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Reconstruction Methods -
Using the Tummy
Reconstructing a breast with your tummy (TRAM or DIEP flap)
Procedure in brief
The procedure essentially involves the removal of the skin and fat from the lower tummy (same tissue as taken in a tummy tuck operation) and using this to build a breast. This is done by re-attaching this tissue in the breast with microsurgery. If done at the same time as the mastectomy then the breast skin is usually kept and the tummy tissue used to give the breast shape and to make a nipple. If done at a later date (delayed reconstruction) the tummy skin is also used for the new breast skin.
To do the microsurgery blood vessels are left attached to the tummy tissue.
This means taking some muscle (TRAM flap version) although a modification leaves all the muscle behind (called the DIEP flap). reconstruction using the tummy (TRAM/DIEP flap).
What can be good about this type of reconstruction?
- Uses your own tissue (fat) to re-build your breast and this very closely resembles the normal breast in texture and movement.
- Tends to naturally droop like normal breast tissue and therefore very good at achieving the same shape of the opposite side.
- Changes over time with the opposite breast be it in size and shape (i.e ‘its alive and part of you’). Generally this reconstruction gets better over time
- Can give a flatter and slimmer tummy
- Regarded world-wide the gold standard of breast reconstruction
- Successful in ~96% of patients
- Single operation
What can be bad about this operation?
- Is a big operation taking 5-6 hours to perform, with a 6-9 day hospital stay and 2-3 month recovery
- Has a 2-6% failure rate depending on risk factors (obesity, smoking, past surgery, radiotherapy, other medical illnesses)
- Leaves a scar on the tummy
- Can give pain, bulge or weakness in the tummy (uncommon)
- Leaves some numbness on the lower tummy skin
- Slightly greater risk of general complications like pneumonia and blood clots (uncommon)
Operation facts
- Average length of stay - 7 days
- Average length of surgery - 5-6 hours
- Time restricted to bed - 3 days
- Bladder catheter used - Yes
- Time to walking - 5 days
- Walking easily - 10-14 days
- Time to exercise - 4 weeks
- Time to full recovery - 3 months
- Time off work - 3 months
- Dressings - Tummy and breast
- How long for dressings - 2 weeks
- Bras and garments - Pressure garment 4 weeks
- Potential donor site problems - ~6% - Pain, bulge, hernia, skin infection, fluid collection, wound breakdown
- Potential reconstruction problems - ~5% - Total failure, lumps in fat, part failure
- Long term problems - Few. Can be tummy weakness.
- Single or staged operations - Single
