What are the benefits of autogenous autogenous breast reconstruction over implant breast reconstruction surgery?

Since autologous reconstruction uses your own body’s tissue to reconstruct the breast, the tissue is there for life. It will change in volume as your normal weight fluctuations occur throughout life, and it tends to improve in shape over time. The breast is reconstructed with fat, which is similar in density to breast tissue—thus, the “feel” is similar to that of a normal breast.

Implant breast reconstruction tends to require multiple operations over time. These additional procedures may include sequential expansion of breast skin, repositioning of the implant, correction of infra-mammary fold distortion, correction of shape deformity, correction of implant extrusion, correction of implant leakage, correction of capsular contracture, removal of implant due to infection, and replacement of temporary implant or expander with permanent implant.

If a patient has had radiation or is planning to have radiation, implant reconstruction is discouraged because of the unacceptably high complication rate. Breast implants often require replacement, as implant manufacturers do not consider them “lifetime devices”. Their life expectancy is around 10 years, per manufacturer documentation. Implant reconstructions often tend to remain firmer than a normal breast.

What is autogenous (natural tissue) breast reconstruction?

Autogenous breast reconstruction is the use of your own body’s tissue to reconstruct the breast. This includes the DIEP flap (deep inferior epigastric perforator flap); stacked DIEP flap (stacked deep inferior epigastric perforator flap) ; GAP flap (gluteal artery perforator flap); PAP flap (profunda artery perforator flap) ; SIEA (superficial inferior epigastric artery flap), and TUG flap (transverse upper gracilis flap) techniques.

What are the benefits of implant implant breast reconstruction over autogenous breast reconstruction surgery?

Implant reconstructions are typically shorter operations (1-2 hours) and do not usually prolong hospitalization. Autogenous reconstruction specifically, perforator flap reconstruction—typically takes 2-4 hours for a single reconstruction and 5-6 hours for a bilateral breast reconstruction. The hospital stay is 3 days for perforator flap breast reconstruction. Implant reconstructions also do not require a donor site and recovery, which means the procedure usually includes an overnight stay.

What is a DIEP flap breast reconstruction?

DIEP stands for “Deep Inferior Epigastric Perforator”; the procedure is based on the name of the vessels on which the tissue is to be transferred. “Flap” is a plastic surgery term referring to the tissue that is to be transferred. The deep inferior epigastric vessels arise from the external iliac vessels (the external iliac vessels become the femoral vessels in the leg). The deep inferior epigastric vessels course beneath the rectus abdominus (the major abdominal “six-pack” muscle) on each side. These vessels send off branches to the muscle, as well as through the muscle into the overlying fat. These perforating branches are those which are identified, preserved, and transferred with the overlying tummy fat to reconstruct the breast.

What is a GAP flap breast reconstruction?

GAP stands for “Gluteal Artery Perforator”. It may at times be described as an S-GAP or IGAP procedure. The prefixes indicate whether the superior or inferior branches of the gluteal artery supply the fatty tissue.

As with DIEP flap breast reconstruction, the gluteal artery perforator arises from a branch of the gluteal artery, and courses through muscle to deliver blood to the overlying buttock fat. This procedure allows for use of the buttock fat to reconstruct the breast when abdominal fat is inadequate. Similar to the DIEP breast reconstruction procedure, it is also a “muscle-preserving” surgery, and does not sacrifice the buttock muscles to collect the tissue.

What is a PAP flap breast reconstruction?

PAP stands for “Profunda Artery Perforator”. Your breast surgeon creates a flap isolated from the tissue just underneath the buttock crease, where an abundant amount of fatty tissue may be harvested from the posterior thigh. This procedure is for the use of this tissue in reconstruction of the breast when the abdominal fat is not available, and the gluteal area may not be the patient’s ideal choice for a donor site. Similar to DIEP breast reconstruction, this method is also a “muscle-preserving” procedure, and does not sacrifice the thigh muscles to collect the tissue.

How do the DIEP flap breast surgery and PAP/GAP breast reconstruction procedures differ from the TRAM flap breast surgery?

TRAM flap breast reconstruction takes the underlying muscles, along with skin and fat, for the breast reconstruction. This can lengthen your recovery, and may increase your risk for hernia or abdominal “bulge”.

What is the success rate of the DIEP breast reconstruction and PAP/GAP flap reconstruction?

DIEP flap surgeons who perform these operations routinely may have success rates exceeding 99 percent. The success rate equals that of TRAM and gluteal flaps, depending on the experience of the surgical team.

What determines if I am a candidate for a DIEP flap, or PAP flap, or /GAP flap breast reconstruction?

You are a candidate for a DIEP breast reconstruction if the amount of fat you have on your lower abdomen is sufficient to reconstruct one or both breasts to the desired volume. The tissue used is that which is often removed during tummy tucks. Prior abdominal operations (i.e. hysterectomy, C-section, appendectomy, bowel resection, liposuction) do not exclude DIEP flap reconstruction as an option for you. A prior tummy tuck does exclude the DIEP flap from being used. In those cases where abdominal fat is inadequate or prior surgery excludes the use of the DIEP flap, the PAP flap is the procedure of choice.

How long does a DIEP fFlap breast surgery take to perform?

In our hands, a unilateral DIEP flap reconstruction can be performed usually in 2-4 hours, with a bilateral reconstruction usually finishing in 4-6 hours. This time often includes the mastectomy time during immediate reconstructions.

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