FAQ's about DIEP flaps:

What is the advantage over a TRAM flap?

The TRAM flap sacrifices the entire rectus abdominus (sit up muscle) while the DIEP flap removes no muscle.  The risk for developing an abdominal hernia with a DIEP flap is almost zero while with a TRAM flap the risk can be up to 30%.

Since the DIEP flap involves microsurgery and the TRAM flap does not, shouldn't the risk be greater for a DIEP flap?

No. In the hands of a well-trained and experienced microsurgeon, the microsurgery should not pose a problem.  The better blood supply to the flesh of the lower abdomen comes from the blood vessel to the lower abdomen and these are the vessels utilized in a DIEP flap.  This leads to a healthier piece of flesh.  In the TRAM flap, while no microsurgery is utilized, the blood supply is not as vigorous.  This is because the included blood vessels in the muscle are from the upper abdomen and obviously their contribution to the blood supply of the lower abdominal tissue is less.

The DIEP flap takes much longer than a TRAM flap.  Doesn't that increase the risk?

No.  All of this surgery is skin and subcutaneous surgery that is very superficial.  The surgery is done on the surface of the abdomen and chest and not inside of these areas.  The body interprets the loss of the abdominal muscle (in a TRAM flap) as a major insult.  This prolongs recovery much more than a careful surgery that does less harm to the body.

I've heard that a free TRAM flap has all the advantages of a DIEP flap and doesn't have the disadvantages of a conventional TRAM flap.  Is that true?

No.  The free TRAM flap does utilize the more vigorous blood supply of the lower abdomen to the flap, but it also includes muscle.  This can lead to hernia.

If the DIEP flap is so much better, why don't more surgeons do it?

The DIEP flap is a very technically difficult flap to do that requires experience and skills that most trained microsurgeons do not possess. 

If this is such a difficult procedure what is the failure rate?

In my experience, and I have personally done over 150 DIEP flap breast reconstructions, the failure rate is less than 1%.

Copyright 2000-2007 Alex Keller, MD, FACS. pc.  All rights reserved.