps from your abdomen that may be used to re-create a breast mound are listed below:

Pedicled Transverse Rectus Abdominis Myocutaneous (TRAM): this flap is rotated on its blood supply and consists of skin, fatty tissue and muscle, with or without fascia.  

TRAM Flap: Pedicled

Free Transverse Rectus Abdominis Myocutaneous (TRAM): This flap is disconnected from its blood supply and connected to the blood supply in the chest. It also consists of skin, fatty tissue and muscle, with or without fascia.  

TRAM Flap: Free

Muscle-Sparing & Perforator Flaps
Recent surgical advances have made it possible to lessen the amount of muscle and fascia taken with the flap. Depending on your surgeon’s training and experience and the size and availability of blood vessels, a flap may even be created without removing any fascia or muscle, or only a small amount. These procedures have been shown to reduce problems such as abdominal weakness, hernia and “bulges” that may occur as a result of removing some of the supporting structure of the abdominal wall.

Free Superficial Inferior Epigastric Artery (SIEA): this flap is disconnected from its blood supply and is connected to the blood supply in the chest. It consists of skin, fatty layer, and the superficial inferior epigastric artery and vein and its perforators (small blood vessels). Often the superficial inferior epigastric artery and vein are too small for this flap to be used. Less than 20% of patients will have large enough vessels to use this flap.

Free Deep Inferior Epigastric Perforator (DIEP): this flap is disconnected from its blood supply and is connected to blood supply in the chest. It consists of skin, the fatty layer, and the deep inferior epigastric artery and vein and its perforators.

Free Muscle-Sparing TRAM: this flap is taken off its blood supply and is connected to blood supply in the chest. It consists of skin, the fatty layer and a small portion of muscle with or without fascia. Most of your fascia and muscle is not taken (spared).

Other Abdominal Flaps


 

Banner MD Anderson Cancer Center
Higley Road and US 60
2946 E. Banner Gateway Drive
Gilbert, AZ 85234
(480) 256-6444
(855) 256-6444

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