After a mastectomy, natural tissue reconstruction allows a woman to have a new breast shaped out of tissue that has been shared from another part of her body. (The transfer is sometimes referred to as autologous, which means the donor and recipient of the tissue are the same person.) The end result is a living breast that feels fuller and softer, looks more authentic and hangs more naturally than it likely would with an implant.
Use of natural tissue in breast reconstruction has evolved over time, and there are several different procedures with shorthand names usually related to the muscles or blood vessels involved. Earlier generation procedures (TRAM and LD) still are available but have drawbacks because they involve transferring muscle tissue along with skin and fat tissue.
Newer procedures, including DIEP, transfer skin and fat tissue but no muscle. They are often referred to as “free flap” procedures because the surgeon separates the donated flap of tissue, including the blood vessels, from the body before moving it to the breast area. Reattaching the blood vessels requires an experienced and skilled surgeon trained in microscopic techniques. Often, these flaps are named for the defining blood vessel (perforator) in the flap, and as a result, they are collectively called perforator flaps.
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