Tissue flap reconstruction
Breast reconstruction using tissue from your own body to re-create a breast provides the most natural result of any technique. The choice of tissue to be moved from another part of your body to your chest to re-create a breast mound will vary, depending on the blood vessels that supply the tissue and the skills of your surgeon.
If a flap-based procedure is right for you, options may include:
Abdominal free flap: This option is also known as a DIEP (deep inferior epigastric perforator) flap reconstruction. Surgeons may take skin, fat and muscle tissue from your lower abdomen. We transfer the flap and its blood supply to your chest, then reshape and attach it to a nearby artery and vein. This technique typically provides the largest amount of tissue and is the most breast-like in feeling. It is sometimes possible to connect sensory nerves to improve sensation.


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- Thigh-based flap: This technique may be an option when an abdominal flap is not possible, most commonly if you have undergone a large abdominal surgery in the past. We may use a transverse upper gracilis flap (TUG), which involves a small muscle from the upper thigh, blood vessels, fat and skin. The profunda artery perforator (PAP) flap uses tissue from the back of the thigh but leaves nearby muscles intact.
- Latissimus dorsi (LD) flap: Surgeons make an incision on your back near the bra line and isolate a section of fat, muscle and skin. They do not remove the flap from its blood supply. Instead, they slide it past nearby tissue to reach the chest. We may use this option by itself to create a small breast. To create a larger breast, we may use this type of flap in conjunction with an implant

Implants
Implant-based reconstruction does not use tissue from another part of the body. There are two types of implants: saline-filled and silicone gel-filled. Both types of implants have a silicone outer shell. They vary in shape (contour), size and profile. The U.S. Food and Drug Administration has ruled these options as safe and effective. Your surgeon will help determine which implant is best for your body shape.
Implant-based options we offer include:
- Skin expansion and implants: We perform a procedure to implant an inflatable device into the breast area. During outpatient visits, we fill the balloon with a saltwater solution, which expands the skin, creating space for a future permanent implant. We remove the device and replace it with a permanent breast implant during a later procedure.

- Direct to implant: Some patients are candidates for placement of permanent breast implants during the same procedure as their mastectomy.
- Flap reconstruction using an added implant: We create a new breast using a flap of skin and fat from another body area, with a permanent implant included to increase the size of the final breast created.
Images via MD Anderson
Additional procedures
Following the main surgeries for breast reconstruction, you may want to undergo additional minor procedures to optimize the shape and appearance of your breasts. They include:
- Nipple reconstruction: Surgeons use nearby tissue to create a new realistic nipple to replace what had been removed during your mastectomy.
- 3D nipple and areola tattooing: We use medical-grade tattooing techniques to create a 3D nipple and areola. This can be done after nipple reconstruction or on its own without nipple surgery if the patient does not want a new nipple bud.
- Symmetry procedures: An additional smaller surgery may be necessary to ensure breasts are of similar shape, size and positioning on your chest. Commonly, this is needed if one breast was reconstructed and the other did not undergo surgery for the treatment of cancer. There are many options, but they include breast lifts (mastopexies), augmentation (implant placement), breast reductions and fat grafting.