What This IsOne's own body tissue is used to re-create a breast. There are several potential sources for this tissue. A TRAM (transverse rectus abdominus muscle) flap involves skin, fat, and often muscle from the abdomen to fill the breast. A gluteal flap is one that uses muscle, overlying fat, and skin from the buttocks, while a latissimus dorsi flap uses fat and the swimmer's muscle from the back. Some of these procedures are performed as "free" flaps, in which the surgeon removes skin, fat and, often, muscle from the donor site and transplants it to the chest. Small blood vessels in the transferred tissue are connected to small vessels in the mastectomy site. By contrast, with a "pedicle" flap, surgeons raise a strip of muscle and flesh, leaving it partially connected at the muscle, and then tunnel from that part of the body to the chest, where the transferred tissue is sculpted to create the new breast. This does not require blood vessel reconnection, as the blood supply comes from the abdominal muscles. Which is best: free or pedicle? Experts differ, and it often comes down to the procedure your surgeon is most comfortable doing.
Recovery TimeSix to eight weeks
RisksWith TRAM flaps, 80 percent of women have no complications, but 6 percent have hernias, or bulging of tissue beneath weakened abdominal walls. About 2 percent of women (this included me) have bleeding or infection, and less than 1 percent have circulation problems that lead to the loss of the moved tissue. The last occurs more frequently with free flaps.
Pros/ConsThe surgery is more elaborate, requiring up to six hours (versus one hour for an implant). These procedures will leave a scar at the site from which tissue is taken (from the lower abdomen, back, or buttock area), but you probably won't need to be operated on again once the nipple is created. "It's the closest thing to a breast, versus a sac filled with salt water or silicone," says Joseph J. Disa, MD, a reconstructive surgeon at New York's Memorial Sloan-Kettering Cancer Center and author of 100 Questions and Answers About Breast Surgery (Jones and Bartlett, 2006). If muscle is used, that which remains may not be as strong. If back muscle is used, the shoulder may be less mobile.