Breast reconstruction with tissue from the abdomen
This surgical technique is the one most commonly used at our clinic for breast reconstruction, as this type of reconstruction produces the most natural-looking results. It is based on the concept of replacing one thing with another that is as similar as possible. Consequently, the skin and fatty tissue of the abdomen are most similar to breast tissue. A prerequisite is the presence of sufficient abdominal tissue. In the standard technique used, the abdominal fat tissue is transplanted as a free graft; that is, a block of skin and fat tissue, along with its supplying bundle of blood vessels, is harvested and then microsurgically connected to the recipient vessels in the chest using a microscope.
To better visualize the small blood vessels, a computed tomography (CT) scan with contrast dye is usually performed before surgery. This allows for preoperative selection of the preferred vessels, simplifies their identification during surgery, and ultimately enhances patient safety. To achieve the best possible aesthetic result, the incision line and the dimensions of the key landmarks are marked on each patient prior to surgery.
Breast reconstruction with tissue from the thigh
The so-called transverse myocutaneous gracilis flap (TMG) consists of a portion of the thigh muscle along with the overlying skin and fatty tissue. This method also ensures a very natural-looking result, with a discreet scar located in a natural body crease (the groin). The procedure is particularly suitable for slim female patients with small breasts. Similar to breast reconstruction using abdominal tissue, the vessels supplying the flap are dissected and transplanted along with the muscle-skin-fat tissue block, and then sutured to the recipient vessels under microscopic magnification. The anatomy of the three components (muscle, skin, and fat) allows for individual adjustment of the flap to the opposite side and shaping of the flap into a tissue-based implant.
If the condition warrants it, it is also possible to reconstruct both breasts at the same time using this technique.
In some cases, it is also possible to dissect a skin-fat flap without including the muscle. The major advantage of this method for patients is that the scar is discreetly located in the groin area, while at the same time tightening the thigh, similar to a thigh lift. A limitation in thigh function is not expected, as there are numerous other muscles in this region. Occasionally, sensory disturbances may occur on the back of the thigh for a few months. After about six months, the tissue has fully healed. In most cases, the tissue has by then reached its final shape, allowing for corrective procedures—such as a lift of the opposite breast to achieve symmetry or nipple reconstruction—to be performed.
The surgery is performed under general anesthesia. The hospital stay lasts approximately six to ten days. The risks and complications are the same as those associated with other free-flap breast reconstructions. Occasionally, wound-healing complications may occur at the site of the procedure. Patients should avoid spreading their legs wide apart during the first five days to ensure that the wound heals well and remains stable, with a cosmetically pleasing result. Sitting for long periods should also be avoided during the first two weeks. Compression pants and a support bra should be worn for about two to three months.
