In pedicled flaps, skin, muscle and fat is moved from your back or abdomen (tummy) to the chest by tunnelling it under the skin so that the blood supply to the muscle doesn’t need to be cut.

The large muscle used from the back is called the latissimus dorsi muscle and the muscle from the abdomen is the rectus abdominis muscle.

This type of surgery is appropriate for women:

• if tissue expansion is unsuitable because of radiotherapy.
• if tissue expansion is unsuitable because the skin is too tight as a lot of skin and muscle has been removed from the breast.
• who have large or droopy breasts.

Whichever type of procedure is used, women with larger breasts usually need to have surgery to make the other breast smaller.

Any type of breast reconstruction using muscle, fat and skin flaps is a major operation so you will need to stay in hospital for about a week. These types of reconstruction can be used to create a new breast after mastectomy, or to replace large areas of the breast tissue that have been taken away during a lumpectomy (wide local excision).

This operation involves moving a large muscle (latissimus dorsi) and some overlying fat and skin from the back of your body. The flap and its blood supply are tunnelled under the skin just below the armpit. It is then put into position to make a new breast shape. The operation is referred to as a latissimus dorsi flap (LD flap).

Often, there isn't enough tissue to form a whole breast, so an implant may be put behind it to match the size of the other breast.

This type of operation leaves scars both from where the skin and muscle flap is taken, and on the reconstructed breast. The scar around the reconstructed breast is oval (elliptical) and the scar on your back usually goes straight across (horizontally), so a bra strap will generally cover it. Sometimes this scar is more diagonal, which can make it more difficult to cover with a bra, but it could be covered with a swimsuit. You can ask your surgeon which type of scar you will have.

This type of reconstruction generally has few problems and can make a small or moderate size breast very well. However, it cannot always match a very large breast. Some women with large breasts may need to have a breast uplift procedure (mastopexy) or breast reduction of the other breast at a later time, to get a good match.

In some women, a larger amount of fat can be taken from the back together with the muscle and skin. This is called an extended latissimus dorsi flap. This additional volume of fat means that an implant is not needed to give a satisfactory breast shape.

A flap of fat and some muscle, with its overlying skin, is taken from the abdomen. It is then tunnelled upwards from the abdomen and put on the chest wall to create the shape of a breast. This method usually gives enough tissue to match the remaining breast, so an implant is not usually needed.

This type of operation is referred to as a pedicled TRAM flap because the transverse rectus abdominis muscle is used.

Breast reconstruction using muscle, fat and skin from the back or abdomen, is a major operation and needs a hospital stay of at least one week. Using a flap from the back generally gives less risk of complications than using a pedicled flap from the abdomen, but an implant is often needed.

The pedicled TRAM flap can only be used for women who are in good health and do not smoke. After the muscle of the abdominal wall has been removed, a mesh is used to strengthen the muscles to prevent hernias or bulges. However, a few women may still develop a hernia or bulge.