Breast Reconstruction with DIEP/TRAM flap

The operation in short

This surgery involves the transfer of skin and fat from the lower abdominal wall — between the navel and the pubes (this same tissue is removed during an abdominoplasty for aesthetic purposes) – to the area of ​​the breast that has undergone a mastectomy. The skin from the abdomen is the most ideal skin for reconstruction, as it resembles the normal breast both in color and fat composition (soft and pliable) and for this reason, it is considered the best reconstruction that one can offer to patients.

In addition, the most important thing about this method is that the implant is maintained for life without problems, fluctuates in size along with the rest of the body, and is as warm and soft as a normal breast. Autologous transplantation (tissue transplantation from our own body) is done by reconnecting the flaps/skin of the abdomen to the breast area, using the method of microsurgery.

If it is performed as a Primary Reconstruction operation at the same time as a mastectomy operation, then the skin of the breast is usually preserved and the skin of the abdominal area is used in order to give shape to the breast as well as to form the nipple. In the event that a Delayed Restoration is performed then the skin of the abdomen is used to create the new skin of the removed breast. Thanks to an established team of associates, this operation lasts 6 to 8 hours (in the past it used to last 8 to 10 hours) thus allowing patients to recover faster and minimizing their hospitalization.

Microsurgery

The concept of microsurgery involves the transplant of tissues by grafting vessels (arteries and veins) that are less than 3-4 millimeters in diameter under the magnification of an electrical microscope. This is the most modern technique in the field of reconstruction within the context of Reconstructive Plastic Surgery. Regarding the application of microsurgery in the context of breast reconstruction, it is performed by connecting the vessels of the skin of the abdomen with the vessels in the area of ​​the breast, thus giving new life to the flap (skin and fat) that has already been removed from the abdomen. In order for the vessels to reach the skin and belly fat they pass through the muscles of the abdominal wall.

In most cases, it is possible to keep intact the anatomy of the area from where the implant is taken, as the rectus abdominis muscle remains in the abdomen, while in other cases part or all of the muscle is removed along with the vessels to ensure the proper perfusion of the flap and its survival. In the first case where all the muscle is left behind, the flap is called DIEP (Deep Inferior Epigastric Perforator flap), while in the cases where the muscle around these vessels is removed, then the flap is called TRAM (Transverse Rectous Abdominis Muscle flap) or Ms-TRAM (Transverse Rectous Abdominal Muscle flap). With the exemption of this small variation, it is the same surgery. In our clinic, we apply the DIEP method – which is considered the most optimal method for breast reconstruction in the world – to seventy-five percent (75%) of patients.

Advantages of Using the Abdominal Flap (Abdominal Tissue)

The use of the abdominal flap (skin and fat) for breast reconstruction has the best aesthetic result, as it resembles the natural breast both in texture and behavior (mobility, fluctuation in size following the patient’s physical changes). The newly constructed breast will have the same shape as the other breast.

 The results of this reconstruction method improve over time.

 This operation is completed with a surgery and the abdominal area becomes flatter and slimmer (abdominal surgery). It is widely considered to be the most successful breast reconstruction surgery with a success rate of 99%.

Disadvantages of Using the Abdominal Flap (Abdominal Tissue)

Despite the fact that it is now performed in less time, it still remains a major surgery, with a duration of up to 8 hours and a recovery period of two to three (2-3) months.

 Surgery has a 1-2% failure rate and this failure depends on risk factors including obesity, smoking, previous surgeries, other diseases, and whether radiotherapy has preceded. 

In the area of ​​the lower abdomen from where the implant will be taken an incision will be made, similar to that made for a simple abdominoplasty, and patients might experience some tenderness which will improve over time. 

Rarely, patients may experience some degree of pain, weakness, or bloating / swelling in the abdomen, and there is also a small risk of general postoperative complications such as pneumonia and thrombosis.

Recovery from Surgery and Final Outcome

Duration

Depending on the type of operation, the duration may vary from 6 to 8 hours.

Duration of hospitalization

The patient is usually required to stay in the hospital for 6 days.

Mobilization

Patients will need to stay in bed for two days, during which time a bladder catheter will be required. After three to four days they will be able to move, while after ten to fourteen days they will be able to walk without feeling any discomfort.

Exercise

After four weeks, patients will be able to exercise, while after two to three months they will have fully recovered and will be able to return to work.

The bandages that patients will have on their chest and abdomen should remain for a week, while the use of an elastic band on the abdomen for four weeks is recommended.

Complications

There is also a six percent (6%) chance of developing postoperative problems, such as abdominal pain and swelling, skin inflammation, fluid retention, wound disruption, and possible postoperative hernia.

There is also a 5% chance of developing small nodules in the breast that are nothing more than fatty cysts (fat that has died) and partial or complete failure of surgery.

Please do not hesitate to contact us if you have any further questions.