The tissue from the lower abdomen (belly) is moved to the chest area to reconstruct the breast shape.
Learn more about:
- Types of abdominal flaps reconstructions
- DIEP flap reconstruction
- TRAM flap procedure
- What are the impacts of these procedures?
Types of abdominal flaps reconstructions
There are two main types of abdominal flaps: a free transverse rectus abdominis myocutaneous (TRAM) flap and a newer type called a free deep inferior epigastric perforator (DIEP) flap. These flaps are called free flaps because the flap is cut completely away from the blood supply in the abdomen.
The surgeon then reconnects the flap to the blood vessels in the chest area using microsurgery (surgery using miniature instruments and viewed under a microscope).
DIEP flap reconstructions
DIEP flap reconstructions are now done more often than TRAM flap procedures. In a DIEP flap procedure, the surgeon uses only the skin and fat to reconstruct the breast. The abdominal muscle is left in place. This means the strength of your abdomen is not affected and there is less risk of abdominal problems after surgery.
This type of reconstruction is called DIEP because it uses the deep blood vessels called deep inferior epigastric perforators.
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After the reconstruction you will have a scar on your breast and a scar across your abdomen from one hip to the other (seen only faintly here). |
TRAM flap procedure
In a free TRAM flap procedure, all or some of the muscle in the lower abdomen and a flap of local skin and fat is moved to the chest to form the reconstructed breast. The muscle in the lower abdomen that runs from the breastbone to the pubic bone is the rectus abdominis muscle.
What are the impacts?
Because the reconstructed breast is formed from tissue from the abdominal area, a DIEP or TRAM flap reconstruction means your abdomen is tighter and flatter (“tummy tuck”). You will have a long scar across the lower abdomen from one hip to the other and a scar on the reconstructed breast. You will have little to no feeling in the skin over the breast.
Another type of TRAM flap reconstruction that is no longer often done is called a pedicle TRAM flap. In this procedure, the flap remains attached to its original blood supply and is tunnelled under the skin of the upper abdomen to the breast.
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More resources
A/Prof Elisabeth Elder, Specialist Oncoplastic Breast Surgeon, Westmead Breast Cancer Institute and Clinical Associate Professor, The University of Sydney, NSW; Dragana Ceprnja, Senior Physiotherapist and Health Professional Educator, Westmead Hospital, NSW; Jan Davies, Consumer; Rosemerry Hodgkin, Consumer; Gillian Horton, Owner and Director, Colleen’s Lingerie and Swimwear, ACT; Ashleigh Mondolo, Clinical Nurse Consultant Breast Care Nurse, Mater Private Hospital South Brisbane, QLD; Dr Jane O’Brien, Specialist Oncoplastic Breast Cancer Surgeon, St Vincent’s Private Hospital, VIC; Moira Waters, Breast Care Nurse, Breast Cancer Care WA; Sharon Woolridge, Consumer; Rebecca Yeoh, 13 11 20 Consultant, Cancer Council Queensland.
The photograph above has been reproduced with permission from Dr Pouria Moradi, NSW.
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