FAQs on Natural Breast Reconstruction

Autogenous breast reconstruction is the use of your own body’s tissue to reconstruct the breast. This includes the TRAM (transverse rectus abdominus myocutaneous flap), gluteal flap (gluteus maximus myocutaneous flap), latissimus dorsi flap, DIEP (deep inferior epigastric perforator flap), SIEA (superficial inferior epigastric artery flap) and GAP (gluteal artery perforator flap) techniques.

To learn more about your Autogenous Reconstructive Breast surgery options with Dr. Joshua Levine, visit our Natural Tissue Breast Reconstruction Procedures page.

Since autogenous reconstruction uses your own body’s tissue to reconstruct the breast, the tissue is there for life. You cannot reject it. It will change in volume as your normal weight fluctuations occur through life and often tends to improve in shape over time. The breast is reconstructed with fat, which is similar in density to breast tissue, thus the “feel” is similar to that of a normal breast. Implant reconstructions tend to require multiple operations prior to achieving the final result. These could include sequential expansion of breast skin, repositioning of the implant, correction of infra-mammary fold distortion, correction of shape deformity, correction of implant extrusion, correction of implant leakage, correction of capsular contracture, removal of implant because of infection, replacement of temporary implant or expander with permanent implant. If a patient has had radiation or is planning to have radiation, implant reconstruction is discouraged because of the unacceptably high complication rate. The implants often require replacement. Implant manufacturers do not consider them “lifetime devices”.

Learn more about muscle-sparing, natural tissue breast reconstruction with no implants.

Implant reconstructions are typically shorter operations (1-2 hours) and do not prolong hospitalization. Autogenous reconstruction, specifically perforator flap reconstruction, typically takes 4-5 hours for a single reconstruction and 5-7 hours for bilateral reconstructive breast surgery. The hospital stay is 3-4 days for perforator flap reconstruction and may be slightly longer with TRAM flap procedures. Implant reconstructions also do not require a donor site and recovery is therefore usually shorter.

DIEP stands for Deep Inferior Epigastric Perforator. This is the named vessel for which the tissue to be transferred is based. “Flap” is a plastic surgery term referring to the tissue which is to be transferred. The deep inferior epigastric vessels arise from the external iliac vessels (the external iliac vessels become the femoral vessels in the leg). The deep inferior epigastric vessels course beneath the rectus abdominus (the major abdominal “six pack” muscle) on each side. These vessels send off branches to the muscle as well as through the muscle into the overlying fat. These perforating branches are those which are identified, preserved and transferred with the overlying tummy fat to reconstruct the breast.

Dr. Levine is a world leading authority and foremost expert on the many natural tissue breast reconstruction procedures including DIEP, SIEA, SHaEP, PAP, GAP, LAP and TDAP Flap procedures. Learn more about the DIEP breast reconstruction procedure option.

GAP stands for Gluteal Artery Perforator. This may at times be described as S-GAP or I-GAP. The prefixes define superior or inferior branches of the gluteal artery. As with the DIEP, the gluteal artery perforator arises from a branch of the gluteal artery, courses through the muscle, to deliver blood to the overlying buttock fat. This procedure allows for use of buttock fat to reconstruct the breast when abdominal fat is inadequate. Similar to the DIEP it is also a “muscle preserving” procedure and doesn’t sacrifice the buttock muscles to collect the tissue (unlike the gluteal flap).

Learn more about the GAP Flap Breast Reconstruction Procedure Option offered by Dr. Levine.

The TRAM and gluteal flaps take the underlying muscles with the skin and fat for the breast reconstruction. This can lengthen recovery and and in the case of the TRAM flap may increase your risk for hernia or abdominal “bulge”. Taking the gluteal musculature may result in some weakness in the buttocks.

Learn about other natural breast reconstruction options such as the DIEP, SIEA, SHaEP, PAP, GAP, LAP and TDAP Flap procedures on or Natural Tissue Procedures page.

Surgeons whom perform the operations routinely may have success rate exceeding 99%. The success rate equals that of the TRAM and gluteal flaps depending on the surgical team.

Learn more about Joshua Levine’s expert surgical teams and expertise as a pioneer and top surgeon in natural tissue breast reconstruction.

You are a candidate for a DIEP flap reconstruction if the amount of fat you have on your lower abdomen is sufficient to reconstruct one or both breasts to the desired volume. The tissue used is that which is often removed during tummy tucks. Prior abdominal operations (i.e. hysterectomy, c-section, appendectomy, bowel resection, liposuction) does not exclude the DIEP flap from use. A prior tummy-tuck does exclude the DIEP flap from being used. In those cases where abdominal fat is inadequate or prior surgery excludes the use of the DIEP flap the GAP flap is used.

To find out more, schedule a private consultation with Dr. Levine to learn about your unique breast reconstruction options.

Yes. This is referred to as “immediate reconstruction”. Some of the best aesthetic results are accomplished when the reconstructions are performed at the time of mastectomy in conjunction with a skin-sparing mastectomy. The total surgical time is unchanged because the breast surgeon and the reconstructive surgeons work together at the same time.

To learn more about immediate breast reconstruction visit our Timing: Immediate vs. Delayed page.

You should wait 3-6 months following chemotherapy. This allows your body time to recover from the chemotherapy before stressing it with an operation. You should wait 6 months or more following radiation therapy. This allows your chest skin to recover from the effects of radiation before your reconstruction.

To learn more about breast reconstruction after chemotherapy and to view a 3D Animation that walks you through it, visit our Breast Reconstruction After Cancer page.

Most Plastic Surgeons do not perform perforator flap breast reconstruction due to its complexity. It is technically very difficult and time consuming. Best success rates and efficiency are afforded when performed by a team of microsurgeons. There are very few microsurgical breast reconstruction teams committed to such an endeavor.

Learn more about Dr. Levine’s expertise as a top breast reconstruction doctor.

Yes. If your insurance covers mastectomy, they must by law cover the reconstruction method of your choice. If you do not have a surgeon in your community who performs the type of reconstruction you are seeking, your insurer will often pay for surgery in another city or state if required.

Learn more about our first class care and breast reconstruction insurance options.