Tissue from the lower abdomen (tummy) is used to reconstruct the breast shape.
Learn more about:
- Types of abdominal flaps reconstructions
- DIEP flap reconstruction
- TRAM flap reconstruction
- How the abdomen will look after reconstruction
Types of abdominal flaps reconstructions
There are 2 main types of abdominal flaps:
- free deep inferior epigastric perforator (DIEP) flap
- free transverse rectus abdominis myocutaneous (TRAM) flap.
These flaps are called free flaps because the flap is cut completely away from the blood supply in the abdomen. The surgeon then reconnects the flap to the blood vessels in the chest area using microsurgery (surgery using miniature instruments and viewed through a microscope).
DIEP flap reconstructions
This is called DIEP because it uses deep blood vessels called deep inferior epigastric perforators (DIEP). It is now done more often than TRAM flap procedures.
In a DIEP flap procedure, the surgeon uses only the skin and fat to reconstruct the breast. The abdominal muscle is left in place. This means the strength of your abdomen muscle is less affected and the risk of abdominal problems after surgery is reduced.
Reconstruction with a DIEP flap
 | After the reconstruction you will have a scar on your breast and a scar across your abdomen from one hip to the other (seen only faintly here). |
TRAM flap reconstruction
In this procedure, all or some of the muscle in the lower abdomen and a flap of skin and fat are used to reconstruct the breast shape. The muscle in the lower abdomen that runs from the breastbone to the pubic bone is the rectus abdominis muscle, or “six pack” muscle.
A type of TRAM flap reconstruction that is not often done anymore is called a pedicle TRAM flap. In this procedure, the flap remains attached to its original blood supply and is tunnelled under the skin of the upper abdomen to the breast. A pedicle TRAM flap has a high risk of hernia.
How the abdomen will look after reconstruction
After a DIEP or TRAM flap reconstruction, your abdomen is tighter and flatter. This is because the reconstructed breast is formed from tissue taken from the abdominal area.
You will have a long scar across the lower abdomen from one hip to the other, a scar around your bellybutton and a scar on the reconstructed breast. While everyone heals differently, the appearance of the scars will improve with time.
Both types of flap reconstructions can make the abdominal area weaker, and you will have little to no feeling in the skin over the breast and the scar over the abdomen. You may be advised to wear a garment called an abdominal binder to protect and support the wound. Ask your surgeon how long you will have to wear the binder.
Try to look at your new breast shape as soon as possible. Breast care nurses often advise looking down at your breast first and then looking in the mirror. This may help you prepare for the change. A breast care nurse can do this with you.
→ READ MORE: Flap from the back (LD flap reconstruction)
Key resource
Download a PDF booklet on this topic.
More resources
Dr Jane O’Brien, Specialist Oncoplastic Breast Cancer Surgeon, St Vincent’s Private Hospital, VIC; Clare Bradshaw, Clinical Nurse Consultant, Breast Assessment Unit, Fiona Stanley Hospital, WA; Rene Hahn, Consumer; Sinead Hanley, Consumer; Dr Marc Langbart, Specialist Plastic and Reconstructive Surgeon, Randwick Plastic Surgery, NSW; Melanie Law, Consumer; Sally Levy, Consumer; Annmaree Mitchell, Consumer; Ashleigh Mondolo, Breast Cancer Nurse Clinical Consultant, Mater Private Hospital Brisbane, QLD; Rochelle Osgood, Clinical Nurse Consultant – McGrath Breast Care Nurse, Sunshine Coast University Hospital, QLD: Dr Kallyani Ponniah, Head of Department, Breast Centre, Sir Charles Gairdner Hospital, WA; Meg Rynderman OAM, Consumer; Sarah Stewart, Breast Care Nurse, The Royal Women’s Hospital, VIC; Erin Tidball, 13 11 20 Consultant, Cancer Council NSW; Jane Turner, Senior Exercise Physiologist, Sydney Cancer Survivorship Centre, Concord Cancer Centre, NSW.
The photograph above has been reproduced with permission from Dr Pouria Moradi, NSW.
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