Plastic Surgeons trained in microsurgery, called microsurgeons, use high-powered microscopes in order to meticulously reconnect small blood vessels and maintain a healthy blood supply to the transferred tissue. When the tissue is inserted into the empty breast envelope, blood vessels must be reconnected to provide sufficient bloody supply and keep the tissue (flap) healthy. There are a variety of different types of microsurgical flap breast reconstruction procedures, with each type of tissue originating from different parts of the body.
The most common tissue (flap) utilized comes from the abdomen, called a Deep Inferior Epigastric Perforator (DIEP) flap. In a DIEP flap, skin and fat are harvested from the lower abdomen to create the breast. Similar to a DIEP, the Superficial Inferior Epigastric (SIEA) flap uses skin and fat from the lower abdomen for reconstruction, but a different bloody supply to the flap is utilized.
Most women with adequate skin and fat on the lower abdomen are candidates for DIEP reconstruction. If not, there are many other options including using tissue that comes from the lower back (flanks) called the Lumbar Artery Perforator (LAP) flap. Alternatively, the thigh can be utilized with the Profunda Artery Perforator (PAP) flap or a Transverse Upper Gracilis (TUG) flap. Finally, tissue from the buttocks can be utilized to reconstruct the breast by using the Gluteal Artery Perforator (GAP) flap. The LAP, PAP, TUG, and GAP flap procedures are very similar to DIEP flap breast reconstruction in that they require tissue to be transferred and reconnected to a blood supply. However, with these alternative flaps, the tissue comes from the lower back, thigh, or buttocks, rather than the abdomen. For thinner women who lack a surplus of donor fat, stacked flap reconstruction is an alternative. With this technique, two flaps are used in combination to reconstruct a single breast.