Microvascular Breast Reconstruction

AAMG Plastic Surgery Specialists offer the most complex procedures available. But if a simple procedure can work, we always suggest starting there.

Recent advances have brought safer, more effective breast reconstruction than ever before. Both of our plastic surgeons are trained as microvascular surgeons. They work together to perform all breast free-flap procedures. This collaborative approach improves results and decreases time in the operating room.

The Procedures


The Deep Inferior Epigastric Perforator (DIEP) flap uses tissue from the lower abs to make a new breast mound. It combines breast reconstruction with a tummy tuck.

Our surgeons open the covering around the muscle and take out the blood vessels that run through the muscle to the skin and fat. Then they attach the blood vessels to other vessels near your new breast. Finally, they close in a fashion similar to a cosmetic tummy tuck.

DIEP flap surgery might be a good option if you:

  • Have enough extra skin and fat in the lower abs to make a breast
  • Are physically active and want to keep your ab muscles
  • Have had radiation therapy
  • Have had breast reconstruction with an implant and didn’t like the results

DIEP flap surgery may not be right for you if:

  • You have a severe blood clotting disorder
  • You have severe or uncontrolled medical problems
  • You have had radiation therapy to the chest in the past six to 12 months
  • You are significantly overweight
  • You smoke cigarettes
  • You’ve had a tummy tuck, open gall bladder removal or other surgery through a large incision across the abdominal wall


The SIEA (superficial inferior epigastric artery) flap breast reconstruction procedure uses tissue from the lower abs to make a new breast mound. In this procedure, surgeons use blood vessels in the abdominal tissue instead of tunneling the blood vessels in the muscle.

This procedure is only possible in certain patients with specific blood vessel networks. Here are potential benefits of SIEA flap surgery:

  • The operation is usually quicker and easier than other methods.
  • Surgeons don’t have to remove muscle, so there is usually less pain in recovery and less risk of hernia.


Sometimes you might not have enough skin and tissue in your abs or buttocks to create a breast. For example, let’s say you had a tummy tuck or butt lift, or you are very slim. In this case, the TUG/DUG (transverse upper gracilis/ diagonal upper gracilis) flap procedure could be an option.

The TUG/DUG flap procedure is also called an inner thigh breast reconstruction procedure. It uses a process similar to the SGAP (superior gluteal artery perforator) or SIEA flap. But this procedure uses skin from your inner thigh. There is no risk of hernia. But it does move muscle from your thigh.

Pre-pectoral Breast Reconstruction

Pre-pectoral (over the muscle) breast reconstruction does not cut the muscle to create a pocket. It also does not stretch the muscle to put in an implant or flap. Instead, it uses a biologic mesh to support the front of the implant. It keeps the skin intact.

Benefits of pre-pectoral breast reconstruction may include:

  • Less pain after the surgery
  • Quicker recovery
  • More comfort and mobility
  • Reduced risk of chronic breast pain
  • More natural look
  • Less painful and quicker expansion

Frequently Asked Questions

What is the difference between TRAM flap surgery and DIEP flap surgery? With the DIEP flap, most or all of the abdominal muscles stay in place and functional. The DIEP flap reduces risks associated with the TRAM flap, such as bulging, hernia and weakness. But DIEP flap surgery takes more time because it’s complex. It usually takes four to five hours for each breast. The DIEP surgery usually causes less pain and weakness, and has a shorter recovery and hospital stay.

Breast Reconstruction Animation

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Anne Arundel Medical Group Plastic Surgery