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Surviving cancer is truly an ordeal. And for the woman who has nobly fought breast cancer and won, there begins a new struggle to reintegrate herself back into daily life. To assuage the psychological trauma of a mastectomy or lumpectomy, many women choose breast reconstruction. The aim of breast reconstruction is to cosmetically rebuild the chest to approximate its pre-surgical appearance. It is a deeply personal decision for a woman to determine what kind of reconstruction she will have (if any) and when she will have it. There are many options to consider. Tissue flap reconstruction—also called “autologous reconstruction”—is a method that grafts your own living tissue to the surgical site for realistic and enduring results. 

Rotemberg Plastic Surgery is a state-of-the-art, spa-like sanctuary serving the aesthetic needs of Miami and all of South Florida with professionalism, compassion and expertise. If you seek cosmetic or reconstructive surgery, tell us your story. Call (305) 539-7083 to schedule a consultation.     


Autologous reconstruction offers an all-natural alternative to breast augmentation reconstruction for a woman considering her post-mastectomy options. Also called “flap reconstruction,” the procedure makes use of a “flap” of autologous flesh harvested from your back, belly, thigh or buttocks to recreate a realistic-looking breast. 

Learn more about what’s new at Rotemberg Plastic Surgery by reading our blog.   

While augmentation reconstruction achieves similar ends with the use of breast implants, flap reconstruction grafts your own living tissue to the target site in a more complex procedure that nonetheless produces enduring results. The use of autologous tissue for reconstruction has been improved and enhanced by cutting edge technology and advances in microsurgery technique. 

Benefits of Autologous Reconstruction

Flap reconstruction is not a woman’s only option. Since it is a complex surgery, it is important to run a thorough cost-benefit analysis for yourself when determining if the procedure is right for you

Flap Reconstruction vs. Augmentation Reconstruction 

Flap Reconstruction vs. Augmentation Reconstruction

An augmentation reconstruction is not so different from a standard Breast Augmentation. Hence, it is a simpler procedure that most plastic surgery practices are well-equipped to perform. In flap reconstruction, the donor tissue is harvested from your own body. This adds time to your recovery. For many women, however, the frontend costs pay dividends down the line. Your autologous donor tissue will reintegrate with the tissue at the grafting site, becoming as much a part of you as any other physical feature. Breast implants, on the other hand, are manufactured prosthetics. As realistic as they are designed to seem, implants may require periodic refresh or revision through the years as they endure the rough and tumble of a life well-lived.  

Hybrid Breast Reconstruction

In a hybrid breast reconstruction, the flap and augmentation reconstruction procedures are combined. This may grant Dr. Rotemberg more options for producing your desired results, especially in cases where there is not enough grafting tissue available.[1] 


The timing of a woman’s reconstructive surgery is up to her. She may opt to have the procedure done at the same time as her mastectomy. Conversely, she may feel more comfortable taking a break from surgery, having recently logged more than enough hospital time already. 

Breast Reconstruction Timing 

  • Immediate Reconstruction – mastectomy/lumpectomy and reconstruction can be performed simultaneously in a combined procedure
  • Delayed Reconstruction – a woman may opt to wait as long as she likes to undergo reconstruction
  • Delayed-Immediate Reconstruction – for the patient who is unsure how she would like to proceed, a tissue expander is put in place in preparation for the technique of her choice 

The tissue flap may be harvested in one of two ways. This depends on an array of individual factors, including the location of the donor area. 

Tissue Flap Excision Options

  • Pedicle Flap – blood vessels are left intact as the donor flap is pulled under the skin to the grafting site
  • Free Flap – blood vessels are cut to free the flap from the donor area, requiring microsurgery to reattach them at the grafting site   

The conditions of your unique breast reconstruction will vary depending on where Dr. Rotemberg determines is the best donor area for harvesting tissue.

Autologous Reconstruction Techniques[2]

  • Latissimus Dorsi Flap – skin, fat and muscle at the back, under the shoulder blade, are harvested for tissue 
  • TRAM Flap – skin, fat and muscle are harvested from the belly for their soft, breast-like appearance and response 
  • Muscle sparing TRAM Flap – similar to TRAM flap, except only a minimal amount of muscle is removed.
  • DIEP Flap – similar to the TRAM flap, this alternative method excises skin and fat but does not remove the abdominal muscles, leading to fewer potential complications 
  • SGAP Flap – skin, fat and muscles are harvested from the upper buttocks to create a new breast
  • IGAP Flap – this procedure is similar to the SGAP flap but the IGAP flap uses fat and skin from the lower buttock to create the new breast 

How Long is Flap Reconstruction Recovery?

Recovery from flap reconstruction requires a hospital stay of between three and five days. Because the procedure demands more incisions than an augmentation reconstruction, autologous breast reconstruction comes with more downtime. 

The flap technique offers a number of unique advantages, however, chief among them being that Dr. Rotemberg utilizes your body’s own tissues in the procedure. So, flap reconstruction’s lifetime value proposition avoids the complications frequently associated with implants, such as rupture and capsular contracture. 

While you heal, the tissue graft from flap reconstruction rejoins your body’s natural processes as a vital, living constituent. The effects of the procedure are long-lasting because blood vessels at your chest reconnect with the autologous graft to nurture your new breast as they did before. 

Complementary Procedure: Nipple Reconstruction

If you qualify, you may undergo a Nipple Sparing Mastectomy. The procedure preserves your original nipples for reconstruction. This leads to a more natural-looking breast that approximates many of the responses of the original. Nipple sparing mastectomies have risen in popularity as techniques and technology have improved. 

If necessity dictates that the nipple cannot be preserved, nipple reconstruction surgery involves recreating the nipple using a flap of tissue grafted from another part of the body. In some versions of the procedure, tattooing defines the areola.

Nipple reconstruction typically takes place after the reconstructed breast has healed, about three to four months later.[3]     

Cost of Tissue Flap Breast Reconstruction in Miami

The Women’s Health and Cancer Rights Act of 1998 requires health insurance plans that cover mastectomy to also cover reconstruction procedures. The requirement applies no matter how long you choose to wait for reconstruction. It includes any revision surgeries that may be needed to correct or revise the procedure.

However, some government and church-sponsored plans are exempt from this requirement. And, while Medicare covers breast reconstruction, Medicaid coverage differs in each state.

Rotemberg Plastic Surgery will be your advocate and ally in this process. We will help you reclaim and rebuild your life. Financing options are available for those who qualify. 

Reconstruct Your Life

Every survivor has a story. Your story did not end with cancer. Let Rotemberg Plastic Surgery help you begin a new chapter

If you live in or will be traveling through the Miami and South Florida area, tell us your story. Call (305) 539-7083 to schedule a consultation.     


What is the difference between a TRAM flap and DIEP flap?

The TRAM and DIEP are similar methods of breast reconstruction in that both techniques involve harvesting abdominal tissue for autologous grafting. The DIEP method has supplanted TRAM as the more frequently performed surgery in recent years because DIEP does not remove the abdominal muscle as TRAM does. Hence, DIEP lowers the risks that may arise from belly weakness.  Muscle sparing TRAM Flap issimilar to TRAM flap, except only a minimal amount of muscle is removed.  The risk of belly weakness is decreased. An added bonus to both procedures is the abdominal tissue excision at the donor site is identical to the one made during a tummy tuck. In one of life’s unexpected twofers, you receive the body contouring benefits of abdominoplasty included with your breast reconstruction!

What is a latissimus dorsi flap breast reconstruction?

Latissimus dorsi (LD) flap reconstruction harvests tissue from your back at the area lying below the shoulder blade and behind the armpit. The skin, muscle and fat in this area are relatively close to the grafting site at your chest, so the donor tissue is often left attached to its original blood supply. This diminishes the need for complex microsurgery to fuse severed blood vessels. The grafted tissue’s high muscle content may lead to a firmer-feeling breast. LD flap is often partnered with implant reconstruction to achieve an augmented outcome.              


  1. Breast reconstruction with flap surgery. (2019, January 8). Retrieved January 14, 2020, from
  2. Autologous or “Flap” Reconstruction. (2019, March 9). Retrieved January 14, 2020, from
  3. Nipple Reconstruction: What to Expect. (2019, March 7). Retrieved January 14, 2020, from
  4. Paying for Reconstruction Procedures. (2018, April 6). Retrieved January 14, 2020, from