Natural breast reconstruction removes skin, fat, and sometimes muscle and transfers it to the chest to rebuild the breast. This borrowed tissue is called a “flap”, and there are several techniques that are commonly used:
DIEP flap surgery uses skin and fat from the abdomen to re-create the breast(s). It is the most common donor-based breast reconstruction. A DIEP (deep inferior epigastric artery perforator) reconstruction has the added benefit of the patient receiving a flatter stomach, as that excess fat is removed.
The SHAEP (stacked hemiabdominal extended perforator) method is an advanced microsurgical technique. As an extended version of DIEP flap surgery, the SHAEP method uses the small perforator vessels in the hip area to go beyond the perfusion area of the DIEP flap. This method is a good option when large-volume breast reconstruction is needed.
A stacked DIEP flap surgery is an excellent option for patients who are thinner, but would prefer flap surgery instead of implants. In traditional DIEP flap surgery, only a half of the abdomen tissue is used to create the breast mound. With a stacked DIEP flap surgery, the entire unit from the abdomen is used to re-create the breast mound. This provides more volume, which is why it’s a good option for thin patients. Blood vessels in the chest are used for the blood supply.
Very similar to DIEP flap surgery, this method uses the superficial inferior epigastric (SIEA) vessels to source the blood supply to the flap, as opposed to the perforator vessels.
A good option for patients who are thin or have low body fat, the TUG (transverse upper gracilis) method takes the flap from the upper, inner thigh. The PAP (profunda artery perforator) method uses available skin, fat, and vessels from the back of the thigh.
A useful option for patients who are thin or have low body fat, an IGAP (in the crease) flap method uses available skin and fat from the lower buttock.
The SGAP (superior gluteal artery perforator) flap method is similar to the IGAP technique, but uses skin and fat from the upper buttock.
The LAP (lumbar artery perforator) flap method uses skin and fat from the lower back and hip area (flanks or “love handles”). As most women even very thin ones, have extra fat in this area, a LAP flap is a good option for many.