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

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April 05, 2013

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!

10 Comments

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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

    Reply
  • 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!

    Reply
  • Mary

    What is the recovery time for something like this?

    Reply
  • 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.

    Reply
  • Lisa

    I noticed many of the after photos, show the belly button as an “outie”, after surgery are all the belly buttons “outies”?

    Reply
  • 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 http://prma-enhance.com/before-after-photos/breast-reconstruction-surger... for some examples of the post-operative belly buttons. Hope this helps!

    Reply
  • 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

    Reply
  • 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 http://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!

    Reply
  • Cynthia

    Would love this procedure, I have been lop sided for years. Is it affordable?

    Reply
  • 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.

    Reply
PRMA Plastic Surgery