Autologous Breast Reconstruction Following Mastectomy: Options, Recovery, and Therapy Support

Autologous Breast Reconstruction Following Mastectomy:

Written by Amanda N. Rosso, MS, OTR/L, CLT

Breasts hold a unique and personal significance for many individuals. They nourish and nurture our children and often contribute to our sense of identity and femininity. The decision to undergo a mastectomy is deeply emotional and traumatic, and choosing to reconstruct the breasts is a highly personal decision. While breast reconstruction was once limited to saline and silicone implants, medical advances now offer a range of options—including the use of the body’s own tissue. This method, known as autologous breast reconstruction, involves using skin, fat, and sometimes muscle from another part of the body to rebuild the breast.

This approach comes with both benefits and considerations. A patient’s medical history and current physical condition are crucial in determining whether autologous reconstruction is the best option. Not every individual who undergoes a mastectomy will be a candidate for this type of reconstruction; for some, implants may be the only viable option. It is always a highly individualized decision made in collaboration with a medical team.

Below are the most common types of autologous breast reconstruction:

Free TRAM Flap (Transverse Rectus Abdominis Myocutaneous Flap)

This procedure involves removing skin, fat, and a portion of the rectus abdominis muscle from the lower abdomen and transferring it to the chest to reconstruct the breast. The navel is typically repositioned during the surgery, which lasts between 3 to 6 hours. Because blood vessels are reconnected microsurgically, patients may require extended hospitalization to monitor circulation and healing.

Post-operative care includes managing swelling (edema) and scars. Patients are usually fitted with abdominal binders and chest compression garments to support healing. Scar management techniques such as massage, silicone sheets, taping, and manual lymphatic drainage can be helpful during early recovery. Physical limitations are expected for several weeks, but light activity should be encouraged. Once healing is sufficient, patients can begin strengthening exercises for the core and upper body.

Latissimus Dorsi Flap (LD Flap)

The latissimus dorsi is a large muscle located in the upper back, just below the shoulder blade. In this procedure, a section of skin, fat, muscle, and blood vessels is rotated to the chest to form the new breast mound. This flap may be used on its own or in conjunction with an implant, especially in patients who have undergone radiation therapy or have limited tissue in the abdominal area.

Because the surgery involves moving a large muscle, temporary changes in shoulder and trunk movement may occur, particularly if the patient has pre-existing orthopedic concerns. Edema and scar management remain top priorities in early recovery, and modalities such as kinesio taping, lymphatic drainage, and scar care can help. As healing progresses, strengthening exercises can help restore trunk stability and rebalance the body's center of gravity.

DIEP Flap / SIEA Flap (Deep Inferior Epigastric Perforator / Superficial Inferior Epigastric Artery Flap)

This technique involves using skin and fat from the lower abdomen to reconstruct the breast—similar to a tummy tuck. Unlike the TRAM flap, these procedures preserve the abdominal muscles, which may lead to shorter recovery times and better core strength post-surgery. The procedure takes approximately 6 to 9 hours.

Post-operative drains are typically placed in the abdominal and chest areas. These can limit mobility initially, but gentle movement is encouraged as soon as it is safe. Once drains are removed and healing is adequate, therapy focuses on relieving abdominal tightness and improving strength and flexibility in the core and upper extremities.

How Can Cancer-Related Occupational Therapy Help?

A cancer diagnosis changes every aspect of life—self-care routines, relationships, goals, and emotional well-being. Occupational therapy (OT) can play an essential role in supporting individuals before and after breast reconstruction surgery. OT helps patients regain independence, build strength, and improve quality of life through individualized care plans that address both physical and emotional needs.

Benefits of Pre-Surgical Therapy

Meeting with an occupational therapist before surgery provides the opportunity to:

• Build a relationship with a rehabilitation professional

• Receive education and preventive care information

• Ask questions and better understand your current status

• Learn about lymphedema and get fitted for compression garments

• Create a customized exercise plan with progressive goals

• Reduce the risk of post-surgical complications

  
  

Post-Surgical Therapy Considerations

Surgery is a form of trauma, and recovery goes beyond physical healing. After sedation, the body begins the process of repair and regaining balance (homeostasis). A comprehensive post-surgical therapy plan should address:

• Disruption in the body's center of gravity, which may affect posture, movement, and breathing

• Numbness and sensory changes

• Wound and scar management

• Compression garment education and proper fitting

• Introduction to gentle yoga and meditation techniques

• Guidance in self-care and daily living activities

• Restoration of strength and flexibility

Patients greatly benefit from working with occupational or physical therapists who specialize in oncology and lymphedema care. Therapists with CLT (Certified Lymphedema Therapist) credentials have undergone advanced training in Complete Decongestive Therapy. To find a qualified specialist, visit the National Lymphedema Network.

For More Information

To learn more about cancer-related rehabilitation, treatment options, and wellness resources, visit:

HONEYS LINKTREE

References: Winicour, Jodi. Breast Cancer Rehabilitation. Retrieved 2022 from www.klosetraining.com