Reconstruction Using Abdominal Tissue

Breast reconstruction using tissue from the abdomen (stomach) to re-create a breast mound provides the most natural result of any technique. The choice of tissue to be moved from your stomach to your chest to re-create a breast mound will vary, depending on the blood vessels that supply the tissue of your abdomen and the skills of your surgeon.

Understanding the different types of flaps taken from your abdomen can be confusing. Looking at the makeup of your abdomen can be helpful. Your abdominal wall is made up of multiple layers, with the skin being the outermost layer. Under the skin is a layer of fat. This is followed by a layer of tissue known as fascia, which is sturdy and helps prevent your intestines from bulging out. Under the fascia is a layer of muscle known as the rectus abdominis muscle (your “6-pack” muscle).

Two blood vessels supply this muscle: the deep superior epigastric artery and vein, and the deep inferior epigastric artery and vein. The deep inferior epigastric artery and vein has smaller blood vessels that come off and travel back through the rectus abdominis muscle to supply the fatty layer and overlying skin. These smaller blood vessels are called “perforators.” Another set of blood vessels known as the superficial inferior epigastric artery and vein also help supply blood flow to the fatty tissue and skin. These blood vessels lie on top of the fascia layer.

The tissue taken from your abdomen can consist of all of these layers of the abdomen or only a few. Also, the tissue may be rotated to your chest on its blood supply (called a “pedicled” flap) or disconnected from its blood supply and connected to a new blood supply in your chest (called a “free” flap).

Advantages of reconstruction with abdominal flap:

• Natural breast shape, consistency and behavior
• Improved abdominal shape
• No breast implant required

Disadvantages of reconstruction with abdominal flap:

• Longer surgery
• Requires a surgeon trained in microsurgery techniques
• Additional scarring on stomach
• Longer hospitalization and recovery 

The different types of flaps from your abdomen that may be used to re-create a breast mound are listed below:

Pedicled Transverse Rectus Abdominis Myocutaneous (TRAM): this flap is rotated on its blood supply and consists of skin, fatty tissue and muscle, with or without fascia. (below)

Free Transverse Rectus Abdominis Myocutaneous (TRAM): This flap is disconnected from its blood supply and connected to the blood supply in the chest. It also consists of skin, fatty tissue and muscle, with or without fascia. (below)

TRAM Flap: Free