TRAM Flap vs DIEP Flap Breast Reconstruction – How Are They Different?
Author: Dr. Minas Chrysopoulo
Is there a difference in recovery between the different abdominal flap breast reconstruction options?
A study published in Plastic and Reconstructive Surgery examined the abdominal recovery rates and patient satisfaction after breast reconstruction with different abdominal flaps: the DIEP, SIEA and muscle-sparing free TRAM.
The SIEA (superficial inferior epigastric artery) flap is the least invasive method of lower abdominal flap breast reconstruction; however, there are no published reports comparing the donor-site morbidity of SIEA flaps to that of TRAM (transverse rectus abdominis myocutaneous) flaps or DIEP (deep inferior epigastric artery perforator) flaps.
The authors of the study used a 12-question patient survey and retrospective chart review to compare donor-site (abdominal) function, pain, and aesthetics in 179 patients who had unilateral or bilateral breast reconstruction with 47 SIEA flaps, 49 DIEP flaps, and 136 muscle-sparing free TRAM flaps during a 5-year period.
Unilateral SIEA flap patients scored higher on 10 of the 12 survey questions compared with unilateral muscle-sparing TRAM flap patients, including reporting significantly better postoperative lifting ability.
Abdominal pain also seemed to lessen sooner in the unilateral SIEA group (though this was not statistically significant) when compared to the muscle-sparing free TRAM group. Bilateral breast reconstruction patients with at least one SIEA flap scored higher on all 12 survey questions, including reporting significantly better ability to get out of bed (sit-up motion) compared with patients with bilateral muscle-sparing TRAM or DIEP flaps. The greatest benefit of the SIEA flap occurs in cases of bilateral breast reconstruction where at least one of the flaps used is an SIEA flap. There were no differences between patients that had undergone reconstruction of only 1 breast (unilateral) with an SIEA flap versus those that had had a DIEP flap.
The authors’ conclusions were that breast reconstruction using SIEA flaps results in significantly less abdominal donor-site issues than DIEP flaps in bilateral cases and free muscle-sparing TRAM flaps in both unilateral and bilateral cases. The authors felt that these differences were “clinically relevant” and recommended that SIEA flaps be used whenever possible in preference to DIEP or muscle-sparing free TRAM flaps for breast reconstruction.
These findings are not surprising on the whole; they make sense considering that the SIEA flap procedure requires the least amount of surgical dissection while the muscle-sparing free TRAM is the most invasive (due to removal of some of the rectus abdominis muscle). One would expect recovery to be easiest in patients that undergo the least invasive surgery and this is essentially what this study has shown.
Interestingly, in patients undergoing unilateral breast reconstruction (one breast only), DIEP flaps are just as good as SIEA flaps in terms of recovery and patient satisfaction even though the DIEP procedure is slightly more invasive.
A study published in Plastic and Reconstructive Surgery examined the abdominal recovery rates and patient satisfaction after breast reconstruction with different abdominal flaps: the DIEP, SIEA and muscle-sparing free TRAM.
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Robyn
Hi – can the diep procedure be applicable to a double mastectomy. I have been diagnosed with the Braca 1 gene and I am having both breasts removed and I am considering the diep method. Thanks Robyn
PRMA Plastic Surgery
Hey Robyn! Great question! The DIEP flap is applicable to a double mastectomy. PRMA performs bilateral prophylactic mastectomies with DIEP flap reconstruction regularly. Please let me know if you have any other questions!
Mary
What is the recovery time for something like this?
PRMA Plastic Surgery
Hey Mary! This is a great question. Typically, the recovery for the first stage of the DIEP flap is about six weeks.
Lisa
I noticed many of the after photos, show the belly button as an “outie”, after surgery are all the belly buttons “outies”?
PRMA Plastic Surgery
Good morning Lisa! I am not sure which before and after pictures you are referring to, but the belly buttons after surgery are typically not “outies.” You are more than welcome to review our before and after pictures at https://prma-enhance.com/before-after-photos/breast-reconstruction-surger… for some examples of the post-operative belly buttons. Hope this helps!
Nicki
Hi, have you done this on darker skinned women? How are the aesthetic post-op results compared to caucasians? Any New York city locations? Thank you
PRMA Plastic Surgery
Hey Nicki! Great question! We have performed this procedure on patients with darker skin with amazing aesthetic results. There are examples of the results in our before and after photos which you can find at https://prma-enhance.com/before-after-photos/breast-reconstruction-surger…. I hope you find this helpful. We do not have a PRMA location in New York, but we do routinely welcome out of state patients. If you would like more information on traveling for breast reconstruction please let me know!
Cynthia
Would love this procedure, I have been lop sided for years. Is it affordable?
PRMA Plastic Surgery
Hello Cynthia! Typically the procedure is covered by insurance so out of pocket costs would depend on your policy. You are more than welcome to give our billing department a call at 800.692.5565 and they can look into your coverage and provide you a cost estimate.