Free Flap Breast Reconstruction

https://plasticsinpractice.com/ Free flap breast reconstruction is one of the most technically demanding and rewarding procedures in reconstructive microsurgery. In this episode, we break down flap selection, donor-site strategy, recipient vessel choice, perfusion monitoring, and the key complications every plastic surgery resident needs to know. We focus on why the abdomen remains the preferred donor site for most patients, how DIEP, free TRAM, and SIEA differ in muscle preservation and vascular reliability, and when to move to secondary donor sites like SGAP, IGAP, or TUG/TMG. We also review why the internal mammary system is usually the recipient vessel of choice, how CTA/MRA improves preoperative planning, and how NIR spectroscopy and indocyanine green angiography can improve early detection of vascular compromise. Success in these cases is not just about anastomosis—it is about planning, judgment, and flap-specific decision making. Key Takeaways DIEP offers strong abdominal wall preservation but requires meticulous perforator dissection. Free TRAM may improve perfusion while sacrificing more muscle than DIEP. SIEA avoids fascia violation but is anatomically feasible in only a minority of patients. Internal mammary vessels typically provide superior flow and positioning flexibility versus thoracodorsal vessels. CTA/MRA helps identify dominant perforators and streamline operative planning. Postop monitoring is critical, since early detection drives flap salvage. Disclaimer: This content is for educational purposes only and is not medical advice. #PlasticSurgery #BreastReconstruction #FreeFlap #DIEPFlap #TRAMFlap #Microsurgery #ReconstructiveSurgery #PlasticSurgeryResident #SurgicalEducation #AutologousReconstruction 🎧 Full episodes available now: Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ References Nahabedian MY. Breast reconstruction: free flap techniques. In: Grabb and Smith’s Plastic Surgery. Chapter 62. Nahabedian MY, Momen B, Galdino G, Manson PN. Breast reconstruction with the free TRAM or DIEP flap: patient selection, choice of flap, and outcome. Plast Reconstr Surg. PMID/DOI not verified from provided materials. Keller A. Near-infrared spectroscopy for free flap monitoring. PMID/DOI not verified from provided materials. Colwell AS, et al. Near-infrared spectroscopy in free flap breast reconstruction. PMID/DOI not verified from provided materials.