Breast reconstruction from the M. latissimus dorsi

In this procedure a part or the complete back muscle is loosened. This also leaves a piece of skin, from which a natural breast shape can finally be built. The supplying blood vessels are not cut through, but are transplanted with the tissue, so that the blood supply is guaranteed throughout.

Often, however, an additional implant is also necessary here. The removed back muscle is balanced by other muscle groups on the back, so that there are no restrictions. Disadvantages are on the one hand the additional scar on the back and the risk of capsule fibrosis due to the implant.

TRAM – Transverse rectus abdominis muscle flap

This procedure is one of the most original methods of breast reconstruction and has been continuously developed. From the straight abdominal muscle (M. rectus abdominis), transverse strips of skin and fatty tissue are taken and finally sutured into the breast region. In the meantime, it is also possible to save on muscle tissue.

Only a small muscle spindle containing the supplying blood vessels is removed. This prevents excessive impairment of the abdominal muscles. Furthermore, this procedure can also be performed with stalks.

Accordingly, the tissue is removed, always remains connected to the body and is transferred under the skin up to the breast region. It is then not necessary to connect the vessels and therefore the effort is less, but this method also offers the risks of circulatory problems and wound healing disorders. With this method, which has become the gold standard for reconstruction from the patient’s own tissue, the straight muscle is not removed, but only split to dissolve the blood vessels.

This prevents abdominal wall weakness and fractures. Furthermore, similar to the TRAM, skin and fatty tissue is removed for breast reconstruction. This operation leaves a transverse scar on the lower abdomen and a circular scar around the navel.

S- GAP/I- GAP – Superior/Inferior Gluteal Artery Perforator Flap

In these procedures, skin and fatty tissue is taken either from the lower gluteal fold or from the upper gluteal fold to build up the breast. This method has the advantage that it can be used for a second breast reconstruction attempt. It is particularly suitable for slim patients, as they sometimes do not have enough fatty tissue on their stomach.

The size of the flap depends on the size of the breast to be reconstructed, so the size of the scar also varies. However, the resulting scar can be covered very well by clothing and is less conspicuous compared to the other procedures. There are, however, statements from patients who have had long complaints when sitting.

TMG – Transverse Musculocutaneous Gracilis Flap

In this variant, a part of the gracilis muscle, including skin and fatty tissue, is removed from the inner side of the thigh. The removal of a muscle part does not impair the mobility of the leg, but is very well compensated by other muscle groups. For this method there must be enough material available to be able to remove it, but also to ensure a cosmetically beautiful tightening of the tissue. This surgical technique is particularly popular when the patient’s own breast skin has been preserved, as the skin on the thighs is usually darker than on the breast. The remaining scar is not very noticeable and it is also a very simple and time-limited operation.