When the abdominal tissue is not adequate in reconstructing the breasts, we can look at alternate donor sites to get more tissue. To reconstruct both breasts, we use fatty tissue from the abdomen (as in a DIEP flap reconstruction) in conjunction with the tissue from the back of the thigh (as in a PAP flap reconstruction) or the hips (as in an SGAP) or the back (as in a TDAP). This is termed the 4-flap breast reconstruction where fatty tissue from the abdomen and the thighs, hips or back are used together to reconstruct both breasts.
When both halves of the abdomen are used for reconstruction of one breast, we call this a “stacked DIEP flap.” Our team performs breast reconstruction using stacked GAP flaps and stacked PAP flaps, as well as stacked DIEP & GAP or stacked DIEP & PAP flaps for breast reconstruction. More and more, Dr. Sadeghi is performing “stacked flaps,” where he combines tissues from different parts of the body in tandem to reconstruct the breasts. The advantages of using the DIEP flap are to reconstruct the superior pole of the breast and the PAP flap to resurface the lower pole of the breast. Together, this combination of tissue from the abdomen and the posterior thigh provides superior results in breast reconstruction.
Combining tissue from the abdomen (as in a DIEP flap breast reconstruction) and the thigh (as in a PAP flap breast reconstruction) allows us to perform a thigh lift and a tummy tuck simultaneously since the harvested fatty tissue can be contoured into breasts.
The TDAP flap uses fat from the bra back roll area. This is a perforator flap using tissue from the upper back. Therefore underlying muscle tissue is preserved. Since this area of the body is so close to the breast region, the tissue can be rotated into place without having to divide and reattach blood vessels, resulting in less hospitalization time.