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This operation uses a flap of skin, fat and sometimes muscle from the tummy area (abdomen) to create a breast shape.
The procedure also tightens and flattens the tummy area (similar to a ‘tummy tuck’ operation). The tummy button has to be recreated and re-sited.
The types of reconstruction operations using tissue from the tummy area are:
This procedure uses a flap of fat, muscle and skin from your tummy area to create the shape of a breast. It’s called a TRAM flap because the transverse rectus abdominis muscle is used. After the muscle has been removed, a mesh may be needed to strengthen the tummy wall to prevent a bulge or hernia developing.
There are two types of TRAM flaps:
A flap of skin, fat and muscle is taken from your tummy, with its blood supply still connected, and is tunnelled under the skin to the chest to make a breast shape. The operation takes about 4-6 hours.
A flap of skin, fat and muscle is taken from your tummy. The tissue and its blood vessels are completely detached from the tummy and transferred to the breast area. The flap is then reconnected to a new blood supply in the armpit or near the breastbone. This involves micro-surgery, where the surgeon uses a microscope to help them see the very fine blood vessels that need to be joined.
Once the blood vessels are reconnected, the blood supply to the new breast is better than with a pedicle TRAM flap because the blood doesn’t have so far to travel. This means it’s possible to make a larger breast using this technique, although less muscle is taken from your tummy than in the pedicle TRAM flap.
Free flap surgery is very specialised and is done by a plastic surgeon. It takes longer than pedicle flap surgery, usually about 6-8 hours.
Most plastic surgeons advise delaying a free flap reconstruction if radiotherapy| is planned, as radiotherapy can affect the look of the reconstructed breast.
Photographs of TRAM flap reconstruction
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The photo on the left shows TRAM flap with nipple reconstruction|, showing the abdominal scar. Over time the scar fades to a pale white line.
The photo on the right shows a woman who has had both breasts reconstructed using free TRAM flap and nipple reconstruction.
A flap of fat and skin (but not muscle) is taken from your tummy area to create the shape of a breast. The tissue and its blood vessels are completely detached from your tummy and reconnected to a new blood supply in your chest area. It is called DIEP because the deep inferior epigastric perforator blood vessels are used. This is a free flap operation and requires micro-surgery. Like the free TRAM flap it is a long and complex operation and takes about 6-8 hours.
Another possible operation using fat and skin from the tummy area is called the free SIEA flap (superficial inferior epigastric artery flap). The operation is similar to the free DIEP flap.
Free TRAM, DIEP and SIEA flaps all involve very specialised surgery. You may have to travel to a specialist unit for this. There may be a longer waiting time for these operations.
Photographs of immediate DIEP flap reconstruction (left) and delayed SIEA flap reconstruction (right)
View a large version of the photographs|
Reconstruction using tissue from the tummy area may be suitable for women:
They may not be suitable for women who:
Complications| are more common for women who smoke or are very overweight.
This sometimes happens soon after the operation, but usually gets better within a few weeks. This is more common after a pedicle TRAM flap operation (7 in 100 women), than after free flap operations, where the blood supply to the tissue is cut and reconnected (2 in 100 women).
Taking muscle from your tummy can weaken the tummy wall, and some women develop a bulge or hernia in the tummy area. There is a greater chance of a hernia or bulge developing after a pedicle TRAM flap, as more muscle is taken. To reduce the risk, you will have gauze mesh put into your tummy wall to support it. Hernias are less common after a free TRAM flap and are rare after a free DIEP or SIEA flap reconstruction.
Your surgeon and nurses will keep a very close check on the new tissue in the reconstructed breast in the first few days after the operation. They will want to be sure that its blood supply is working well. If there are any signs of a problem, you may need to go back to the operating theatre to have it checked. This is done to make sure the new breast tissue stays healthy and heals well. About 1 in 8 women (12%) who have a flap made from their tummy tissue may need one of these ‘second check’ operations the week after their surgery. It’s more likely to be needed after a free flap operation than after a pedicle TRAM flap.
Most operations are successful, but occasionally the new tissue in the breast fails if the blood supply to the reconstructed breast isn’t good enough. This happens to about 1 in 500 women (0.2%) who have a pedicle TRAM flap and to about 2 in 100 women (2%) who have a free flap procedure.
Sometimes a small area of the new breast is lost soon after the operation. This happens to about 1 in 100 women (1%) after a pedicle TRAM flap and to about 2 in 100 women (2%) who have a free flap operation. Another operation may be needed to improve the appearance of the breast.
Content last reviewed: 1 June 2011
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