Autologous Reconstruction: Free Flaps
DIEP- and ms-TRAM flaps are the workhorse free flaps in autologous breast reconstruction. The first TRAM flaps, transverse rectus abdominis muscle flaps, were cranially based on the rectus abdominis muscle and transposed to reconstruct the breast. Perfusion arises from the superior epigastric artery. The main disadvantage is that the lower abdomen is mainly perfused from the deep inferior epigastric artery and not the superior. The network between both of the arteries lies within the muscle and is very variable. It is not always sufficient to nourish the desired amount of tissue. Harvesting the muscle can result in weakness of herniation of the abdominal wall leading to pain or additional mesh stabilization surgery.
DIEP-Flaps, ms-TRAM Flaps and SIEA-Flaps
- 7.Munhoz AM, Pellarin L, Montag E, Filassi JR, Tachibana A, Gebrim H, Gemperli R, Ferreira MC. Superficial Inferior Epigastric Artery (SIEA) free flap using perforator vessels as a recipient site: clinical implications in autologous breast reconstruction. Am J Surg. 2011;202:612–7.CrossRefGoogle Scholar
Inner Thigh Flaps (IT-Flap)
- 19.Whitaker IS, Karavias M, Shayan R, et al. The gracilis myocutaneous free flap: a quantitative analysis of the fasciocutaneous blood supply and implications for autologous breast reconstruction. PLoS ONE. 2012;7(5):e36367. https://doi.org/10.1371/journal.pone.0036367. Lin SJ, ed.CrossRefPubMedPubMedCentralGoogle Scholar
Fasciocutaneous Infragluteal Flap (FCI-Flap)
Lymph Node Transplantation
- 25.Tuinder SMH, Beugels J, Lataster A, de Haan MW, Piatkowski A, Saint-Cyr M, van der Hulst RRWJ, Allen RJ. The lateral thigh perforator (LTP) flap for autologous breast reconstruction: a prospective analysis of 138 flaps. Plast Reconstr Surg. 2017. https://doi.org/10.1097/PRS.0000000000004072.