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TRAM Flap Reconstruction

The TRAM flap stands for a Transverse Rectus Abdominus Myocutaneous Flap. Put simply, it uses your abdominal skin and fat based on blood vessels that travel through the rectus abdominus muscle (AKA your six-pack muscle). There are many variations of this type of flap which indicates the method by which Dr Rosenberg moves the abdominal tissue up to the chest to create the breast. In a pedicled TRAM, the tissue is moved to the chest by a subcutaneous tunnel in the lower portion of your breast. In a free TRAM, the abdominal tissue is transferred to the chest by using microsurgical techniques to reconnect the blood vessels that provide nourishment to the tissues.

The advantages of the TRAM are that it removes abdominal tissue to reconstruct the breast, which improves your abdominal contour after surgery similar to an abdominoplasty (tummy tuck). In addition, it avoids the use of an implant, has a more natural look and feel, and is durable.

The disadvantages of this approach are that it requires a longer surgery with a longer recovery time than for both an implant-based or latissimus flap reconstruction, it creates a scar across your lower abdomen (similar to the scar after a tummy tuck), it may result in some abdominal muscle weakness, and it is possible to develop bulging or a hernia at the site where the flap is taken from.

The DIEP flap stands for the Deep Inferior Epigastric Perforator flap. This flap falls under the category of a perforator flap, which are advanced microsurgical procedures that attempt to spare the abdominal muscles. The advantage of using these flaps is that it spares the abdominal wall fascia and muscles, and may reduce the incidence of weakness, hernia/bulging, and post-operative pain. The disadvantages of the DIEP flap is that is a significantly longer operative procedure, and has the risk of problems with the microsurgical connections of the blood vessels.