Recent studies have shown a trend toward more breast cancer patients opting to undergo breast reconstruction following a partial or full mastectomy. Given the recent advances in breast reconstruction techniques, this should not be surprising. Breast cancer patients who have undergone a mastectomy are looking for reconstructive techniques that will provide them with breasts that look and feel as natural as possible. Dr. Paul Pin understands this desire on the part of his patients, which is why he recommends using an abdominal flap technique for reconstructing the missing breast.

Abdominal Flap Reconstruction Technique

There are two main types of techniques used for an abdominal flap breast reconstruction: TRAM and DIEP. Each has advantages and disadvantages.

Transverse rectus abdominis (TRAM) technique: The transverse rectus abdominis forms the "six pack" abdominal muscle group. In a TRAM flap reconstruction technique, this muscle group, along with the surrounding tissue, skin, blood vessels and arteries are moved to the chest as the means to construct a new breast.

There are two types of TRAM flap reconstructive procedures. In a free flap procedure, the main blood vessels and arteries for the abdominal graft are cut out and then reattached to vessels in the breast by means of microsurgery. Alternatively, the vessels and arteries remain attached at their original location if a pedicled flap procedure is performed. The attached flap is moved to its new location underneath the skin, so no microsurgery is needed.

Deep inferior epigastric perforator (DIEP) technique: The deep inferior epigastric perforator is a main artery for the abdominal region of the body. The DIEP flap technique is very much like the TRAM flap technique. However, it does not include any muscle. Instead, just the skin, tissue, and major blood vessels are used. A pedicled (stacked) DIEP technique can be used, but the procedure is complicated and requires more recovery time than just a simple DIEP flap technique.

Pros and Cons of Abdominal Flap Breast Reconstruction

Dr. Pin prefers to use either the TRAM or DIEP techniques because abdominal skin and tissue are very similar to that of the breast, so the reconstructed breast is likely to both look and feel much like a natural breast. This is perhaps the biggest advantage of using abdominal flaps for breast reconstruction.

Another advantage, particularly for women who may have excess abdominal skin and tissue, is that both the DIEP and TRAM techniques require a tummy tuck procedure to be performed at the same time. A tummy tuck procedure removes excess skin and tissue from the abdominal region and tightens up loose muscle structures. The tummy tuck will flatten the abdominal region, which some patients may find desirable.

The main disadvantage of using an abdominal flap technique to reconstruct a breast is that it may require microsurgery to re-attach arteries and vessels in the breast area. Microsurgery can be complicated and, if not performed properly, can result in the body rejecting the flap graft. While pedicled techniques do not require microsurgery, they will entail a longer healing time with a somewhat greater risk of complications.

Certain patients may not feel that it is enough to have beaten cancer through a combination of mastectomy and radiation or chemotherapy. They still may feel that they have not completely conquered cancer until their missing breast can be restored. Dr. Pin can help these patients finally feel like themselves again.