Recreate your breasts using natural tissue
What Is Natural Tissue Flap Reconstruction?
Natural tissue flap reconstruction is a popular technique used in breast reconstruction surgery to restore the breast mound without (or in combination with) breast implants. During perforator flap procedures, subcutaneous fat and skin are taken from other areas of the body to recreate a natural-looking and feeling breast.
This technique does not sacrifice the underlying muscle.
Who Can Get Natural Tissue Flap Reconstruction?
Many women may seek natural tissue flap reconstruction after undergoing a mastectomy on one or both breasts. Many women want their breasts to have a natural, balanced appearance in certain types of clothing, which is often more possible using tissue flaps than other breast reconstructive options.
Though you notice some differences between the natural and reconstructive breast tissue, Dr. Sadeghi’s techniques achieve a very natural look even when wearing a bra or bathing suit.
Natural Tissue Flap Reconstruction Procedures
Natural tissue flap reconstruction can be performed in an immediate or delayed fashion (at the time of your mastectomy versus months or years down the line).
Natural tissue flap reconstructive techniques usually take between two and six hours to perform, and you can expect up to six to eight weeks of recovery.
Dr. Ali Sadeghi practices multiple types of natural tissue flap reconstruction, including:
- DIEP flap (deep inferior epigastric perforator flap)
- SIEA flap (superficial inferior epigastric artery flap)
- GAP flap (gluteal artery perforator flap),
- PAP flap (profunda artery perforator flap)
- TDAP flap (thoracodorsal artery perforator flap)
- Stacked flaps
What Are My Natural Tissue Flap Reconstruction Options?
Deep Inferior Epigastric Perforator (DIEP) Flap
The deep inferior epigastric perforator (DIEP) flap is one of the most common natural tissue flap procedures performed for breast reconstruction. Also known as the “tummy tuck flap,” this technique takes fat and skin from the abdominal wall while leaving the abdominal muscle intact to maintain core strength.
Deep inferior epigastric perforator (DIEP) flap breast reconstruction differs from past procedures in that abdominal muscle is not removed, allowing for a quicker recovery and the maintenance of core strength.
The older versions of this abdominal flap, known as the TRAM flap, sacrificed part or all of the rectus abdominis muscle (six-pack muscle), causing core strength weakness, abdominal hernias, or bulges.
For this reason, the TRAM flap is not used in our practice. We exclusively use abdominal tissue in the form of DIEP flaps for breast reconstruction.
Dr. Sadeghi is an expert in the revolutionary DIEP flap breast reconstruction procedure, reconstructing breasts from a patient’s abdominal fat.
This technique takes between four to five hours to complete for a bilateral reconstruction.
Will I Need Implants With My DIEP Flap?
Patients who do not have adequate abdominal fat to reconstruct both breasts can consider combining their DIEP flap reconstruction with implants.
Implants can be used along with your tissue at the time of the reconstruction or in a delayed fashion after DIEP surgery. The choice between these procedures is made during the consultation with Dr. Sadeghi.
Superficial Inferior Epigastric Artery (SIEA) Flap
Another way to use the abdominal tissue in breast reconstruction is the superficial inferior epigastric artery (SIEA) flap.
Like the DIEP flap, the SIEA flap allows Dr. Sadeghi to use the fat and skin from the lower abdominal wall based on its superficial blood supply. The abdominal muscle is left intact, allowing you to continue to use the abdominal muscles for core strength.
This procedure is similar to the DIEP, but the blood vessels used to harvest the abdominal tissue are from the superficial blood vessels of the lower abdomen. Muscles are not sacrificed, and the risk of herniation or abdominal bulges is eliminated.
Before surgery, imaging studies, such as CT or MRI scans, help identify the SIEA or the DIEP system for breast reconstruction.
This technique is usually performed in 30 to 90 minutes.
Profunda Artery Perforator (PAP) Flap
The profunda artery perforator (PAP) flap reconstructs the breast using tissue taken from the posterior thigh. This option does not sacrifice muscle function.
Dr. Sadeghi is one of the pioneers of the PAP flap, which was introduced in 2012 by a team of highly specialized reconstructive microsurgeons. Dr. Sadeghi has refined this technique over the past 10 years, and it has now become one of his go-to options for natural-looking flap reconstruction results.
How Is PAP Flap Reconstruction Done?
The PAP flap allows Dr. Sadeghi to use fat and skin from the posterior thigh underneath the buttock crease. The tissue removed is typically the same tissue that would be discarded in a thigh lift.
Here, the tissue is used along with its vital blood vessels to reconstruct breasts. The main advantage of this procedure is that the donor site scar falls in the crease of the buttock as it would in a thigh lift.
This technique is optimal for patients who have had previous surgery that precludes the use of the abdomen as a donor site. Our patients have been very pleased with the introduction of this procedure, and the results from both the breast recipient site and the donor site are superior.
With the introduction of this flap, we no longer need to perform the TUG flap. The TUG flap sacrifices the gracilis muscle in the thigh for breast reconstruction. In our breast center, Dr. Sadeghi believes that natural breasts do not contain muscle tissue, and, therefore, muscles should not be used in breast reconstruction.
The PAP flap technique usually takes between three and five hours to perform.
Thoracodorsal Artery Perforator (TDAP) Flap
The TDAP flap uses fat from the upper back, including the bra back roll area. Therefore underlying muscle tissue is preserved.
Since this area of the body is so close to the breast region, the tissue can be rotated into place without dividing and reattaching blood vessels, resulting in less hospitalization time.
This procedure can be performed as a rotational flap or separately as a free flap. In some cases, a stacked TDAP flap (by itself or in combination with other perforator flaps) can be used to reconstruct the breast.
This technique takes between four and six hours to perform.
Stacked Flap Procedures
Stacked flap procedures use a combination of fatty tissue from the abdomen (DIEP flap), the lateral intercostal artery (LICAP flap), the back (TDAP flap), the back of the thigh (PAP flap), the hips (LAP flap), and the buttock region (GAP Flap).
When the abdominal tissue is not adequate to reconstruct the breasts, additional donor sites are required. Coined as four-flap breast reconstruction, we use fatty tissue from the abdomen (DIEP flap) in conjunction with the tissue from the back of the thigh (PAP flap), the hips (SGAP flap), or the back (TDAP flap and LICAP flap).
For instance, a “stacked DIEP flap” uses both halves of the abdomen.
Our team performs breast reconstruction using stacked GAP flaps, stacked PAP flaps, and stacked DIEP and GAP or stacked DIEP and PAP flaps for breast reconstruction.
More and more, Dr. Sadeghi is performing “stacked flaps,” where he combines tissues from different parts of the body in tandem to reconstruct the breasts.
This allows Dr. Sadeghi to use the DIEP flap to reconstruct the superior pole of the breast and the PAP flap to recreate the lower pole of the breast.
Together, this combination of tissue from the abdomen and the posterior thigh provides superior breast reconstruction results.
Combining tissue from the abdomen (as in a DIEP flap breast reconstruction) and the thigh (as in a PAP flap breast reconstruction) allows us to perform a thigh lift and a tummy tuck simultaneously since the harvested fatty tissue can be contoured into the breasts.
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How Long Is Recovery From Natural Tissue Flap Reconstruction?
Though your results will be visible immediately after your surgery, it’s important to give yourself enough time to heal. You’ll notice some swelling for the first week following the procedure. This is normal. As the swelling subsides, your new breast tissue will slowly stretch, and the result will be full and natural.
What Are the Risks of Natural Tissue Flap Reconstruction?
As with any surgical procedure, breast reconstruction comes with risks. Some of these risks include bleeding, infection, and scarring.
However, Dr. Sadeghi has performed thousands of breast reconstruction procedures for patients inside and outside of the New Orleans area with wonderful and safe success.
His patients are extremely satisfied with their reconstructive surgery results and the feeling of wholeness they have following their breast cancer treatment.
View some before and after pictures from happy patients in our patient gallery, or browse testimonials from women who underwent breast reconstruction in Dr. Sadeghi’s expert care.