TRAM / DIEP flap
Implant based breast reconstruction
Autologous breast reconstruction
With this technique the skin and fat of the lower abdomen is removed, reattached to the chest and shaped to reform the breast. Small blood vessels in this tissue are connected to blood vessels in the chest just under the rib using microsurgery techniques.
When a portion of the rectus muscle ('six-pack') is used this is called a TRAM (Transverse Rectus Abdominus Myocutaneous) flap. Where possible though, Mr Roblin performs a DIEP (deep inferior epigastric perforator) flap, for which he carefully dissects the blood vessels away from the muscle so that the muscle is left in place, which helps speed recovery and prevents possible weakness and bulging of the abdomen.
This method has become the gold standard for breast reconstruction. The advantages are that the body's own tissue is used to recreate a breast. No implants are required with this procedure, and once the reconstruction is complete to the patient's satisfaction no further procedures should be required. There is a potential failure rate; meaning that the new breast tissue does not survive. This is currently <1% in Mr Roblin's practice.
Further information
Anaesthetic
The operation is performed under general anaesthesia. The operation takes 5-8 hours.
Length of stay
4-5 nights following the operation.
Risks/Possible complications
Early (1-2 days):
Frequent
- Bruising
- Swelling
- Discomfort
Infrequent
- Bleeding (haematoma)
- Infection
- Failure of the flap (approx 1%)
- Partial failure of flap
- Re-operation (approx 1%)
- Wound breakdown
- Necrosis of the mastectomy skin flaps
Later (after one week):
Frequent
- Temporary reduced sensation of the abdominal wall
- Reduced or no sensation of reconstructed breast
Infrequent
- Scars - abdominal, umbilicus, breast unsightly, lumpy, stretch
- Bulging, weakness, hernia (<1%) of the abdomen
- Seroma
- Fat necrosis
General anaesthetic
- Deep vein thrombosis
- Chest infection
- Allergic reaction to drugs or tape
Recovery
Immediately after the operation
- You will feel bruised and sore and there will be some swelling
- Pain is usually moderate and controlled with standard painkillers
- There will be drains in the chest and the abdomen, which will be removed between 2-5 days later
- A urinary catheter will be left in for 2 days until you are mobile
- You will be sat out of bed the next day. Over the next few days you will increase the amount of walking that you do
After return home
- Socialising with friends 1-2 weeks
- Return to work at 4-6 weeks
- Driving at 4-6 weeks
- Swelling and bruising 6-8 weeks
- Wear abdominal compression garment for 5 weeks
- Return gym and strenuous activity after 3 months
- Final result at 4-6 months
Permanence of results
Permanent.