Breast reconstruction using your tissue

Surgery that uses your own tissue to reconstruct the breast is called 'tissue flap' or 'autologous' surgery.

Tissue flap surgery is usually performed by a plastic surgeon trained in microsurgery.

During the operation, the surgeon takes tissue, called a ‘flap’, from another part of your body. The tissue includes skin, fat, blood vessels and sometimes the muscle. It comes from a 'donor' site on your body, such as your:

• tummy (abdomen) - this is the most common donor site
• back 
• buttocks 
• inner thigh.

The operation is long and may take between 5 and 8 hours. It is major surgery, and you will be under general anaesthetic. Discuss with your surgeon the best way you can prepare, in your individual situation. They may suggest exercises to help you prepare for breast reconstruction.

When tissue flap reconstruction is suitable

Several factors affect whether a flap reconstruction is recommended. It may be more suitable for you if: 

• you have already had radiotherapy (delayed reconstruction) 
• the size of the reconstruction is larger than is possible with an implant 
• you cannot have an implant reconstruction, for example for health or religious reasons
• it is your personal preference.

A tissue flap reconstruction may not be suitable if you: 

• are slim and don’t have enough tissue to use to create a breast mound 
• are overweight or smoke as your risk of complications is higher 
• have pre-existing health conditions such as diabetes, connective tissue disease or heart disease
• have had surgery before on your tummy or other relevant part of your body.

Advantages of tissue flap reconstruction

Compared to an implant reconstruction, using your own tissue has several advantages. For example:

• the look and feel may be closer to your natural breast (e.g. skin-sparing mastectomy) 
• as you grow older, the reconstructed breast will droop naturally, like your other breast
• the breast will gain and lose weight as your body gains and loses weight
• this option is suitable for all breast shapes 
• you are less likely to need further surgery in the future, unless there are complications after surgery or the skin graft doesn't 'take'. 

Disadvantages of tissue flap reconstruction

• There are also some disadvantages of using your own tissue, including: 
• the surgery is longer so you will be in hospital for longer
• wait times may be long if you are in the public system
• this option may not be available in all regional or rural areas
• the recovery time is longer as there are more wounds to heal 
• out-of-pocket costs are higher if you have treatment in the private health system 
• you will have a scar where tissue is removed, such as your abdomen, back, buttocks or thigh
• if you use abdominal muscle, you may lose strength in your stomach muscles and risk a hernia or abdominal bulging
• if you use muscle from your back, you may lose strength in your upper back and shoulders
• the area of skin transferred may be a different colour and texture
• the surgery is complex so the risk of post-operative complications is higher.
• you may need to delay starting post-operative treatment such as chemo or radiotherapy
• the reconstruction may fail if the blood supply is not good enough. If this happens and the flap tissue dies, you may need another operation to remove the tissue.
• the reconstructed breast will have less feeling, or none.

Potential complications of tissue flap reconstruction

Straight after surgery

Potential problems that can occur immediately after tissue flap reconstruction surgery include: 

• bruising and bleeding 
• infection in the wound – signs may include redness around the breast, discharge from the wound, fever, feeling generally unwell 
• fluid under the wound ('seroma')
• delayed wound healing 
• flap failure – the new flap may die if the blood supply is not good enough. If this happens, you may need urgent surgery to try and save the flap. It is rare for the flap to fail completely (i.e. flap dies). If this does happen, you will need surgery to remove the flap. Around 6 to 12 months later, after you recover from the surgery, you can have reconstruction again. 

Longer-term complications of tissue flap surgery

Potential problems over the long term after tissue flap reconstruction surgery include: 

• folds of skin that develop at the ends of the abdominal scar (referred to as ‘dog ears’). 
• abdominal hernia, if abdominal muscle is removed. 
• the flap can become hard (‘fat necrosis’) if the blood supply isn’t good enough. This is more common in DIEP flaps. A hard lump may develop a few weeks after surgery. A small area may heal on its own, but a large area of fat necrosis may need surgery to remove the dead tissue. It is important to contact your specialists if you notice any changes or have any concerns.
• shoulder stiffness. Your physiotherapist or breast care nurse will show you exercises to improve movement in your shoulder after surgery. You can also follow exercises to help you after breast reconstruction.

It may take months for a reconstructed breast to heal and settle and for scars to fade. It is important that you are satisfied with your reconstruction. Some people need further surgery to achieve the result they want.

If you are unhappy with the size and shape of your reconstruction let your breast care nurse or surgeon know. You may want further surgery to achieve symmetry.

If you had other treatments

If your lymph nodes are removed during surgery, you may have different or additional side effects. Read more about surgery to the lymph nodes and armpit. 

Radiotherapy near the flap may cause changes to the reconstructed breast. The flap might shrink, become hard or change shape. You may need further surgery to create a new flap from another part of your body.