This is a longer reconstructive procedure, involving about 4-5 hours of surgery. One of the rectus abdominus muscles is tunneled along with the overlying skin up to the chest. The breast mound is created to match the opposite site. A blood transfusion may be required. You may donate your own blood prior to surgery to be re-infused during the surgery.

Breast implants are not usually required. The tissue is generally adequate to match the size of the opposing breast. If the opposite breast is large or pendulous it can be decreased in size by a simultaneous breast reduction. Patients wishing to have this procedure must stop smoking six weeks prior to and six weeks following surgery. Failure to comply may result in death of the flap. A synthetic mesh is placed over the area where the muscle is moved. This strengthens the abdominal wall and minimizes the chance of herniation of the bowel. Nipple reconstruction is done as a second procedure. Some contouring of the new breast mound may be necessary at the same time.

Advantages

This provides the most natural looking breast reconstruction with the added benefit of a “tummy tuck”. No implant is needed so capsule formation is not a risk. The scar is easily hidden with clothing.

Disadvantages

There is a risk of herniation of the bowel resulting from moving the rectus abdominus muscle. Abdominal strength is diminished. This is the longest procedure and has the greatest risk for requiring a blood transfusion.

Possible Complications

1. Inadequate tissue requiring the use of a breast implant
2. Poor circulation to the flap resulting in tissue loss
3. Weakness or herniation of the abdominal wall.
4. Placement of the umbilicus off center
5. Collection of fluid (seroma) under the skin requiring needle aspiration.
6. Infection, in particular of the mesh requiring surgery for removal.