TRAM Flap vs DIEP Flap Breast Reconstruction - How Are They Different?

What's the difference between TRAM and DIEP flap breast reconstruction?

Many patients call us to ask about the differences between the TRAM flap and the DIEP flap. While many plastic surgeons recommend and offer the TRAM flap, few offer the DIEP flap procedure mostly because they do not have the specialized training or experience required to perform the procedure successfully and routinely.

Although the TRAM flap used to be the preferred method of breast reconstruction a few years ago, it has now been replaced as the gold standard in breast reconstruction by the much more advanced DIEP flap procedure.

So how are the two procedures different?

The major difference between the two is what happens to the abdominal muscle (sit-up muscle). The TRAM flap uses one or both of the abdominal muscles in the reconstruction process which typically makes recovery much more difficult and the patient loses abdominal strength long term. Sacrificing abdominal muscle also increases the risk of abdominal complications such as bulging (pooching), and even hernia.

Although both the TRAM flap and DIEP flap use skin and fat from the lower tummy area, the DIEP flap spares all of the abdominal muscle. This reduces recovery time, preserves abdominal strength and decreases the risk of abdominal complications.

At PRMA we very rarely perform the TRAM flap procedure due to the amount of muscle sacrificed and the potential abdominal complications associated with the TRAM.

How is the DIEP flap performed?

The DIEP flap utilizes the skin and fat from the lower abdomen as this tissue feels very much like the natural breast(s). The surgeons begin by making a tummy-tuck incision in the abdomen that looks a lot like the shape of a football. The blood vessels that will ultimately keep the flap alive are located just beneath or within the abdominal muscle. A small incision is therefore made in the abdominal muscle to expose these vessels.

The flap is then disconnected from the abdomen and transplanted to the chest where the vessels are reconnected to the vessels in the chest. The flap is then shaped into the new breast and the abdomen is closed, resulting in the added bonus of a tummy tuck!