What is Autologous Breast Reconstruction?
Autologous breast reconstruction rebuilds the breast using a woman’s own tissue instead of an implant. “Autologous” means “from the same person.” Skin and fat are taken from an area of the body with extra tissue and shaped into a new breast. With microsurgery, the tissue’s blood vessels are reconnected in the chest, giving the reconstructed breast its own living blood supply.
This guide walks through the three types of autologous reconstruction, how it compares to implants, and where donor tissue comes from.
The Three Types
There are three main ways a woman’s own tissue can be used to rebuild the breast. Choose one to jump to it.
2Myocutaneous FlapsSkin, fat and muscle move together. The muscle is sacrificed.Read more ↓
3Fat GraftingFat is moved by liposuction, most often to refine a reconstructed breast.Read more ↓
Autologous Reconstruction vs. Implants
Because it is living tissue, an autologous reconstruction looks, feels and ages like a natural breast, with no device to rupture, harden or replace. The tradeoff is a longer initial surgery and recovery, since there is a donor site as well as the breast.
| Comparison | Your own tissue | Implants |
|---|---|---|
| Look and feel | Warm, soft, living tissue | A device beneath the skin |
| Over time | Ages and changes with the body, including weight | Does not change with the body |
| Device risks | None: no device to rupture or harden | Rupture, capsular contracture |
| Future surgery | Typically a single, lasting reconstruction | May need replacing years later |
| Initial surgery | Longer surgery and recovery, with a donor site | Shorter initial surgery |
Perforator Flaps – True Muscle-Sparing Techniques
Only the tissue needed to rebuild the breast is taken: skin, fat, and the small blood vessel that supplies them, called a perforator. Each flap is named for that vessel (the “P” stands for perforator). The most common is the DIEP flap, from the lower abdomen.
Skin, fat and the perforator blood vessel. The muscle stays in place.
The tissue and its blood vessel are fully detached and shaped into a new breast.
Under a microscope, Dr. Levine reconnects the vessel to blood vessels in the chest.
SIEA · Lower abdomen
SHaEP · Stacked abdomen
PAP · Upper thigh
GAP · Buttocks
LAP · Lower back
TDAP · Upper back
Myocutaneous Flaps – Muscle-Sacrificing
These flaps move skin, fat and muscle together, because the muscle carries the blood vessels that keep the tissue alive. Examples include the TRAM, latissimus dorsi and TUG flaps. Today, a perforator flap is an option in almost every case.
TRAM Flap
Uses skin, fat and the rectus abdominis muscle from the lower abdomen. In a pedicled flap, the tissue stays attached to the muscle and is tunneled up to the chest. In a free flap, the tissue is fully detached and its blood vessels are reconnected in the chest. Either way, the abdominal muscle is lost, which can weaken the core and raise the risk of a bulge or hernia.
Latissimus Dorsi Flap
A large muscle in the back, most often used together with an implant. The muscle is brought around to the chest, where it covers the implant and adds soft tissue that thin or radiated skin may need. For some women, there is enough skin and fat on the back to rebuild the breast with the latissimus alone, without an implant.
Fat Grafting
Fat is harvested with liposuction, processed, and injected into the chest to enhance or refine a reconstructed breast. Unlike a flap, it does not bring its own blood supply. Only part of the fat survives, so several sessions are usually needed, and it is best for adding modest volume rather than rebuilding the whole breast.
Common Donor Sites
The donor site depends on each woman’s body type, where she carries extra tissue, and how much volume is needed.
Lower abdomen
DIEP · SIEA
The most common site, using the same tissue removed in a tummy tuck.
Stacked abdomen
SHaEP
Combines tissue from both sides of the abdomen. Ideal for women with less abdominal tissue.
Back of the upper thigh
PAP
Tissue from the upper inner and back of the thigh.
Buttocks
SGAP · IGAP
For women with more volume there than in the abdomen.
Lower back
LAP
The “love handle” area above the buttocks.
Upper back
TDAP
Below the armpit, often used for partial reconstruction.
When one donor site doesn’t have enough tissue, flaps from two areas can be combined, the approach Dr. Levine pioneered.
Meet Dr. Joshua L. Levine
Dr. Levine performs the full range of perforator flap procedures, including DIEP, SIEA, SHaEP, PAP, GAP, LAP and TDAP flaps. He developed first-ever techniques in extension and stacked flap procedures, so women of every body type can restore the look and feel of their own warm, natural breasts.