Breast reconstruction with autologous tissue method (from our own body) is the most modern and most complex technique in the field of breast reconstruction after mastectomy.
This method provides breast reconstruction without the use of silicone implants.
The most common method of breast reconstruction with autologous tissues is the one in which we remove tissue and muscle from the tummy (the lower abdominal wall) and transfer it to the chest where we create the new symmetrical and healthy breast (TRAM: transverse rectus abdominis muscle).
There are three different types of TRAM methods:
A pedicle TRAM flap.
A free TRAM.
The DIEP (deep inferior epigastric perforator) flap.
It has to be mentioned that the planning and results are similar in all the techniques. The differences among them are detected in the technical surgical details and surgical handling of the donor area in order for the patient to have the slightest possible burden on abdominal wall after taking the flap.
In cases of a non-skin sparing mastectomy we perform a pedicle TRAM flap. In this method we transfer tissue from the lower abdominal area (skin and fat) and place it to the mastectomy area where we have the formation of the new breast.
In cases of skin sparing mastectomy we use only the fat tissues of the abdominal area- since the skin is in place- providing a totally natural result.
In this method the receiving of fat and skin of the lower abdomen is based on the perfusion of the rectus abdominis muscle which is attached to the lower section of the flap and is transferred as a stem.
The method gives a natural result without the use implants. The main disadvantage of this method is the loss of abdominal rectus muscle of the abdominal wall which can cause the weakening of the anterior abdominal wall and the development of postoperative hernia.
Usually, when the procedure of the TRAM flap is performed, a grid is used is used to reinforce the abdominal wall.
It is performed under general anesthesia, and if we need to simulate the other breast, we perform abdominoplasty at the same time.
The duration of the operation is longer than the other methods because two extra surgical operations are performed, the patient remains hospitalized 5 to 6 days.
The patient returns to daily activities after 15 days.