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How do surgeons use tissue from a woman's own body to reconstruct the breast?
Source: Breast Reconstruction After Mastectomy, National Cancer Institute.
Source updated: December 2, 2025 · Captured 2026-09-09.
Selected source text with whitespace normalised. This Triangle page is not an NCI PDQ summary. Independent clinical review is pending.
NCI patient treatment article for this disease Exact source article; not a clinically reviewed indication or current-standard recommendation.
Context: Breast Reconstruction After Mastectomy
How do surgeons use tissue from a woman's own body to reconstruct the breast?
In autologous tissue reconstruction, a piece of tissue containing skin, fat, blood vessels, and sometimes muscle is taken from elsewhere in a woman’s body and used to rebuild the breast. This piece of tissue is called a flap.
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Different sites in the body can provide flaps for breast reconstruction. Flaps most often come from the abdomen or back. However, they can also be taken from the thigh or buttocks.
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Depending on their source, flaps can be pedicled or free.
With a pedicled flap, the tissue and attached blood vessels are moved together through the body to the breast area. Because the blood supply to the tissue used for reconstruction is left intact, blood vessels do not need to be reconnected once the tissue is moved.
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With free flaps, the tissue is cut free from its blood supply. It must be attached to new blood vessels in the breast area, using a technique called microsurgery, to give the reconstructed breast a blood supply.
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Abdominal and back flaps include:
DIEP flap: Tissue comes from the abdomen and contains only skin, blood vessels, and fat, without the underlying muscle. This type of flap is a free flap.
Latissimus dorsi (LD) flap: Tissue comes from the middle and side of the back. This type of flap is pedicled when used for breast reconstruction. (LD flaps can also be used for other types of reconstruction, such as abdominal or head and neck reconstruction.)
SIEA flap (also called SIEP flap): Tissue comes from the abdomen as in a DIEP flap but includes a different set of blood vessels. It also does not involve cutting of the abdominal muscle and is a free flap. This type of flap is not usually an option for breast reconstruction because the necessary blood vessels are often not adequate or do not exist.
TRAM flap: Tissue comes from the lower abdomen as in a DIEP flap but includes muscle. TRAM flaps can be either pedicled or free.
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Flaps taken from the thigh or buttocks are used for women who have had previous major abdominal surgery or who don’t have enough abdominal tissue to reconstruct a breast. These types of flaps are free flaps.
IGAP flap: Tissue comes from the buttocks and contains only skin, blood vessels, and fat.
PAP flap: Tissue, without muscle, comes from the upper inner thigh.
SGAP flap: Tissue comes from the buttocks as in an IGAP flap but includes a different set of blood vessels and contains only skin, blood vessels, and fat.
TUG flap: Tissue, including muscle, comes from the upper inner thigh.
The table below summarizes the different types of flaps used for breast reconstruction:
| Name of flap | Type of flap | Source of tissue | Includes muscle? |
|---|---|---|---|
| DIEP | Free | Abdomen | No |
| Latissumus dorsi | Pedicled | Middle and side of back | Yes |
| SIEA/SIEP | Free | Abdomen | No |
| TRAM | Pedicled or free | Lower abdomen | Yes |
| IGAP | Free | Buttocks | No |
| PAP | Free | Upper inner thigh | No |
| SGAP | Free | Buttocks | No |
| TUG | Free | Upper inner thigh | Yes |
In some cases, an implant and autologous tissue are used together. For example, with flaps taken from the thigh or buttocks an implant is often used as well to provide sufficient breast volume. Also, autologous tissue may be used to cover an implant when there isn’t enough skin and muscle left after mastectomy to allow for expansion and use of an implant (1, 2).
Preserved source evidence · Independent clinical review pending · Not medical advice