Description

The most commonly used flaps are taken from abdomen called DIEP and from back known as LD flap. Other common flaps can be taken form lower abdomen with muscle known as TRAM/VRAM or from the buttock and thighs like IGAP/SGAP/PAP and FALT/TUG. In some cases, implant and autologous tissues are used together. Autologous tissue may be used to cover an implant when there is not enough skin after mastectomy to allow for expansion and use of an implant. While the reconstruction with autologous flaps results in longer surgery and recovery time, the long term results are superior in terms of natural breast shape and feel. Expander stage may need multiple follow ups for inflation. Smoking, diabetes and obesity result in a higher risk of complications and in case of implants the risk of implant loss is also high. Autologous flap surgery also results in a scar at the donor site. Possible complications of autologous flap include necrosis of transferred tissue, formation of blood clots (hematoma), risk of infection at donor and mastectomy site. Possible complications of implant based reconstruction include infection, accumulation of fluid (seroma) or blood (hematoma) in the reconstructed breast, implant extrusion and loss. Long term risks are development of capsular contracture, implant rupture, and very rarely, anaplastic large cell lymphoma, a form of immune system cancer. Implant surgery is more technically challenging if there is history of radiotherapy as the skin and underlying tissue is fibrosed and opposes stretching and expansion.