Editing Breast reconstruction (section)

=== Flap-based reconstruction ===
Flap-based reconstruction uses tissue from other parts of the patient's body (i.e., autologous tissue) such as the [[human back|back]], [[buttocks]], [[thigh]] or [[human abdomen|abdomen]].<ref name=":5">{{Cite web |title=Flap Procedures {{!}} Breast Reconstruction Using Your Own Tissue |url=https://www.cancer.org/cancer/breast-cancer/reconstruction-surgery/breast-reconstruction-options/breast-reconstruction-using-your-own-tissues-flap-procedures.html |access-date=2023-04-05 |website=www.cancer.org |language=en}}</ref> In surgery, a "flap" is any type of tissue that is lifted from a donor site and moved to a recipient site using its own blood supply. Usually, the blood supply is a named vessel.  Flap-based reconstruction may be performed either by leaving the donor tissue connected to the original site (also known as a pedicle flap) to retain its blood supply (where the vessels are tunneled beneath the skin surface to the new site) or by cutting the donor tissue's vessels and surgically reconnecting them to a new blood supply at the recipient site (also known as a free flap or free tissue transfer).<ref>{{cite web|title=Breast cancer {{!}} Breast reconstruction using body tissue | work = Cancer Research UK|url=http://www.cancerresearchuk.org/about-cancer/breast-cancer/treatment/surgery/breast-reconstruction/using-body-tissue#collapseListRefeferences }}</ref> The latissimus dorsi is a prime example of such a flap since it can remain attached to its primary blood source which preserves the skins functioning, and is associated with better outcomes in comparison to other muscle and skin donor sites.  <ref>{{Cite journal| vauthors = Hallock G, YoungSang Y |date=2020|title=Left Mastectomy Wound Closure with Left Latissimus Dorsi Musculocutaneous Local Flap |journal=Journal of Medical Insight|language=en-US|doi=10.24296/jomi/290.7|issn=2373-6003}}</ref>

[[File:Blausen 0140 BreastReconstruction TRAM.png|thumb|Transverse Rectus Abdominis Myocutaneous flap (TRAM).]]One option for breast reconstruction involves using the [[latissimus dorsi muscle]] as the donor tissue.<ref name=":5" />  As a back muscle, the latissimus dorsi is large and flat and can be used without significant loss of function.  It can be moved into the breast defect while still attached to its blood supply under the arm pit (axilla). A latissimus flap is often used to recruit soft-tissue coverage over an underlying implant; however, if the latissimus flap can provide enough volume, then occasionally it is used to reconstruct small breasts without the need for an implant.  The latissimus dorsi flap has a number of advantages, but despite the advances in surgical techniques, it has remained vulnerable to skin dehiscence or necrosis at the donor site (on the back).<ref name=":2" /> The Mannu flap is a form of latissimus dorsi flap which avoids this complication by preserving a generous subcutaneous fat layer at the donor site and has been shown to be a safe, simple and effective way of avoiding wound dehiscence at the donor site after extended latissimus dorsi flap reconstruction.<ref>{{cite journal | vauthors = Mannu GS, Farooq N, Down S, Burger A, Hussien MI | title = Avoiding back wound dehiscence in extended latissimus dorsi flap reconstruction | journal = ANZ Journal of Surgery | volume = 83 | issue = 5 | pages = 359–364 | date = May 2013 | pmid = 23088555 | doi = 10.1111/j.1445-2197.2012.06292.x | s2cid = 32228590 }}</ref>

[[File:Blausen 0141 BreastReconstruction TRAM PostOp.png|thumb|Post-operative state after Transverse Rectus Abdominis Myocutaneous flap(TRAM).]]Another possible donor site for breast reconstruction is the abdomen.<ref name=":5"/>  The TRAM (transverse rectus abdominis myocutaneous) flap or its technically distinct variants of microvascular "perforator flaps" like the DIEP/SIEA flaps are all commonly used.  In a TRAM procedure, a portion of the abdominal tissue, which includes skin, subcutaneous fat, minor muscles, and connective tissues, is taken from the patient's abdomen and transplanted to the breast site.  Both TRAM and DIEP/SIEA use the abdominal tissue between the umbilicus (or "belly button") and the pubis. The [[DIEP flap]] and free-TRAM flap require advanced microsurgical technique and are less common as a result. Both can provide enough tissue to reconstruct large breasts and are a good option for patients who would prefer to maintain their pre-operative breast volume. These procedures are preferred by some breast cancer patients because removal of the donor site tissue results in an [[abdominoplasty]] (tummy tuck) and allow the breast to be reconstructed with one's own tissues instead of a prosthetic implant that uses foreign material.  That said, TRAM flap procedures can potentially weaken the abdominal wall and torso strength, but they are generally well tolerated by most patients.<ref name=":2" />  Perforator techniques such as the DIEP (deep inferior epigastric perforator) flap and SIEA (superficial inferior epigastric artery) flap require precise dissection of small perforating vessels through the rectus muscle and, thus, do not require removal of abdominal muscle.  Because of this, these flaps have the advantage of maintaining the majority of abdominal wall strength.

Other donor sites for autologous breast reconstruction include the buttocks, which provides tissue for the SGAP and IGAP (superior and inferior gluteal artery perforator, respectively) flaps.<ref>{{Cite journal | vauthors = Allen RJ, LoTempio MM, Granzow JW |date=May 2006 |title=Inferior Gluteal Perforator Flaps for Breast Reconstruction |journal=Seminars in Plastic Surgery |language=en |volume=20 |issue=2 |pages=089–094 |doi=10.1055/s-2006-941715 |issn=1535-2188 |pmc= 2884781}}</ref> The purpose of perforator flaps (DIEP, SIEA, SGAP, IGAP) is to provide sufficient skin and fat for an aesthetic reconstruction while minimizing post-operative complications from harvesting the underlying muscles. DIEP reconstruction generally produces the best outcome for most women.<ref>{{cite journal | vauthors = Erić M, Mihić N, Krivokuća D | title = Breast reconstruction following mastectomy; patient's satisfaction | journal = Acta Chirurgica Belgica | volume = 109 | issue = 2 | pages = 159–166 | date = 2009-03-01 | pmid = 19499674 | doi = 10.1080/00015458.2009.11680398 | s2cid = 42474582 }}</ref>  See [[free flap breast reconstruction]] for more information.

Mold-assisted reconstruction is a potential adjunctive process to help in flap-based reconstruction.  By using a laser and 3D printer, a patient-specific silicone mold can be used as an aid during surgery, used as a guide for orienting and shaping the flap to improve accuracy and symmetry.<ref>{{cite journal | vauthors = Melchels F, Wiggenhauser PS, Warne D, Barry M, Ong FR, Chong WS, Hutmacher DW, Schantz JT | display-authors = 6 | title = CAD/CAM-assisted breast reconstruction | journal = Biofabrication | volume = 3 | issue = 3 | pages = 034114 | date = September 2011 | pmid = 21900731 | doi = 10.1088/1758-5082/3/3/034114 | url = https://eprints.qut.edu.au/46842/15/46842.pdf | url-status = live | bibcode = 2011BioFa...3c4114M | s2cid = 206108959 | archive-url = https://ghostarchive.org/archive/20221009/https://eprints.qut.edu.au/46842/15/46842.pdf | archive-date = 2022-10-09 }}</ref>