TRAM (transverse rectus abdominismusculocutaneous) and DIEP (deep inferior epigastric perforator) flaps are similar procedures that involve the use of tissue from your abdomen to create a new breast. The difference between the two procedures is that the DIEP flap does not involve any muscle being taken from the abdomen, whilst the TRAM flap does.
What does it involve?
Both involve the tissue being carefully removed from your abdomen with its blood supply (an artery and a vein). At the same time, at the site of your mastectomy, a small piece of cartilage is removed from one of your ribs to gain access to blood vessels in the chest. The tissue from your abdomen is moved up to your chest and the artery and vein are then connected to the blood vessels in your chest under a microscope using very fine stitches. Your abdomen is then closed in a similar manner to a “tummy-tuck” procedure, and the tissue that has now been “brought back to life” on your chest is then sculpted into a new breast.
What are the benefits?
This method of breast reconstruction uses only your own tissue and does not involve the use of any implant: your new breast is 100% part of you. When you put on weight it will put on weight (albeit in the way your abdomen used to) and conversely when you lose weight, so it will too. Once you have completed your breast reconstruction journey (after any adjustments and the creation of a nipple) you should not have to undergo any further procedures for the rest of your lifetime.
How long does the surgery take?
The surgery takes up to 8-hours. This is mainly due to the technical challenges of microsurgery including the small blood vessels involved. As a result you will be carefully monitored during and after the procedure, needing a catheter (a tube that goes into your bladder to collect your urine), a variety of drips and surgical drains – all of which come out during the first few days in hospital.
What is the recovery period?
You will stay in hospital for about 5-7 days. You should take things easy for 2-weeks and gradually build up your activities over the next few weeks. Exercise can be started at 6-8 weeks, but it can take up to 3-months until all energy levels are back up to normal.
How long before daily activities may be resumed?
You will be able to resume all regular activities by 8-weeks, although your energy levels may not feel completely restored for a further 4-weeks after that. You should be able to drive by 4-6 weeks.
What are the success rates?
The overall success rate of this procedure is 98%. The problems that result in failure are usually due to blood vessel problems. To prevent these, we sometimes have to take you back to surgery promptly to try to save the reconstruction within the first 72-hours after the procedure. A further 10% of reconstructions undergo partial failure or fat necrosis (dying of part of the fat in the reconstruction), where a small part of the reconstruction is lost, but enough is preserved to provide you with a good new breast.
What are the possible complications?
Other complications include: wound infection or breakdown (both abdomen and breast); seroma (accumulation of fluid, usually in the abdomen); bleeding (requiring transfusion or occasionally return to surgery); tummy wall bulges or hernia (due to weakness of the abdominal wall from the surgery); lumpy scarring in some people; blood clots in the legs (DVTs) that may go to the lungs (PEs) and chest infections (as a result of the long anaesthetic).