Breast reconstruction with abdominal tissue flap

A breast reconstruction is an operation to recreate a breast shape after you have had a mastectomy (removing all your breast). Your surgeon will recreate a breast shape using tissue from your lower abdomen.

You should get a breast shape again.

Most women who have a successful breast reconstruction are more comfortable with their appearance.

Using padded bras or bra inserts can give the appearance of a breast shape when you are wearing clothes.

It may be possible to have a reconstruction using only an implant.

A reconstruction can be performed using the latissimus dorsi muscle that is moved from the side of your back and used to recreate a breast shape.

A breast reconstruction will not improve your physical health. Your surgeon may be able to recommend an alternative to recreate a breast shape. Your healthcare team may be able to provide prosthetic and underwear fitting which may help with your body image.

If you are booked in for immediate reconstruction as part of your cancer surgery, you should not have to wait too long. Your healthcare team will talk to you about this.

The operation is performed under a general anaesthetic and usually takes 5 to 8 hours.

Your surgeon will make a cut on your 'bikini' line and around your belly button.

During the operation, your surgeon will assess the blood vessels in your lower abdomen. Depending on the size and condition of the blood vessels, they will perform one of the following procedures.

• Free TRAM flap — Your surgeon will cut a flap that includes your abdominal muscle on one side below your belly button and bring it to your chest.
• Muscle-sparing TRAM flap — Your surgeon will cut away only a small part of your abdominal muscle with the flap.
• DIEP flap — Your surgeon will cut a flap that includes a single blood vessel that passes through your abdominal muscle, along with some skin and fat.
• SIEA flap — Depending on the size of your breasts, your surgeon may be able to move only a superficial blood vessel and not need to disturb your abdominal muscle.
• Pedicled TRAM flap — If the blood vessels in your lower abdomen are not suitable, your surgeon will cut a flap that includes all of your abdominal muscle on one side up to your ribcage along with some skin and fat of the flap. After cutting the lower end of the muscle, your surgeon will create a tunnel under the skin in your upper abdomen and will move the flap, including the muscle, up through the tunnel to your chest and use it to recreate a breast shape.

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight. If you gain weight after your cancer surgery, this operation may not be considered safe.

Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

You can reduce your risk of infection in a surgical wound by taking the following steps:

• In the week before the operation, do not shave or wax the area where a cut is likely to be made.
• Try to have a bath or shower either the day before or on the day of the operation.
• Keep warm around the time of the operation. Let the healthcare team know if you feel cold.
• If you are diabetic, keep your blood sugar levels under control around the time of your procedure.

Speak to the healthcare team about any vaccinations you might need to reduce your risk of serious illness while you recover. When you come into hospital, practise hand washing and wear a face covering when asked.

The healthcare team will try to reduce the risk of complications.

Any numbers which relate to risk are from studies of people who have had this operation. Your doctor may be able to tell you if the risk of a complication is higher or lower for you. Some risks are higher if you are older, obese, you are a smoker or have other health problems. These health problems include diabetes, heart disease or lung disease.

Some complications can be serious and may even cause death.

General complications of any operation

• Bleeding during or after the operation. You may need a blood transfusion or another operation.
• Infection of the surgical site (wound).
• Allergic reaction to the equipment, materials or medication.
• Acute kidney injury — any kidney damage is usually short lived although some people may need to spend longer in hospital and a small number can go on to develop chronic kidney disease that may require dialysis.
• Blood clot in your leg (deep-vein thrombosis – DVT).
• Blood clot in your lung (pulmonary embolus), if a blood clot moves through your bloodstream to your lungs.
• Chest infection — your risk will be lower if you have stopped smoking and you are free of Covid-19 (coronavirus) symptoms for at least 7 weeks before the operation.

Specific complications of this operation

• Developing a lump under your wound caused by fluid collecting.
• Developing a lump under your wound caused by blood collecting. You may need another operation to remove the blood and you may need a blood transfusion.
• Loss of the flap during the operation or in the first 5 days.
• Partial loss of the flap. You will need another operation so your surgeon can remove this area and restore your breast.
• Fat necrosis. This is when there is not enough blood being supplied to an area of fat, and the fat becomes hard.
• Skin necrosis, where some of the original breast skin at the edge of your wound dies leaving a black area.
• Difference in shape, size and appearance.
• Numbness of the surface of the reconstructed breast.
• Abdominal weakness, including a bulge or hernia.

Consequences of this procedure

• pain
• unsightly scarring of your skin

You should be able to go home after 4 to 7 days when the drains have been removed.

You should be able to return to normal activities after 4 to 6 weeks.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

Do not drive for at least 3 weeks.

The healthcare team will arrange for you to come back to the clinic after 1 to 2 weeks. At the clinic your surgeon will check your wounds and tell you when you can return to work.

The shape of your reconstructed breast takes several weeks to settle. It can take up to a year for you to feel as if your reconstructed breast is part of you.

A breast reconstruction with abdominal tissue is an operation to recreate a breast shape. You should consider the options carefully and have realistic expectations about the results.