With so many techniques available for breast reconstruction after mastectomy, you may be having some trouble figuring out which option would be best for you. This post is all about “flap” procedures. At my breast reconstruction practice on Long Island, New York, I carefully evaluate each patient and we decide together which procedure technique will work best.

Flap Procedure Basics

Flap-type procedures (unlike implant-and-expander surgery) use your own skin, muscle, and fat to reconstruct your breast. The tissue can be taken from different areas of the body (the abdomen, back, or buttocks), but the biggest difference between flap procedures lies in how the surgeon will supply this “flap” of tissue with blood flow to keep it healthy.

• With TRAM flap procedures the breast reconstruction surgeon removes or repositions a piece of upper-abdominal muscle tissue containing blood vessels to divert blood flow to the tissues.
• With DIEP flap procedures no muscle is removed; the surgeon only takes a few blood vessels from the lower abdomen and uses microsurgery to connect the tissues to a healthy blood supply.

TRAM vs. DIEP: How They Measure Up

1 - Tissue health:

This factor is absolutely essential for good results; in order for your new breast tissues to live, they need a healthy blood supply to nourish and maintain the cells.

• TRAM flaps usually use upper-abdominal muscles that aren’t ideal to nourish the flap. Taking the muscle along with the vessels makes this procedure faster, but it also means the surgeon is taking blood vessels that carry less blood, which can make it more difficult for the flap tissues to thrive.
• The DIEP flap utilizes blood vessels from the lower abdomen, and connects them to the flap’s own blood vessels through microsurgery. This takes a bit of time, but it means better blood flow, better tissue health, and lower complication risk.

2 - Muscle functionality:

Your abdominal muscles help hold your internal organs in place. Removing part of this muscle sometimes may cause your internal organs to press forward through the gap in the muscle (a hernia), making a bulge that looks (and feels) uncomfortable.

• TRAM flaps, especially the Free TRAM Flap, pose a clear risk of hernia. Healing times are also longer and less comfortable, since the surgeon has to cut into muscle directly.
• The DIEP flap addresses only the skin, fat, and blood vessels while leaving the muscles intact, so recovery is fast and there’s no risk of hernia.