When surgeons began to use a woman’s own tissue in breast reconstruction, they would move the living tissue from a nearby location, often from the abdomen or back, without detaching it from the body. These flaps are still used today and are collectively called pedicle flaps, which mean they remain connected to the blood supply.
In breast reconstruction, the most common pedicle flaps are TRAM and LD flaps. These flaps involve the removal of not just skin and fat but also muscle, so the woman may lose some strength in the region where the muscle is taken. She might also be at risk for other complications, for example, hernia in the case of the TRAM flap, which is taken from the abdomen.
Today, more sophisticated surgical techniques have allowed surgeons to detach free flaps of a woman’s tissue from the abdomen or another location and then attach the blood vessels from the flap to those at the mastectomy site. These flaps usually include a perforating blood vessel and are called perforator flaps. While tissue transfers with perforator flaps may be more complex and require more time surgically, they do not involve the transfer of muscle, lessening recovery times and risks of long-term complications.
Even so, pedicle flaps still offer a viable option of breast reconstruction and may be the preferred option for some women, including those who have had problems with perforator flaps.