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Breast Reconstruction Primer: DIEP, SIEA, Free TRAM and Pedicled TRAM

Plastic Surgery for Torrance & Los Angeles | South Bay Plastic Surgeons

Screen Shot 2014-05-27 at 7.55.57 PM
As you know, the skilled plastic surgeons at South Bay Plastic Surgeons in Torrance perform a variety of breast reconstruction procedures. This article describes four common breast reconstruction methods:

  1. Free TRAM flap,
  2. Pedicled TRAM flap
  3. DIEP flap and
  4. SIEA flap

These four breast reconstruction procedures all use tissue (flaps) from the abdomen to reconstruct the breast(s). The primary difference between them is the choice and management of blood vessels to nourish the abdominal flap once it has been relocated to the chest wall.

The Benefits of Flap Reconstruction
One benefit of abdominal tissue for breast reconstruction is its similarity to natural breast tissue. It drapes on the chest like breast tissue and is soft like breast tissue. Because the tissue comes from the patient’s own body, there is no worry about capsular contracture, implant failure or foreign-body reaction. Second, the reconstruction appears more natural over time as scars fade and tissues soften. Last, this ingenious procedure includes the added benefit of abdominal rejuvenation—flap reconstruction patients appear to have had a tummy tuck with their breast reconstruction.

The Best Patients for Flap Reconstruction
The best candidate for one of these four procedures is a patient in otherwise good health, with some extra skin and fat in the tummy area. Patients must be tobacco-free to minimize the risk of wound healing.

Free TRAM Flap Reconstruction Screen Shot 2014-06-24 at 2.22.32 PM
TRAM stands for transverse rectus abdominal myocutaneous. In a free TRAM flap reconstruction, a section of the transverse rectus abdominal muscle, plus surrounding skin, fat and blood vessels are removed from the abdomen and attached to the chest wall using microsurgical techniques to attach the tissue to existing blood vessels.
Pedicled TRAM Flap Reconstruction Screen Shot 2014-06-24 at 4.52.09 PM
A pedicled TRAM flap reconstruction is similar to a Free TRAM flap reconstruction in that an ellipse of skin, muscle and fat are removed, but there are three distinctions: (1) the entire transverse rectus abdominal muscle is used; (2) some of the blood vessels remain intact, and (2) the flap of skin, muscle and fat is tunneled beneath the skin to its new location on the chest wall, where it’s used to create a new breast mound.
DIEP Flap Reconstruction Screen Shot 2014-06-24 at 2.21.56 PM
DIEP stands for deep inferior epigastric perforator. This flap reconstruction is similar to the free TRAM flap but only skin and fat are removed, and minimal abdominal muscle is used to form the new breast. Microsurgery is used to reattach the blood vessels to the new breast mound.
SIEA Flap Reconstruction Screen Shot 2014-06-24 at 2.22.15 PM

SIEA stands for superficial inferior epigastric artery. This flap uses the same abdominal tissues as the DIEP flap but utilizes blood vessels that are not as deep within the abdomen. While this is a less invasive procedure than DIEP flap reconstruction, not all women have SIEA blood vessels that will work for this type of flap surgery.

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