Free flap breast reconstruction

Free-flap breast reconstruction is a type of autologous-tissue breast reconstruction applied after mastectomy for breast cancer, without the emplacement of a breast implant prosthesis. As a type of plastic surgery, the free-flap procedure for breast reconstruction employs tissues, harvested from another part of the woman's body, to create a vascularised flap, which is equipped with its own blood vessels. Breast-reconstruction mammoplasty can sometimes be realised with the application of a pedicled flap of tissue that has been harvested from the latissimus dorsi muscle, which is the broadest muscle of the back, to which the pedicle (“foot”) of the tissue flap remains attached until it successfully grafts to the recipient site, the mastectomy wound. Moreover, if the volume of breast-tissue excised was of relatively small mass, breast augmentation procedures, such as autologous-fat grafting, also can be applied to reconstruct the breast lost to mastectomy.^[1]

In surgical praxis, the abdomen is the primary donor-site for harvesting the tissues to create the free flap, because that region of the woman's body usually contain's sufficient (redundant) adipocyte fat and skin -tissues that are biologically compatible and aesthetically adequate for the construction of a substitute breast. The secondary donor-sites for harvesting adipocyte and skin tissues to create a free flap are the regions of: (i) the gluteus maximus muscles, (ii) the medial thigh, (iii) the buttocks, and (iv) the waist of the woman's body.

The clinical advantage of the free-flap breast reconstruction procedure is avoidance of the medical complications—infection, malposition of the breast implant(s), capsular contracture—which occasionally occur consequent to breast-reconstruction surgery procedures that emplace breast prostheses to the mastectomy wounds. In which cases, the correction of such medical complications might surgically require either the revision (rearrangement) or the explantation (removal) of the breast implants.

For the woman, the anatomic, aesthetic, and psychologic advantages of a free-flap reconstruction procedure are the natural shape, texture, and appearance of the reconstructed breast, and the fact that it will undergo the same biological changes that are natural and normal to the woman's body as she ages; the breast reconstructed with autologous tissues will not remain unnaturally youthful, as would be the case with a breast-implant reconstruction procedure.

The clinical disadvantages of free-flap breast reconstruction surgery are: (i) the technical complexity of the plastic surgery procedure, (ii) prolonged surgical operation times, (iii) additional, secondary scarring at the flap-tissue donor site, (iv) possible medical complications at the flap-tissue donor-site, and (v) possible necrosis of the tissues harvested to create the free-flap.^[2]

Therapeutically, the free-flap breast reconstruction procedure is always possible after radiation oncology for the treatment of breast cancer. Technically, an autologous-tissue breast reconstruction is a good resolution to a failed breast-implant reconstruction.^[3]