The transverse upper gracilis is a specially designed free flap which
either includes the muscle, fat and skin or just fat and skin. The
gracilis muscle, which is small receives its blood supply from a perforator
vessel which is around 1 mm in diameter. This vessel is followed until
it enters the medical femoral cutaneous artery and then finally ends
into the profunda femoral artery. At the junction of entrance into
the profunda femoral it is dissected and transposed to the chest wall.
Once transposed it is microsurgically anastomosed to the internal
mammary vein and artery to create a natural looking breast. This flap
requires an expert surgeon who is trained both in plastic and microsurgery.
The dissection of the flap becomes very challenging because the artery
and vein must be skeletonized in order to follow it until its caliber
becomes large enough to match the internal mammary vessels. This is
when it is most vulnerable to injury. Because of the size of the vessels
are often less than 1 mm in diameter, this procedure requires high
magnification including surgical glasses and a microscope in order
to visualize the dissection. This dissection can take anywhere from
two to three hours per side.
This procedure is an excellent option for women who desire natural
autologous breast reconstruction.
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