Table 5.

Common types of autologous (tissue-based) breast reconstruction

TYPES	DEFINITION	IDEAL CANDIDATE
Pedicled flap
Pedicled TRAM	Rectus abdominis muscle Soft tissue from lower abdomen similar in colour, texture, and longevity Underlying rectus abdominis muscle is separated from its attachment to the pubis and flipped up onto the breast area along with the overlying skin and subcutaneous tissues	Healthy amount of excess abdominal tissue (not obese) Unilateral
Latissimus dorsi	Versatile flap from back Can be used with muscle alone or with overlying skin Small amount of bulk	Thin patient (inadequate abdominal tissue) Generally has significant skin damage from radiotherapy
Free flap
DIEP	Same tissue as pedicled TRAM but without sacrifice of underlying rectus muscle Vessels dissected from muscle and microvascular anastomosis created to recipient vessels in chest	Healthy patients Bilateral cases Desire to harvest larger amounts of tissue
SGAP	Skin and fat from upper buttock	Reserved for unique cases (ie, inadequate abdominal tissue or previous failed abdominal tissue reconstruction)
TUG	Skin, fat, and small muscle from upper inner thigh

DIEP—deep inferior epigastric artery perforator, SGAP—superior gluteal artery perforator, TRAM—transverse rectus abdominis myocutaneous, TUG—transverse upper gracilis.