Answers to Common TRAM Flap Questions

As a breast reconstruction surgeon located in the New York Metro area, I get a lot of questions from women from all walks of life who want to learn more about their reconstructive options following mastectomy. Many women come to me from all parts of New York and across the country to learn more about TRAM flap reconstruction. On this page I have put together a few of the more common questions I get about this technique. For more detailed questions or to find out if you are a candidate for this procedure, request a phone consultation with me or call the practice at 516-482-1100 to schedule an appointment.

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FAQ's about TRAM Flap

My doctor wants to do a TRAM flap and says the DIEP flap is experimental and too risky. Should I just go ahead?

As one of the first doctors to perform DIEP flap breast reconstruction starting in 1993, not only is the DIEP flap not experimental, but it is also less risky than the TRAM flap when performed by someone well trained and very experienced in DIEP flap breast reconstruction. My personal success rate in performing the DIEP flap successfully is better than 99.5%. The chance of having an abdominal hernia with a TRAM flap that could require further surgery ranges from a low of 3% to greater than 40%. The chance of having an abdominal hernia with the DIEP flap is less than 1%. There are more and more doctors being trained every day to perform DIEP flap breast reconstruction.

The TRAM flap can be done in less time than it takes to do the DIEP flap. Doesn't that make it better?

Both the TRAM flap and the DIEP flap are superficial operations that do not involve any body cavity. The length of time of the procedure for this situation plays a very minor role in the risks of the anesthetic. The extra time taken to perform the DIEP flap is time spent being more careful so that less of your body is damaged. The morning after surgery when all of the anesthesia is an out of your system, your body is left to recover from what happened. If less happened because your surgeon was careful not to damage your abdominal muscles, the amount of pain that you have will be less and your recovery time will be shorter.

My doctor has told me that the TRAM flap is the standard. Doesn't that mean it is better than the DIEP flap?

It is true that more patients today, have TRAM flap breast reconstruction than DIEP flap reconstruction. It is also true that the TRAM flap is the standard. That does not mean it is better though, it only means that there are more doctors doing the TRAM flap than DIEP flap.

I cannot find anyone in my area to do DIEP flap breast reconstruction. My only option is a TRAM flap. Should I go ahead?

Our society today is very fluid and it is not unusual for patients to travel from one area to another to get the particular care that they want. Many of my patients are not from the New York area and traveling to our office to have this procedure is fairly straightforward. If your situation is such that you cannot travel and will not be able to do so in the foreseeable future then I would proceed with TRAM flap breast reconstruction.

I have had a TRAM flap that failed. Am I a candidate for a DIEP flap?

Once a patient has had an abdominal flap that has removed the lower abdominal tissue, the patient is no longer a candidate for a DIEP flap.

How does the free TRAM flap or the muscle sparing free TRAM flap compare to the DIEP flap?

The free TRAM flap and the muscle sparing free TRAM flap removed either all or a portion of the lower rectus muscle. This is the main support of the anterior portion of the abdominal wall. The fact that the lower, more dominant blood supply, is included with each of these flaps (including the DIEP flap) gives each of these flaps a better blood supply and a decreased incidence of fat necrosis compared to the conventional TRAM flap. I am not in favor of removing any abdominal muscle routinely, and the more muscle that is removed, the greater the likelihood of abdominal wall weakness or hernia.

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