DIEP Flap Breast reconstruction using tissue borrowed from the abdomen has been commonplace since the 1980s. The TRAM flap procedure moves tissue from the abdomen leaving it attached to the body by the rectus abdominis muscle. This attachment allows blood to flow into and out of the skin and fat which are used to reconstruct the breast supplying it with the nutrients and oxygen it needs to survive and heal. The TRAM flap is an excellent choice for women who desire breast reconstruction using their own tissue but is not without drawbacks. The removal of the muscle from the abdominal wall weakens it and may cause limitations in activity or make patients more susceptible to a hernia or bulge in the abdomen. Additionally, the rectus abdominis muscle is not the primary blood supply to the abdominal tissue meaning that smaller amounts of skin and fat can be used for the breast reconstruction with the TRAM flap.
A newer option for breast reconstruction is the deep inferior epigastric artery perforator (DIEP) flap. This procedure also utilizes abdominal tissue for the breast reconstruction but does not involve sacrifice of an abdominal muscle. During the DIEP flap procedure a small blood vessel, the deep inferior epigastric artery, is dissected free from the abdominal wall. The tissue is then moved to the breast and the artery is re-attached to a blood vessel in the chest. This procedure allows the muscles in the abdomen to remain in place and actually utilizes the dominant blood supply to the abdominal tissue.
The advantage of leaving the muscle behind does come with additional risk. Clot can form where the blood vessel is re-attached in the chest necessitating additional surgery to remove the clot or even causing loss of part or all of the reconstruction. This however is unlikely and may be offset by the benefit of leaving the muscle behind.
Dr. Houle has been performing DIEP flap breast reconstruction exclusively for the past seven years. His experience with the procedure has allowed Midsota Plastic Surgeons to completely replace TRAM flap reconstruction with DIEP flap reconstruction. If you are considering breast reconstruction Dr. Houle would be happy to see you in consultation to discuss all of the options for reconstruction and to see whether the DIEP flap might be right for you.
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