Natural Breast Reconstruction options include Perforator Flaps, Myocutaneous Flaps, Fat Grafting

About Autologous Breast Reconstruction:

Autologous breast reconstruction is the restoration of a woman’s normal anatomy using her own body tissue to recreate her breast(s).

Natural tissue or autologous breast reconstruction that uses your body’s own tissue can be subdivided into three categories:

1.) Perforator Flaps
2.) Myocutaneous Flaps
3.) Fat Grafting

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. Dr. Levine has further advanced this field, developing first ever techniques in extension flap and stacked flap procedures. These pioneering techniques now mean that all women can restore the look and feel of their own warm, natural breasts regardless of their body type.

The 3 Categories of Autologous Breast Reconstruction:


True muscle-sparing Techniques
A perforator flap is a term used to describe a highly specialized type of autologous breast reconstruction. The most common perforator flap for breast reconstruction is the DIEP. This procedure uses the patient’s own extra skin and fat from the lower abdomen to reconstruct the breast. The advantage of the perforator flap is that the skin and fat is removed without any muscle sacrifice. This is a significant distinction from the muscle based flaps like the TRAM.
In all perforator flaps only the tissue that is needed for breast reconstruction is taken from the donor site. This necessary tissue consists only of skin, fat and the perforating blood vessel that supplies it. Each of these operations is named according to that perforating blood vessel. The “P” in the acronym for each perforator flap stands for perforator.

Learn more about available true muscle-sparing natural tissue breast reconstruction.


Myocutaneous flaps are made up of skin and muscle. The most common of these flaps is the TRAM. Other examples include the latissimus dorsi flap and the TUG flap. These procedures sacrifice the underlying muscle in order to take along with it the blood vessel that supplies the overlying skin. In almost every circumstance a perforator flap which does not destroy the underlying muscle would also be an option for patients undergoing breast reconstruction.

TRAM – The TRAM flap is a myocutaneous flap for breast reconstruction. This means that it contains both skin and underlying muscle. The tram harvests skin fat and muscle from the lower abdomen and transfers it to The chest for autologous breast reconstruction. This can be done as a pedicled flap (still attached to the muscle near the rib cage) or is a free flap (taking out of the body so that the blood vessels can be connected in the chest). Either way the underlying muscle is destroyed. The reason that the muscle is sacrificed in these operations is because It contains the vital blood vessels that supply the tissue for transfer. With advanced perforator flap techniques the sacrifice of the underlying muscle is no longer necessary.

Latissimus Dorsi – The latissimus dorsi is a large muscle in the back. This muscle can be used in combination with implants in breast reconstruction. In these operations the muscle is brought around from the back in order to cover the implant. The muscle provides more soft tissue coverage which is sometimes necessary for implant breast reconstruction. In some cases there is enough skin and fat in the lower back that can be harvested along with the latissimus for total breast reconstruction without implants.


Fat grafting is a technique in which fat is harvested from under the skin using liposuction. The fat is then processed and injected back into the chest to enhance or improve a reconstructed breast. In some cases the entire breast can be reconstructed with the patient’s own fat using this technique. This reconstruction requires preparation of the chest skin and muscle with an expansion device called BRAVA.The process takes many months and several operations. BRAVA expansion and fat grafting can also be used to improve or enhance an already reconstructed breast.


No matter how big or how small your needs are – we are here for you.
From the moment you call our office, we will work with you to make sure
you have all of the information you need to make the best decisions
about your breast reconstruction.

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