Breast reconstruction with autologous tissue

The female breast is the central symbol of femininity, sexuality and motherhood. The loss of a breast due to breast cancer leads to physical and emotional dissatisfaction and causes the self-confidence of the women affected to suffer greatly. Dr. Dorrit Winterholer is an expert in breast surgery. As a plastic surgeon, she has many years of professional and surgical experience in performing breast reconstruction in a qualified manner.

Breast cancer now affects every 8th woman. In many cases, breast-conserving therapy can be carried out. There are basically two different ways of reconstructing a breast: Breast reconstruction using breast implants or the use of autologous tissue. In individual cases, both procedures must be combined in order to achieve an optimal result.

The aim of breast reconstruction is to restore the patient’s self-esteem.

What can I achieve with breast reconstruction?

In a detailed personal consultation, we discuss with the patient which breast reconstruction technique is right for her. The right choice depends on many factors. The tissue condition of the breast after tumor or mammary gland removal plays an important role in the choice of breast reconstruction procedure.

The following conditions have a particular influence on the choice of procedure:

• the quantity and quality of the skin and soft tissue mantle
• the size of the healthy opposite breast
• tumor therapy.

What are the different breast reconstruction methods with autologous tissue?

When reconstructing the breast with autologous tissue, skin and fatty tissue, possibly together with muscles, are removed from other areas of the body (back, abdomen, thighs or buttocks) and connected to the blood vessels of the chest wall. There are two types: The “pedicled” and the “free” tissues, which are also referred to as “lobes”. In the case of pedicled flaps, the nourishing blood vessels remain on the displaced tissue.

In contrast, the free flaps are first cut at the donor site and then microsurgically reattached to the vessels on the breast or in the armpit. The procedure is long and requires a high level of experience and good microsurgical skills.

The reconstructed breast undergoes the natural process of tissue change and there is no foreign body sensation. The most natural breast reconstruction can therefore be achieved through reconstruction with the patient’s own tissue.

The following procedures are carried out:

Breast reconstruction with latissimus dorsi flap

Breast augmentation in breast reconstruction using a pedicled latissimus dorsi flap (back muscle). This procedure is particularly suitable for women who are very overweight, when other methods are not an option.

In this standard breast reconstruction procedure, the back muscle is moved forward into the breast region. The blood supply to the muscle is maintained during the transfer, so that microsurgical connection of the vessels to the chest wall is not necessary. With this method, however, the tissue block is not sufficient to reconstruct a sufficiently large breast. Often an implant must also be inserted.

Breast reconstruction with DIEP flap

The DIEP flap (Deep Inferior Epigastric Perforator flap) is currently the gold standard in breast reconstruction procedures. In this breast reconstruction technique, a new breast is reconstructed from the fatty skin tissue of the lower abdomen. This is a free flap plasty, which means that the vessels must be microsurgically connected to the chest wall vessels.

Breast reconstruction SGAP flap/ TMG flap

If the tissue conditions on the abdomen are insufficient, the free SGAP flap (superior gluteal artery perforator flap), for example, can be considered as an alternative for breast reconstruction. In this method, a block of tissue from the buttock region is used for breast reconstruction.

Another method of breast reconstruction after breast cancer is the free TMG flap (transverse myocutaneous gracilis flap). In this surgical method, a block of tissue is removed from the inner thigh to perform the breast reconstruction.

What happens during the consultation?

Breast reconstruction is planned in the tumor board in accordance with the oncological therapy.

During a detailed consultation, your wishes and expectations will be discussed and the various breast reconstruction options explained. Together we will decide whether breast reconstruction is right and suitable for you, whether a primary or secondary reconstruction and which surgical procedure is possible.

It is very important to me to support you with all your questions, concerns and wishes. Experience has shown that it is sensible to go through our discussion and recommendations and to set the final date for the operation at a further appointment.

If you have any further questions, please feel free to arrange a personal consultation.