Q. I’ve decided to have breast reconstruction after my mastectomy, and I’d like to do one of those reconstructions where they use your own body tissue, rather than have an implant. Since the surgeon will be using my body tissue, will my new breast be just like my original one?

A. Autologous (or body tissue) reconstruction uses your own body–muscle, fat, and skin–to build a new breast where your original breast once lived. Your new breast will have a more natural look and feel than it would with an implant. It will never have the sensation of your original breast–some of the nerves are cut, and your new breast may tingle and/or feel numb; you’ll also totally lose any erogenous zones. But it’ll pretty much “hang” like your old breast, feel breast-like to the touch, and look much like your original breast, if all goes well.

Q. Where do they take the tissue from? Do I have a choice?

A. Fat and muscle will be taken most commonly from your belly (a TRAM flap, which stands for transverse rectus abdominis muscle); or from your upper back (a LAT flap, latissimus dorsi flap). When you hear doctors or other women who’ve had the operation referring to their “tram” or “lat,” that’s what they’re talking about: where the tissue came from.

In some cases, tissue can be taken from your buttocks, hips or thighs. But these locations are much less common; chances are you’ll be getting a TRAM flap or LAT flap, with the TRAM flap the first choice offered, if you qualify.

Q. How do I qualify for a TRAM flap?

A. Easy–you have to have sufficient belly fat, something most of us aren’t lacking! And that’s the really great thing with a TRAM flap–you get a tummy tuck at the same time. Trying to exercise away that annoying roll around your middle? Have a TRAM flap, and it disappears from your belly, and becomes your new breast–cool, huh?

If you don’t have sufficient belly fat, you’ll probably be offered a LAT flap, which takes tissue from your upper back, over your shoulder blades–just about where someone would pat you on the back, if they were congratulating you.

If, for some reason, neither a TRAM flap nor LAT flap is right for you, your surgeon will discuss other parts of your body–probably buttocks, hips, or perhaps thighs–that might be suitable to use.

Q. What does “flap” refer to?

A. The most common method of rebuilding a breast with body tissue is to cut a piece of muscle and fat (from belly or shoulders), but leave it attached on one end, so it retains its original blood supply. The surgeon then “tunnels” this piece of tissue under the skin to its new location on your chest. This is called a “pedicle flap.” If the tissue is completely cut, and then reattached in its new location, it’s called a “free flap.”  Free flaps are a newer procedure, and much less commonly performed, as they require a very skilled surgeon, one who’ll spend hours reattaching blood vessels. (Obviously, only tissue from your belly or back is close enough to your chest to become a pedicle flap; if it’s from another location, it would have to be a free flap.)