Perforator Flap Procedures
Natural Tissue Breast Reconstruction with Perforator Flaps
Perforator flaps represent the current state-of-the-art in natural tissue breast reconstruction. Depending on the shape of your body and your personal preference, several areas of the body can act as donor sites for the tissue needed to restore the shape and form of the breast.
State-of-the-Art Options for a More Natural Look and Feel
Perforator flaps represent today’s most advanced techniques in natural tissue breast reconstruction. Rather than using implants, perforator flaps harness your body’s own excess tissue—often from the abdomen, back, or thighs—to recreate the breast after mastectomy. By meticulously preserving muscle, these procedures help you avoid many of the long-term drawbacks associated with muscle-removal techniques or implant-based reconstruction.
Why Choose a Perforator Flap?
- Muscle Preservation
- Muscle does not regenerate once removed, so our goal is always to preserve a patient’s muscle and keep it where nature intended the muscle to be.
- Perforator flaps preserve your muscle, and therefore help you to maintain your strength.
- Preserving muscle also means recovery is generally not very painful; most people do not need much if any narcotic medication after surgery
- Hernia risk is minimal, even when tissue is borrowed from the abdomen because muscle is preserved.
- Natural Look and Feel
- Living tissue integrates with your body and therefore allow you to achieve a reconstruction that is warm, soft, and supple to the touch.
- Living tissue to heals and becomes one with the adjunct tissue, so breasts reconstructed with your body’s tissue feel more natural and less heavy than do breasts reconstructed with implants.
- The potential to regain sensation is more reliable with natural tissue than with breast implant reconstruction.
- Breasts reconstructed with your own tissue tend to change in size with weight fluctuations, thus maintaining natural proportions.
- Reduced Implant-Related Risks
- No concerns about rupture, capsular contracture, rippling, or other complications that are unique to implants.
- No need for routine imaging to monitor for “silent” implant leaks.
- Less Postoperative Pain
- Because muscles remain intact with perforator flaps, recovery is usually faster and more comfortable compared to operations that include or otherwise significantly traumatize muscle.
- Lower Reoperation Rates
- Perforator flap reconstructions have a significantly lower rate of additional unplanned surgeries compared to implant-based reconstructions.
How Perforator Flaps Work
With perforator flap breast reconstruction, a surgeon transfers skin and fat—along with the tiny blood vessels (perforators) that supply the tissue—from a donor area on your body to your chest. The vessels are then connected to blood vessels at the mastectomy site, using microsurgical techniques, to provide the transferred tissue a healthy blood supply. Because no muscle is included, your donor site typically retains its core strength and functionality.
Microsurgical Breast Reconstruction
Thanks to advanced microsurgical techniques, highly skilled surgeons, like all of the breast reconstruction specialists in The Plastic and Reconstructive Surgery Group, can reconnect tiny blood vessels and sculpt transferred tissue to achieve a breast that not only looks, but also often feels, quite natural. This approach, that takes advantage of specialized instruments and enhanced visualization provided by a high power magnification operating room microscope has revolutionized breast reconstruction by combining the best of autologous (your own) tissue reconstruction with minimal impact on functional muscles.
Perforator Flap Procedures
Donor Site Options
The ideal donor site depends on:
- Body Shape and Available Tissue
- Personal Preference
- Prior Surgery
Common donor sites include the abdomen, lower back, upper back, and thighs. In some cases, tissue can even be combined from multiple areas to achieve the desired breast size.
Deep Inferior Epigastric Perforator (DIEP) Flap
Uses lower abdominal skin and fat—analagous to the excess tissue removed during a tummy tuck—without removing any abdominal muscle. This method can provide a natural breast shape while also contouring the abdomen.
Lumbar Artery Perforator Flap
Harvests tissue from the lower back (“love-handle” region), providing a subtle buttock lift while reconstructing the breast. Muscle remains intact, minimizing postoperative discomfort. This procedure narrows the waist and lifts the buttocks, thus producing an excellent contour at the donor site.
Double DIEP Flaps for a Single Breast
An innovative procedure using two DIEP flaps (one from each side of the abdomen) to create a single breast with increased volume. Ideal for those needing more tissue than a standard DIEP flap can provide.
BODY LIFT BREAST RECONSTRUCTION (EXTENDED DIEP)
When One Area Isn’t Enough
Combines lower abdominal tissue with tissue from the flanks, to achieve sufficient volume for both breasts. This approach provides more tissue than can be obtained with DIEP flaps alone, and has the added benefit of contouring the waist and lifting the outer thighs. Some surgeons refer to this procedure as a SHAEP flap.
Superficial Inferior Epigastric Artery Flap
Similar to DIEP in using lower abdominal tissue, but relies on superficial vessels that don’t pass through the abdominal muscle. For a small percentage of women, these vessels are large enough to support a full reconstruction.
Upper Thigh Tissue for Breast Reconstruction
For patients who cannot or prefer not to use the abdomen or back, the upper thigh can sometimes provide the tissue needed to restore one or both breasts. Depending on your anatomy, a PAP, DUG, or TUG flap might be most appropriate.
Buttock-Based Options
Tissue from the upper (SGAP) buttock can be obtained without muscle removal. The SGAp flap is another choice for women who cannot (or choose not to) use abdominal tissue, however, because of the potential of the SGAP flap to flatten the shape of the upper buttock, must women prefer the lumbar artery perforator flap to this option.
Thoracodorsal Artery Perforator Flap
Rotates skin and fat from the upper back to the chest, sparing the latissimus dorsi muscle. Particularly suited for partial reconstructions or adding volume to a previous reconstruction.
Frequently Asked Questions About Perforator Flap Procedures
How soon after a mastectomy can I have a perforator flap reconstruction?
Breast reconstruction surgery frequently begins at the same time as mastectomy surgery. For women who may not have undergone a reconstruction at the time of mastectomy for one reason or another, breast reconstruction can take place at a later time.
What if I’m very slender and don’t have much extra tissue?
While every patient needs to be evaluated to determine if and where there is available tissue with wich to reconstruct her breast or breasts, we are almost always able to find a suitable natural tissue option for those women who seek natural tissue breast reconstruction.
How long do perforator flap reconstructions typically last?
Unlike breast implant reconstructions, once healed, a perforator flap breast reconstruction is forever part of a woman’s body.
We Are Here to Help
If you’re considering natural tissue breast reconstruction or want to learn more about perforator flap options, our experienced microsurgical team is here for you. Contact us today to discuss the flap that best suits your body type, lifestyle, and reconstructive goals.