The benefit of TRAM and DIEP flaps is that a large and ptotic (droopy) breast can be created and the reconstructed breast has the look and feel of a normal breast and will not go hard in the future, unlike implant-based reconstructions.
It uses the same tissue that is removed during a tummy tuck which is an added benefit of this procedure.
This does mean that only patients who have excess lower abdominal tissue will be candidates for a TRAM or DIEP flap. The scarring on the abdomen is the same as that following tummy tuck and runs from one hip to the next (often this can be hidden in a bikini) and around the belly-button.
This lady has had a right DIEP flap breast reconstruction with a nipple reconstruction and fat grafting to her reconstructed breast following a right mastectomy for breast cancer. She has had no surgery to her left breast and is shown here nearly 2 years following her original surgery.
This lady has had mastectomy of both breasts as she carries the BRCA2 gene and immediate breast reconstruction with free DIEP flaps from her abdomen followed by bilateral nipple reconstruction. She is shown here a year following her original surgery.
Plastic surgeons have always had an understanding of the blood supply to the skin to allow them to safely move tissue from one place to another. In situations where the blood supply to the skin comes through the underlying muscle, the muscle is traditionally taken with the skin to allow it to be safely transferred with its blood supply. The advances in the knowledge of the circulation to the skin, together with the growth of microsurgery have led to so-called ‘perforator flaps’. These involve removing only the tissue that is required, ie skin and fat, and leaving the muscle behind. They are more technically demanding operations but it is better for the body to have the muscles left behind.
A TRAM flap involves removing the rectus abdominis muscle (the six pack) to allow safe transfer of the lower abdominal skin and fat to the breast.. A DIEP flap is a perforator flap and it involves removing only the skin and fat of the lower abdomen and leaving the muscle behind to prevent the weakness and bulge that can be associated with a TRAM flap. A free DIEP flap is considered the gold standard in breast reconstruction. Sometimes a suitable perforator to the skin and fat cannot be found, in which case some muscle may need to be taken, this is a free TRAM flap (or muscle sparing free TRAM flap).
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