Breast reconstruction - natural tissue


After a mastectomy, some women choose to have cosmetic surgery to remake their breast. This type of surgery is called breast reconstruction. It can be performed at the same time as a mastectomy (immediate reconstruction) or later (delayed reconstruction).

During breast reconstruction that uses natural tissue, the breast is reshaped using muscle, skin, or fat from another part of your body.

Alternative Names

Transverse rectus abdominus muscle flap; TRAM; Latissimus muscle flap with a breast implant; DIEP flap; DIEAP flap; Gluteal free flap; Transverse upper gracilis flap; TUG; Mastectomy - breast reconstruction with natural tissue; Breast cancer - breast reconstruction with natural tissue


If you are having breast reconstruction at the same time as mastectomy, the surgeon may do either of the following:

In either case, skin is left to make reconstruction easier.

If you will have breast reconstruction later, the surgeon can still do skin- or nipple-sparing mastectomy. If you are not sure about having reconstruction, the surgeon will remove the nipple and enough skin to make the chest wall as smooth and flat as possible.

Types of breast reconstruction include the following:

For any of these procedures, you will have general anesthesia. This is medicine that keeps you asleep and pain-free.

For TRAM surgery:

For latissimus muscle flap with a breast implant:

For a DIEP or DIEAP flap:

For a gluteal flap:

For a TUG flap:

When breast reconstruction is done at the same time as a mastectomy, the entire surgery may last 8 to 10 hours. When it is done as a second surgery, it may take up to 12 hours.

Why the Procedure Is Performed

You and your surgeon will decide together about whether to have breast reconstruction and when. The decision depends on many different factors.

Having breast reconstruction does not make it harder to find a tumor if your breast cancer comes back.

The advantage of breast reconstruction with natural tissue is that the remade breast is softer and more natural than breast implants. The size, fullness, and shape of the new breast can be closely matched to your other breast.

But muscle flap procedures are more complicated than placing breast implants. You may need blood transfusions during the procedure. You will usually spend 2 or 3 more days in the hospital after this surgery compared to other reconstruction procedures. Also, your recovery time at home will be much longer.

Many women choose not to have breast reconstruction or implants. They may use a prosthesis (an artificial breast) in their bra that gives a natural shape. Or they may choose to use nothing at all.


Risks of anesthesia and surgery are:

Risks of breast reconstruction with natural tissue are:

Before the Procedure

Tell your surgeon if you are taking any drugs, supplements, or herbs you bought without a prescription.

During the week before your surgery:

On the day of your surgery:

After the Procedure

You will stay in the hospital for 2 to 5 days.

You may still have drains in your chest when you go home. Your surgeon will remove them later during an office visit. You may have pain around your cuts after surgery. Follow instructions about taking pain medicine.

Fluid may collect under the incision. This is called a seroma. It is fairly common. A seroma may go away on its own. If it doesn't go away, it may need to be drained by the surgeon during an office visit.

Outlook (Prognosis)

Results of this surgery are usually very good. But reconstruction will not restore normal sensation of your new breast or nipple.

Having breast reconstruction surgery after breast cancer can improve your sense of well-being and quality of life.


Burke MS, Schimpf DK. Breast reconstruction after breast cancer treatment: goals, options, and reasoning. In: Cameron JL, Cameron AM, eds. Current Surgical Therapy. 12th ed. Philadelphia, PA: Elsevier; 2017:743-748.

Powers KL, Phillips LG. Breast reconstruction. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 20th ed. Philadelphia, PA: Elsevier; 2017:chap 35.