Currently, the most common form of breast reconstruction performed uses tissue expanders and implants; this is usually at least a two-stage procedure. However, implants used for reconstruction sometimes can look and feel unnatural, as there is no longer any breast tissue to camouflage the implant.
After tissue expanders, muscle flaps are the next most common form of reconstruction. This method takes muscles, usually from the abdomen (TRAM) or back (Latissimus), with the overlying fat and skin still attached, which are then swung into the mastectomy defect, recreating a breast. Although these use your own body tissue and can provide an excellent reconstruction, there is a significant donor site defect; this means that when muscle is moved from one part of the body to another, there is a lack of strength and support in the location from where it was taken.
The flap techniques recreate a breast that is soft and warm, and that has the ability to restore a woman's body image. This is performed by transplanting the skin and fat with its own set of blood vessels, which have been carefully separated from the muscle. Using a microscope, an artery and vein are then reconnected, bringing blood and nutrition into the transplanted tissue. The muscle is not moved or destroyed and remains in its original position. This allows for less pain and quicker recovery, with no reduction of function, while recreating a natural breast without the need for implants.
The GAP Flap (Gluteal Artery Perforator Flap) sources excess skin and fatty tissue from the buttocks and is transplanted to the chest wall area to reconstruct a new breast.
The PAP Flap (Profunda Artery Perforator Flap) on the other hand sources the excess skin and fatty tissue from the posterior thigh, and is a great alternative for women who have had prior abdominal surgeries or who have limited abdominal tissue to work with. Unlike other flaps, the incisions' scars can be well hidden in the crease of the buttock and upper thigh.