Utilizing the "fatty" tissue is called tissue flap procedures. These procedures use tissue from your tummy, back, thighs, or buttocks to rebuild the breast. The 2 most common types of tissue flap surgeries are the TRAM flap (or transverse rectus abdominis muscle flap), which uses tissue from the tummy area, and the latissimus dorsi flap, which uses tissue from the upper back. These operations leave 2 surgical sites and scars -- one where the tissue was taken and one on the reconstructed breast. The scars fade over time, but they will never go away completely. There can also be problems at the donor sites, such as abdominal hernias and muscle damage or weakness. There can also be differences in the size and shape of the breasts. Because healthy blood vessels are needed for the tissue's blood supply, flap procedures are not usually offered to women with diabetes, connective tissue or vascular disease, or to smokers. In general, flap procedures behave more like the rest of your body tissue. For instance, they may enlarge or shrink as you gain or lose weight. There is also no worry about replacement or rupture.
Adding to my uncertainty was the very nice woman I met in the waiting room who told me her breast cancer story. Four years ago she had a lumpectomy (right breast) and then chemotherapy. The chemo was so toxic that it landed her in the hospital so her "chemo cocktail" was changed. This past spring, her cancer returned, this time in both breasts. She had a radical mastectomy and just finished chemotherapy. She was there to have her port removed and discuss reconstruction. At least I can return to work tomorrow. Yeah!