Microsurgical breast reconstruction using perforator flaps is considered the gold standard in breast reconstruction. The breast tissue removed by the mastectomy is replaced with the patient's own fat and skin to recreate a soft, warm, and living breast. This type of natural tissue breast reconstruction adheres to the basic plastic surgery principle to "replace like with like."
Unlike older methods of autologous tissue reconstruction that sacrifice the muscle, like the TRAM flap (from the abdomen) or the latissimus dorsi flap (from the back), perforator flaps carefully preserve the muscle from the patient's donor site. Perforator flap breast reconstruction can be from the abdomen (DIEP or SIEA), upper thigh (PAP), or the back (TDAP). The difference is that in a perforator flap the muscles are preserved.
The preservation of a woman's muscles with perforator flaps decreases postoperative pain to make recovery easier and shorter. It also preserves donor site integrity, so that a woman can maintain muscle strength over the long term. This is particularly important for active women.