Tuesday, February 7, 2012

Abdominal Muscle - Why Save It?

Most women that have looked into breast reconstruction know about the TRAM flap. The TRAM uses lower abdominal skin, fat, and varying amounts of abdominal muscle to reconstruct a "natural", warm, soft breast after mastectomy. The TRAM used to be the gold standard in breast reconstruction, but not anymore.

Over the years, the TRAM flap procedure has evolved into two more advanced procedures that decrease the risk of abdominal complications: the DIEP flap and the SIEA flap. Both use the same lower tummy skin and fat but unlike the TRAM, both SAVE all the abdominal muscle and leave it in place.

The SIEA flap differs from the DIEP flap only in terms of the blood vessels that supply the tissue. While the surgical preparation is slightly different, both procedures spare the abdominal muscle completely and only use the patient's skin and fat to reconstruct the breast. 

All three procedures provide the added benefit of a flatter abdomen with results that mimic a “tummy tuck”. However, because the TRAM flap sacrifices abdominal muscle, the risk of a hernia or abdominal bulging is signifantly higher than with the DIEP or SIEA procedures.

Since the DIEP and SIEA flaps preserve all the abdominal muscles, patients experience less pain than after TRAM flap surgery, enjoy a faster recovery and also maintain their abdominal strength long-term.

I hope this info helps.

Dr C

*****

PRMA Plastic Surgery specializes in advanced breast reconstruction including DIEP flap, SIEA flap, GAP flap, TUG flap, Alloderm One-Step and fat grafting. In-Network for most US insurance plans. Patients routinely welcomed from across the USA. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer reconstruction patients at www.facebook.com/PRMAplasticsurgery.

*****


10 comments:

Marianne Hobbs said...

Thank you so much for this post, it was very informative! I had a TRAM just 1o years ago. It was the GOLD standard at that time. It is strange to think that it is virtually outdated today. I do have the issue of 'stomache bulge' and as an athlete, I find it frustrating to not have the abdominal strength that I would like. My question to you is this: Is it surgically possible to put the abdominal muscle (that was moved with a TRAM) back to the abdomen? Thanks in advance for any info you can share.

Dr C said...

Hello Ms Hobbs,

Thanks for posting. That's a great question. Unfortunately it is not possible to put the abdominal muscle (rectus abdominis) back to its anatomic position in the abdomen. Even if it were, the muscle has wasted away significantly by this time so it wouldn't be much good to you in terms of abdominal function.

I'm sorry to hear that you are experiencing some bulging. Further surgery can improve that but unfortunately it will not address your loss of abdominal strength.

Dr C

Anonymous said...

I have that same problem would like to know how to go about it someone please email me at olga91357@gmail.com please

Kelly said...

I refused to do the TRAM 5 years ago because I knew losing my stomach muscle would be a bad way to go. I am very glad I opted not to go that way. If I have to redo I would highly consider the new procedures having a tummy tuck and saving my muscle.

Dr C said...

We'll be in touch Olga!

Marie said...

Yes, I had a Tram in 2000 on my left breast I too have a pocket on my left side of my abdomen. my complain is I had a Muscle explansion 2005 on my rt. breast...that's the one that is giving me so much trouble with. It is so PAINFUL ! My question is can I have a procedure similar to Tram??? Thank you so much..

Dr C said...

Hi Marie,

Unfortunately once you have had a tummy tuck or a flap procedure using the lower abdominal tissue (TRAM, DIEP or SIEA flap), you cannot use the lower tummy tissue again for a second flap procedure down the line. The lower abdominal tissue can only be used one time.

Fortunately, there are several other reconstructive options that you may want to look into:
www.PRMA-enhance.com/index.cfm/PageID/1571

I hope this info helps.

Dr C
www.PRMA-enhance.com

Lisa Ortiz said...

I had a double mastectomy in Sept. I am in the middle of the wall expanders. if further down the line the implants ruputure could I do this procedure?

Minas Chrysopoulo MD said...

Lisa, you could undergo DIEP flap reconstruction any time.
Dr C

Lisa Ortiz said...

Thanks. I'm kinda wish I would have known about this before wall expanders they are so uncomfortable I have till Feb