Breast Reconstruction Flaps

Recovery and Rehabilitation

When your surgery is complete you may have dressings over your breasts. These will be changed regularly by our nursing staff. Your new breast may appear larger than your existing breast, however over time it will decrease in size.

Depending on your circumstances, your surgeon will advise if you should wear a bra immediately after surgery or not.

You may feel tired and sore for the first two weeks after surgery. We recommend no heavy lifting and to avoid strenuous exercise, sports, and swimming. To help you recover, your surgeon may prescribe pain relief injections. They may also insert a plastic tube into your breast to drain any excess fluid.

Notify the RPS team immediately if you experience any of the following symptoms:

nausea, vomiting or diarrhoea
fever/high temperature – 38°C or higher
shortness of breath
breast leakage after day one of recovery – blood or fluid
increasing pain in either breast
increasing redness around incision site
heavy bleeding from incision site.

More information

What else you should know

What are free and pedicled reconstructive tissue flaps?

The reconstructive tissue flaps procedure can be carried out in two ways, free flap and pedicled flap.

When free flap tissue is moved to your chest it is completely separated from original blood vessels. These vessels are then joined together in the breast area using microsurgery. If the tissue remains attached to its blood vessels, it’s referred to as a pedicled flap.

Pedicled flaps have been used for longer and the surgery is easier to carry out. When using free flaps your plastic surgeon needs microsurgery skills to attach the blood vessels to the flap and chest area to ensure the new breast has adequate blood flow.

Can I have flap reconstruction at the same time as a mastectomy?

Yes, you can have flap reconstruction at the same time as you have a mastectomy. You can also have it after, or you may decide to do it in stages, some of the procedure during your mastectomy and some after.

What are the types of tissue sources available for flap reconstruction?

Flap reconstruction can be carried out using tissue from your abdomen, back, thighs, hips or buttocks. Sources of tissue include:

Tissue from your abdomen (DIEP, SIEA, TRAM). Often women are pleased to use tissue from their abdomen as it’s like having a tummy tuck.
Tissue from your back (Latissimus Dorsi).
If your plastic surgeon uses this option you will also need an implant.
Tissue from your hip/buttocks (IGAP, SGAP, Hip).
Tissue from your thighs (PAP, TUG).
Multi-component/hybrid flap using tissue from your abdomen/hips (Body Lift Perforator, Stacked DIEP, Stacked/Hybrid GAP).
Autologous using fat tissue from your abdomen, buttocks, and/or thighs by liposuction (Fat Grafting).

What factors determine which donor site the tissue comes from?

Where the tissue is sourced from depends on:

Body type

Where the tissue is sourced from will depend on where you have enough extra tissue. For women who are thin it can be difficult to source tissue from TRAM, DIEP or SIEA flaps. Instead, your surgeon may recommend GAP, TUG, PAP or latissimus dorsi flap (always used with an implant).

For women who are thin, instead of implants, our specialist surgeons can use multiple small flaps for one or both breasts.

Breast size

More tissue will be needed if your breasts are large and the stacked or hybrid flaps or an implant may be used to provide more volume.

Pregnancy

The TRAM flap sourced from your belly (tissue and abdominal muscle) may not be available if you plan on falling pregnant after your breast reconstruction. This is due to stretching during pregnancy which can put pressure on the abdominal wall and the incision used to remove the tissue.

A better option if you are falling pregnant is to source tissue from the DIEP or SIEA flaps, or from other sites such as the thighs or buttocks.

Plastic surgeon’s expertise

Not all plastic surgeons have the experience that is required for flap reconstruction.

The surgeons at RPS Australia are multi award-winning reconstructive plastic surgeons, who have been trained to design and manage the restoration of form and function to the affected part of the body.

What are the physical effects I might experience after flap reconstruction?

Everyone experiences different symptoms after flap reconstruction, but some common effects are:

You will have multiple sites that are healing, including your breast and the donor site/s. You may also have additional incisions if you have a sentinel node biopsy or axillary node dissection at the same time as the reconstruction.
You may need additional surgery called ‘finishing work’. This could include reshaping the flap, reconstructing a nipple, repositioning an implant or removing surplus fat from the donor site.
The flap isn’t static, so it will change and get bigger or smaller as you lose or gain weight.
Unlike implants, flaps can be subjected to radiation therapy, but you will need to notify your plastic surgeon.
Once tissue is used once for flap reconstruction it can’t be used again, so if you require additional flap reconstruction it will need to come from a new source.

Will I have scarring?

Scars are an inevitable part of any invasive surgery. Your specialist plastic surgeon will endeavour to minimise scarring and keep your scars as inconspicuous as possible by locating the incisions in easily hidden sites. Scars will be placed along natural skin lines and creases. Scars may fade with time and become barely noticeable. If you are prone to scarring, you should advise your surgeon.

Will I need additional surgery?

This depends on the procedure, but reconstruction usually requires more than one surgery for the best result. Revisional surgery may be needed to correct any irregularities.