Reconstructing the breast with a “flap”….it sounds a bit weird if we’re honest. Plastic Surgeons talk about flaps all the time, but what exactly is a “flap”?

Most patients understand the concept of using an implant to reconstruct the breast. Many patients have also heard of “flaps” being used to reconstruct the breast, either on their own or with an implant. There are many kinds of flap in plastic surgery…. understanding what a flap is and how it can work requires a bit of an anatomy lesson.

We all understand that the blood flows around the body from the heart, travelling to major organs and into the limbs, and then returning to the heart. Plastic Surgeons have, through study of anatomy, been able to determine that there are very small blood vessels that supply distinct areas of the skin (and the fat underlying this skin). This knowledge has then allowed us to use these areas of skin and fat (with those blood vessels) to reconstruct certain defects. In general, we try to borrow tissue from where it may be in excess: a very old saying in Plastic Surgery is that “we borrow from Peter to pay Paul, but only when Peter can afford it!” Areas such as the abdomen are rich pickings for such flaps: the ability to take some skin and then close the abdomen much as one would for a tummy-tuck offers an extra small benefit to our patients.

So, a flap is just a bit of skin & fat (and even other tissues such as muscle or bone if we need them!) that has a distinct, specific blood supply, which allows a Plastic Surgeon to move that tissue from an area where it isn’t needed, into an area where it is needed.

Lets then take this idea one step further.

Some patients will have heard the terms TRAM or DIEP flap (and if you haven’t, don’t worry, we’ll be discussing these flaps in the next article). These are “free flaps”, both raised from the abdominal area. Free flap simply means that a flap of tissue is harvested with the blood vessels that supply it, and these blood vessels are then disconnected, to allow the flap to be moved somewhere else in the body. When a Plastic Surgeon reconstructs the breast using a free flap, this requires microsurgery. Using a microscope, very specialised instruments and sutures so small they can only just be seen with the naked eye, an artery and a vein in the flap can be connected to to other blood vessels in the chest (just next to the sternum) so that blood flow resumes through the tissue of the flap. For the flap survive, there has to be blood flowing in (via the artery) AND blood flowing out (via the vein). Once the blood flow resumes, this tissue is once more a living part of your body, and when used to reconstruct the breast, this means that the flap can grow and change with you over time. No implant will ever do that!

Of course, not all women have sufficient tissue in the abdomen. Depending on a lady’s body shape, there are a variety of other options, including taking tissue from the back, the inner thigh and the buttock. The body has a surprising store of “spare-parts” available to a Plastic Surgeon!

Quick Facts:

• a “flap” is a way of using a patient’s own tissues (skin and fat) to reconstruct the breast
• because this is your own tissue, it will grow and change with you after your breast reconstruction
• flap reconstruction of the breast is the most “natural” form of breast reconstruction
• but remember, a flap always requires a “donor” – the most common donor is the abdomen, which results in a scar that runs from hip to hip (similar to an abdominoplasty)

‍