Autologous reconstruction refers to the use of a patient’s own tissue to make a breast. The tissue used is called a flap and it’s named according to the blood vessel that supplies it. For example, when fat is take from the lower abdomen it’s called a DIEP fap because it is based on the deep inferior epigastric perforator vessels. This is an important concept: you can’t just take fat from some place in the body and put it somewhere else because it will die. The tissue needs a blood supply. The deep inferior epigastric perforator vessels are taken along with the flap and sewn to blood vessel in the chest using an operating microscope. This is called a vascular anastomosis.
Most of the plastic surgeons I work with prefer DIEP flaps for autologous reconstruction. Patients like it too because they get a tummy tuck at the same time. If there is not enough fat to make an appropriate size breast, a small implant can be placed behind the flap.
DIEP reconstruction can only be done once. For instance, if a patient has both breast removed at the same time, she can have bilateral DIEP reconstruction. However, if she has one breast removedand DIEP reconstruction, then, at another time has the other breast removed, she cannot have DIEP reconstruction a second time.
Recovery from bilateral surgery is not much different than unilateral surgery.
Good candidates for autologous reconstruction:
- age less than 60
Poor candidates for autologous reconstruction:
- thin patients (not enough fat)
- previous abdominal surgery (laparoscopic surgery and caesarian sections don’t count)