TRAM & DIEP Flap
TRAM (Transverse Rectus Abdominus Myocutaneous) Flap Reconstruction
During a TRAM flap procedure, the surgeon removes skin, fat and muscle
from your abdomen and moves it to your chest to reconstruct the breast.
The TRAM flap is sometimes referred to as a “tummy tuck” reconstruction
because it may leave the abdominal area flatter.
There are two different TRAM flap options:
pedicle TRAM flap procedure harvests the entire rectus muscle from the abdominal wall.
This often results in compromised abdominal wall function (inability to
sit up). In addition to sacrifice of the abdominal muscle, artificial
mesh is often required to repair the abdominal donor site, and there is
a risk of an abdominal wall hernia. Pedicle TRAM flaps are not advised
for bilateral reconstructions due to the sacrifice of both rectus muscles.
muscle-sparing (free)TRAM flap procedure, in contrast, utilizes only a small portion of muscle,
thus minimizing abdominal wall weakness and maximizing the size of the
flap. With small muscle harvest there often is no need for artificial
mesh reinforcement of the abdominal donor site.
DIEP (Deep Inferior Epigatric Perforator) Flap Breast Reconstruction
This is similar to a free TRAM flap, only
no abdominal muscle is used. This is state-of-the-art microsurgical breast
reconstruction technique and requires specialized training and experience
by your surgeon. As with the TRAM flap, the fat and skin of the abdomen
are moved to create a new breast mound. Microsurgery is involved in order
to allow for the reattachment of the blood supply to the tissue. It is
more complex than TRAM flap procedures and usually requires two microvascular
surgeons. The major advantage of the DIEP flap is that all the abdominal
muscle is preserved and abdominal wall function is maintained. This is
particularly critical for bilateral (both sides) breast reconstructions.
No artificial mesh is required to repair the abdominal flap donor site.