Autologous Breast Reconstruction

As an internationally recognized expert in breast reconstruction, I am one of the pioneers of gentle microsurgical breast reconstruction with autologous tissue and have developed a very gentle reconstruction procedure using autologous tissue from the lower abdomen or thigh, which I would be happy to advise you on. Based on my experience, I can offer you all breast reconstruction procedures.

RECONSTRUCTION WITH TISSUE FROM THE LOWER ABDOMEN (DIEP-FLAP)

Breast reconstruction with the patient's own tissue from the abdomen, also known as DIEP flap (Deep Inferior Epigastric Perforator), usually gives the most natural result, as the skin and fatty tissue from the abdomen most closely resemble the breast tissue.
In the standard technique I use, the abdominal fat tissue is transplanted freely. Here, only skin and fatty tissue from the abdomen with the supplying vessels (artery and veins) is removed and sutured to the breast again under the microscope. The great advantage of this method is that no abdominal muscle is removed, so that the abdominal wall remains intact and the risk of abdominal wall weakness is negligible.
The prerequisite for this operation is of course sufficient abdominal tissue. A positive side effect is the abdominoplasty necessary to close the abdomen.

Indication

Immediate or delayed breast reconstruction with autologous tissue. If you have a tendency to thrombosis, we carry out a blood test beforehand to be on the safe side. Special blood parameters are clarified (so-called thrombophilia). In addition, before surgery, the abdominal vessels can be visualised by means of computer tomography (CTA) to simplify the planning of the operation and thus increase patient safety.

Surgery

Surgery takes place under general anaesthesia. The skin incisions are discussed beforehand and in case of an immediate reconstruction, they are based on the oncological necessities. For later reconstructions we use already existing breast scars. The abdominal fat tissue is removed with its vessels, the abdominal muscle is spared. The tissue is transplanted to the breast and sutured under the microscope to new vessels in the area of the sternum or axilla. The abdomen is closed with an abdominoplasty. The belly button is newly fitted in this procedure. Drains are inserted to drain off wound fluid.

After Surgery

As with all operations, you should stop smoking in order not to endanger the blood supply to the tissue and to minimize the risk of wound healing disorders. You can get up after the operation. However, the bed should be kept for some days in a so-called beach chair position to relieve the abdomen. You will stay in hospital for about 5 to 7 days. We recommend an abdominal belt for about 6 weeks. Corrective surgery if necessary should be performed at the earliest after 6 to 9 months, i.e. after the internal scar healing has been completed.

Risks

In rare cases, the body may not accept the tissue. This risk is less than 2%. In this case, we can try to eliminate a possible thrombosis in the sutured vessels by means of an immediate, revision operation. In the worst case, however, it is possible that the transplanted tissue has to be removed completely. In this case, a new reconstructive procedure must be chosen. However, it also means that in more than 98% the healing process is free of complications. Further risks lie in occasional wound healing disorders. Occasionally, there may be wound healing disorder or accumulation of wound fluid (seroma) in the harvesting area on the abdomen or umbilicus. In most cases, this can be treated conservatively, i.e. without another operation. Occasionally, sensory disturbances in the lower abdomen may occur for several months. Very rarely, little knots within the new breast can occur, so-called "fat necrosis". These are harmless fat encapsulations that can be left in place or removed relatively easily. The exact risks are discussed in detail during the consultation.

RECONSTRUCTION WITH TISSUE FROM THE INNER THIGH

In breast reconstruction, the inner thigh flap, also known as TMG, TUG or PAP, is now a standard procedure. Nevertheless, I am one of the few plastic surgeons who have extensive experience with this technique. The advantage of this form of reconstruction is that the scar is not very conspicuous, it lies on the inside of the thigh. Visible asymmetries on the thighs are rare. The removal of the tissue usually does not cause a loss of function.
This operation is particularly suitable for slim patients. Skin and fatty tissue is transplanted freely from the inner side of the thigh and the lower gluteal fold. For this purpose, the tissue with the supplying vessel is removed from the thigh and sutured to the breast again under the microscope.

Indication

Immediate or delayed breast reconstruction with autologous tissue. If you have a tendency to thrombosis, we carry out a blood test beforehand to be on the safe side, in which special blood parameters are examined (so-called thrombophilia).

Surgery

Surgery takes place under general anaesthesia. The skin incisions are discussed beforehand and in case of an immediate reconstruction they are based on the oncological necessities of the breast. For later reconstructions we use already existing scars. The tissue from the thigh with its vessels is transplanted to the breast, shaped and sutured under the microscope to new vessels in the area of the sternum. The thigh incision is closed with a lifting. Drains are inserted to drain off wound fluid.

After Surgery

As with all operations, you should stop smoking in order not to endanger the blood supply to the tissue and to minimize the risk of wound healing disorders. You can get up and walk around immediately, but you should not sit directly on the scar for 5 to 10 days to allow it to heal properly. You will stay in hospital for about 5 to 7 days. We recommend compression pants for a total of 6 weeks. After that you can go in for sports again. We recommend corrective surgery if necessary at the earliest after 6 to 9 months, i.e. after the internal scar healing process has been completed.

Risks

In rare cases, the body may not accept the tissue. This risk is less than 2%. In this case, we can try to eliminate a possible thrombosis in the sutured vessels by means of an immediate, revision operation. In the worst case, however, it is possible that the transplanted tissue has to be removed completely. In this case, a new reconstructive procedure must be chosen. However, it also means that in more than 98% the healing process is free of complications. Further risks lie in occasional wound healing disorders. There may be wound healing disorder or accumulation of wound fluid (seroma) in the harvesting area on the thigh. In most cases, this can be treated conservatively, i.e. without another operation. Noticeable asymmetries on the thighs are rare. Occasionally, sensory disturbances on the back of the thigh can occur temporarily. Some patients describe an initial feeling of tension in the thigh. Very rarely, little knots within the new breast can occur, so-called "fat necrosis". These are harmless fat encapsulations that can be left in place or removed relatively easily. The exact risks are discussed in detail during the consultation.

RECONSTRUCTION WITH TISSUE FROM THE BUTTOCKS

In the FCI flap, the tissue is taken from the lower gluteal fold and then transplanted freely to the breast. This operation is suitable for patients who do not have enough tissue on the abdomen or thigh. The name FCI stands for Fascio Cutaneous Inferior Gluteal Flap. The advantage of this method for patients is that the scar is not very conspicuous in the lower gluteal fold. Visible asymmetries at the donor site are rare. The removal of the tissue usually does not cause a loss of function, but a permanent numbness may remain on the back of the thigh.

Indication

Immediate or delayed breast reconstruction with autologous tissue. If you have a tendency to thrombosis, we carry out a blood test beforehand to be on the safe side, in which special blood parameters are examined (so-called thrombophilia).

Surgery

The operation takes place under general anaesthesia. The skin incisions are discussed beforehand and in case of an immediate reconstruction they are based on the oncological necessities of the breast. For later reconstructions we use already existing scars. The tissue from the buttocks is prepared with its vessels and then transplanted to the breast, shaped and sutured under the microscope to new vessels in the area of the sternum or armpit. The buttock incision is closed. Drains are inserted to drain off wound fluid.

After Surgery

As with all operations, you should stop smoking in order not to endanger the blood supply to the tissue and to minimize the risk of wound healing disorders. You can get up and walk around immediately, but you should not sit on the scar for 5 to 10 days for it to heal properly. We recommend compression pants for a total of 6 weeks, and corrective surgery if necessary at the earliest after 6 to 9 months, i.e. after completion of internal scar healing.

Risks

In rare cases, the body may not accept the tissue. This risk is less than 2%. In this case, we can try to eliminate a possible thrombosis in the sutured vessels by means of an immediate, revision operation. In the worst case, however, it is possible that the transplanted tissue has to be removed completely. In this case, a new reconstructive procedure must be chosen. However, it also means that in more than 98% the healing process is free of complications. Occasionally, wound healing disorders or accumulation of wound fluid (seroma) in the harvesting area on the buttocks can occur. In most cases, this can be treated conservatively, i.e. without another operation. Conspicuous asymmetries of the buttocks are rare. Permanent sensory disturbances on the back of the thigh and problems with sitting can occur. Very rarely, little knots in the new breast can occur, so-called "fat necrosis". These are harmless fat encapsulations that can be left in place or removed relatively easily. We will discuss al risks in detail during the cosultation.

AUTOLOGOUS TISSUE

IS PERMANENT

Contact

Please make a consultation appointment in advance. Appointments can be made by telephone, online or e-mail contact.

Prof. Dr. med. Hisham Fansa, MBA
Facharzt für Plastische, Rekonstruktive
und Ästhetische Chirurgie (FMH)
Head of Plastic Surgery

Address
Spital Zollikerberg
Trichtenhauserstrasse 20
CH-8125 Zollikerberg