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Flap reconstruction is a reconstructive surgery in which a flap of skin and fat with or without muscle is transplanted from a part of the body (for example, the lower abdomen, back, thigh, or buttock) to the chest area where it is shaped to form a new breast mound. Like the implant surgery, this operation can be performed at the same time as the mastectomy or it can be delayed.

Advantages of flap reconstruction include the following:

• may eliminate the use of foreign material in the body
• reconstructed breast usually looks and feels more natural
• will last the woman's life span
• when successful, requires minimal touch-up or redo operations throughout a woman's lifetime

Disadvantages of flap reconstruction include the following:

• increased complexity and length of the surgery
• may require a longer recovery period if muscle is included in the reconstruction
• additional donor site scars

Because flap reconstruction involves small blood vessels, women who smoke or have diabetes, vascular diseases, or connective tissue diseases are usually advised that they are at higher risks of wound healing complications in both implant and flap-based reconstructions.

Some women may require an implant, in addition to the flap reconstruction, for recreating the breast.

If flap reconstruction is the selected option for reconstructive surgery, then the surgeon must decide from which part of the body the required tissues are taken. The tissues for breast reconstruction can be taken from the following areas:

• Back
  • Latissimus Dorsi Myocutaneous Flap: Pedicled rotational flap composed of skin, fat, and muscle
• Abdomen
  • Transverse Rectus Abdominus Myocutaneous or TRAM flap: Pedicled rotational flap composed of skin, fat, and muscle
  • Free Transverse Rectus Abdominus Myocutaneous (Free TRAM) flap: Microvascular transplant of abdominal flap composed of skin, fat, and muscle
  • Deep Inferior Epigastric Perforator or "DIEP" flap: Microvascular transplant of abdominal flap composed only of fat and skin (muscle sparing)
  • Superficial Inferior Epigastric Perforator or SIEP flap: Microvascular transplant of abdominal flap composed only of fat and skin (muscle sparing)
• Buttock
  • Superior Gluteal Artery Perforator or SGAP flap: Microvascular transplant of buttock flap composed only of fat and skin (muscle sparing)
  • Inferior Gluteal Artery Perforator or In-the-Crease IGAP flap: Microvascular transplant of buttock flap composed only of fat and skin (muscle sparing)
• Thigh
  • Tensor fascia lata thigh flap: Microvascular transplant of thigh flap composed of skin, fat, and muscle
  • Lateral transverse thigh flap: Microvascular transplant of thigh flap composed only of fat and skin (muscle sparing)

Prior to mastectomy, all women should have the opportunity to meet with a qualified plastic surgeon to discuss breast implant and flap breast reconstruction methods. The surgeon and the woman will discuss each alternative and choose the most appropriate one to meet the specific requirements and personal preferences. However, if this did not occur, it is never too late to learn more about breast reconstruction. Many women who did not proceed with immediate breast reconstruction are still good candidates even years after their mastectomy.

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