DIEP Flap vs TRAM Flap
Natural Tissue Options For Breast Reconstruction
Using a flap of tissue from a patient's own body is an alternative to using breast implants. DIEP and TRAM flap procedures both take tissue from the abdomen to reconstruct a breast, but the techniques differ in important ways. Dr. Oren Lerman can patiently explain all your options during a consultation at our Manhattan practice.
DIEP Flap and TRAM Flap: What Is the Difference?
The most common type of natural (autologous) tissue reconstruction performed in the community is the older TRAM flap procedure, which was first described in 1979. However, advances in microvascular surgery have introduced more refined techniques for autologous breast reconstruction.
State-of-the-Art DIEP Flap
Today, microvascular surgeons like Dr. Lerman avoid the TRAM flap in favor of the more advanced DIEP flap method. The state-of-the-art DIEP flap technique minimizes donor site morbidity, which can lead to abdominal wall weakness or hernia. Being less invasive, the DIEP method also cuts down on recovery time while providing a superior result.
Helping Patients Make Informed Choices
The TRAM flap technique is still part of Dr. Lerman's surgical repertoire. However, as director of breast reconstruction at the Institute for Comprehensive Breast Care at Lenox Hill Hospital in Manhattan, NY, he helps educate patients about the benefits of the advanced DIEP flap versus the TRAM flap to ensure that patients make informed decisions about their breast reconstruction.
Dr. Lerman Discusses Flap Reconstruction
Diep flap reconstruction allows for breast reconstruction using your own natural body tissues. Dr. Lerman specializes in breast reconstruction, including natural breast reconstruction. He has the expertise to perform this procedure for more candidates than many other plastic surgeons.
What Is Flap Reconstruction?
Flap reconstruction uses your own natural tissue to rebuild the breast mound. The most common location to transfer tissue from is the lower abdomen. However, tissue flaps can be transferred from any number of places around the body where excess tissue may be found. This includes the inner thighs, back, and buttocks. Important aspects of flap reconstruction include:
During breast reconstruction using the flap method, surgeons transfer entire sections of tissue from a part of the patient's body (where there is an excess) to the chest to create the breast mound. The transferred tissue includes skin, fat, and blood vessels. With TRAM, muscle is also used.
Any blood vessels that were detached in the transferred tissue are then sewn back together using a microscope. This microvascular surgery step re-establishes the blood supply in the breast mound to recreate the living, "breathing" tissue that had been lost in a mastectomy.
Flap reconstruction creates a natural-feeling breast that looks and moves like a normal breast. The reconstructed breast mound ages with the patient and tends to even look better over time as opposed to a breast implant that looks worse over time and needs to be replaced.
Are You Considering Breast Reconstruction Using Your Own Natural Tissue?
If you are considering using natural tissue for breast reconstruction, Dr. Lerman is an exceptionally qualified microvascular and plastic surgeon who strives to provide patients with the highest level of care. Dr. Lerman's distinctions include:
- Director of Breast Reconstruction at Lenox Hill Hospital's Institute for Comprehensive Breast Care in Manhattan
- Director of the Breast Aesthetic and Reconstructive Fellowship
- Board-certified by the American Board of Plastic Surgery and a diplomat of this prestigious organization
- Advanced surgical training fellowship in Microvascular Surgery and Breast Reconstruction at the University of Pennsylvania
- Consistently recognized as a top Manhattan plastic surgeon by Castle Connolly Top Doctors, Super Doctors®, and New York Magazine
For more information about the benefits of the DIEP flap versus the TRAM flap, or to discuss which reconstructive surgery will work best for you, contact Oren Z. Lerman's practice in Manhattan today:
(212) 434-6980
"He has my highest recommendation" 5-Star Reviews from Satisfied Patients
Kleigh NYC
2020
Dr. Lerman is best of the best! From his bedside manner and ability to really listen to his patients to his highly skilled surgical hand, I am so grateful and fortunate to have found him. He has my highest recommendation, as well everyone on his staff. Helpful and lovely to deal with. 5 stars!
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Beth Stern
2019
I came to see Dr. Lerman having begun the implant process post mastectomy but very unhappy with the tissue expander. I had constant discomfort and a misshapen breast. Within hours of flap surgery, my pain was gone. I am so thankful!
View On GoogleA Detailed Look at Tissue Selection
Both the DIEP and TRAM flap surgeries harvest tissue from the lower abdomen. The primary difference between the two procedures is whether muscle is removed in addition to skin and fat.
Let's take a closer look at how tissue transfers in these two methods differ and how they can affect the outcomes:
TRAM Tissue Transfers
In the more traditional TRAM flap surgery, rectus muscle is taken from the abdominal wall and transferred to the breast. The rectus is one of the core abdominal muscles. It helps you do sit-ups and creates the famed "6-pack" in bodybuilders.
However, removing muscle from the abdomen comes with some added risks:
- Because the muscle is cut, there is a significantly higher chance of developing abdominal wall weakness, bulging, or even a hernia that needs to be corrected surgically.
- Recovery is often longer and more painful.
The traditional TRAM procedure has evolved into what we now call the "muscle-sparing" free TRAM flap surgery (msTRAM), but surgeons still cut the muscle to do this muscle-sparing technique – just a smaller portion. Unfortunately, because no two patients or surgeons are alike, it is difficult to predict how much muscle is cut in a muscle-sparing TRAM operation.
DIEP Tissue Transfers
The DIEP flap procedure developed as microvascular surgeons became better and better at harvesting the tissue without any muscle or the supportive outer layer around the muscle called the fascia.
During a DIEP flap procedure, the abdominal muscle and fascia are preserved entirely in the abdomen. Only skin, fat, and blood vessels are transferred to the breast.
This method requires more advanced training and skill, but it:
- Minimizes the risk of post-op abdominal wall weakness, bulging, or hernias
- Reduces recovery time and discomfort
Dr. Lerman completed a surgical fellowship in microvascular surgery and breast reconstruction, and is one of the few plastic surgeons in Manhattan who is able to offer this advanced method of natural tissue breast reconstruction.
Frequently Asked Questions About Autologous Breast Reconstruction
Do I Have Enough Tissue?
A common misconception is that you need to be overweight to have this surgery. This is not the case. There simply needs to be enough tissue to perform the reconstruction. While patients are sometimes told by other surgeons that they do not have enough tissue, Dr. Lerman has often found this to not be the case.
One simple consultation is all that is necessary to determine if you are a candidate.
There are people who truly do not have enough abdominal tissue to use and in these cases, Dr. Lerman can often find alternative flap sites, such as the thighs (PAP or TUG flaps), buttocks (GAP flap), or even multiple sites (stacked flaps).
Can I Replace Implants With My Natural Tissue?
Many patients who have already undergone breast reconstruction in the past with implants and have complications from those implants or are dissatisfied with the shape, feel, appearance, and symmetry of the implants can have those implants removed and replaced with a DIEP flap or other flap procedure.
What If I Didn't Have Reconstruction?
Patients who never undergone any type of reconstruction at the time of their mastectomy may also undergo a DIEP flap procedure in what is called a Delayed Reconstruction.
Speak with a Leader in Breast Reconstruction Restore Your Form, Beauty, & Confidence
Dr. Oren Lerman is committed to helping breast cancer survivors following a mastectomy. If you are looking to use your own tissue for breast reconstruction, Dr. Lerman is at the forefront of microvascular techniques that achieve long-lasting, natural-looking results.
He is a recognized leader in breast reconstruction who performs perforator flap surgery techniques including DIEP flap, PAP flap, and GAP flap. Dr. Lerman also provides breast implant reconstruction.
Throughout his career, he has become known for his caring, warm manner that encourages the two-way conversations that are essential to a successful outcome. To book your consultation, contact Dr. Lerman at his Manhattan practice:
(212) 434-6980
"I feel lucky and blessed to call him my doctor" A Trusted New York Plastic Surgeon Providing Perforator Flap Surgery
Kimberly del Gaizo
2019
He masterfully navigated my demanding journey with breast reconstruction following my cancer diagnosis and double mastectomy. As my body persisted in presenting formidable challenges, Dr. Lerman never wavered in his thoughtful and methodical decisions and treatments. Dr. Lerman is the ideal doctor. I feel lucky and blessed to call him my doctor.
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Lisa
2019
Dr. Lerman changed my life! After a double mastectomy, he did reconstruction via DIEP flap. My fears were quelled by his excellent care. His staff is amazing. They saw and spoke with me throughout my recovery. I could not be happier with the results. Thank you!
View On GoogleA Patient's Perspective On Breast Reconstruction
A patient discusses her exceptional breast reconstruction experience with Dr. Oren Lerman. Dr. Lerman immediately put her at ease with his caring manner and attention to detail. He spent a great deal of time explaining all of her options and making her feel comfortable with her surgery.
A Closer Look At The DIEP Procedure
DIEP stands for Deep Inferior Epigastric Perforators. The name of the technique comes from the specific blood vessels (perforators) that are removed from the lower abdomen as part of the tissue transfer.
Because of the numerous aspects that entail performing microvascular surgery, the DIEP flap procedure is a relatively long procedure. However, because the surgery is only on the skin, fat, and abdominal wall and not on any of the internal organs (lungs, heart, bowel), it is not a very invasive surgery and the recovery is significantly shorter than commonly described.
The TRAM Procedure
The specifics of a TRAM flap procedure depend on whether your surgeon uses the free flap, muscle-sparing, or pedicle technique:
Free-Flap Tram
The abdominal tissue and blood vessels will be transplanted just as they are in the DIEP flap but the tissue section will also include a portion of the rectus, more commonly referred to as the “six-pack” muscle.
Muscle-Sparing Free Flap
The muscle-sparing technique is a type of free flap procedure that removes a much smaller portion of the muscle.
Pedicle Flap
The transfer remains attached to its original blood supply. Instead of moving the tissue externally, your surgeon will tunnel it up to the chest beneath the skin of the upper abdomen. In this case, the entire rectus muscle will be transferred, as well.
Before closing up the abdominal incision, your surgeon may decide to cover up any open areas in your abdominal tissue with mesh material. This will help to support your abdominal wall and minimize complications after surgery.
"I highly recommend Dr. Lerman" Five-Star Reviews from New York Patients
I Am Liz Marie
2019
Dr. Lerman is an outstanding amazing surgeon. Very nice and patient. Communicated my options and what was best for me. Made me feel comfortable and confident in my skin again. I highly recommend Dr. Lerman. I am so thankful.
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Dana M. Panzer
2019
Dr. Lerman is an outstanding surgeon and person. I would highly recommend him to anyone considering breast reconstruction and/or cosmetic procedures.
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