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TRAM vs DIEP Breast Reconstruction

When it comes to autologous breast reconstruction after a mastectomy, two popular options are TRAM and DIEP. Both use the patient’s own tissue to rebuild the breast, making it look and feel natural. But even though they sound similar, there are some key differences between these reconstruction techniques. These differences can affect things like how long it takes to recover and what the final results look like.

In this blog, we’ll take a closer look at these two methods and see what sets them apart and why Sydney Specialist Plastic Surgeon Dr Bish Soliman prefers DIEP breast reconstruction.

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What Is TRAM Breast Reconstruction?

TRAM is an acronym for Transverse Rectus Abdominis Myocutaneous flap. This name might sound technical, but it essentially describes a specific method used in breast reconstruction surgery. The TRAM procedure leverages tissue from the lower part of your abdomen. This isn’t just any tissue; it’s a combination of skin, fat, and a segment of the rectus abdominis (the six-pack muscle). The rectus abdominis is one of the main muscles in the abdominal region, and its inclusion in the flap provides both volume and contour to the reconstructed breast.

What Is DIEP Breast Reconstruction?

DIEP breast reconstruction, or Deep Inferior Epigastric Perforator breast reconstruction, is a sophisticated microsurgical procedure employed by skilled plastic surgeons like Dr Bish Soliman. This technique is utilised to reconstruct a woman’s breast(s) following mastectomy, often associated with breast cancer treatment. Unlike some other methods, such as TRAM (Transverse Rectus Abdominis Muscle) flap reconstruction, which involves the removal of abdominal muscle tissue, DIEP reconstruction avoids removing the abdominal muscles.

During a DIEP breast reconstruction, a section of skin, fat, and blood vessels is extracted from the lower abdomen, typically from below the navel. This procedure maintains abdominal muscle integrity, potentially resulting in reduced abdominal weakness and a quicker recovery for patients.

The harvested tissue is then meticulously reconnected to the blood vessels in the chest area, effectively creating a new breast mound. DIEP breast reconstruction is highly regarded for its ability to provide breast cancer survivors with both aesthetic and functional benefits, as it utilises the patient’s own tissue to recreate a natural-looking and feeling breast. Dr Soliman’s preference for the DIEP technique reflects its reputation as a cutting-edge and effective surgical option, often minimising the need for breast implants and contributing to the overall well-being and satisfaction of breast cancer survivors undergoing breast reconstruction after mastectomy.

Key Differences between DIEP and TRAM Breast Reconstruction

Breast reconstruction is an important step for many individuals following a mastectomy. In your journey to understand and decide on the best reconstruction method, it’s vital to grasp the key differences between the TRAM and DIEP procedures.

Involvement of Abdominal Muscle

  • TRAM method requires a portion of your abdominal muscle to be used in the reconstruction process. This muscle is relocated to the chest region.
  • DIEP method solely uses skin and fat from the abdomen for the procedure, leaving the abdominal muscles.

The implication here is twofold:

  • By preserving your abdominal muscles in the DIEP method, there’s often a reduced risk of potential complications such as abdominal hernias or bulge.
  • The DIEP method can often lead to quicker recovery times as the abdominal muscles aren’t disturbed during the procedure.

Recovery Experience

  • With the TRAM method, as a portion of the abdominal muscle is used, post-operative pain might be heightened, and recovery might be longer. This is because two areas of your body are healing – the abdomen, where tissue was taken, and the chest, where the reconstruction occurs.
  • The DIEP method generally offers a smoother recovery. As the muscles remain, the primary healing is from the removal of skin and fat, which can result in less pain and a slightly swifter healing process.

Duration and Complexity of Surgery

  • The TRAM procedure can be quicker as it doesn’t always involve the meticulous dissection of the abdominal blood vessels.
  • DIEP, on the other hand, requires a surgeon skilled in vessel dissection and microsurgery. As a result, the DIEP surgery might be a bit longer in duration.

Suitability and Pre-existing Conditions

  • If you’ve had previous surgeries or conditions that affect your abdominal region, it might influence the viability of using either the TRAM or DIEP method.
  • The presence of suitable blood vessels for microsurgery, essential for the DIEP method, is another consideration. Not everyone might be a candidate for this procedure based on the state of these vessels.

Is DIEP Flap Reconstruction Right For Everyone?

Breast reconstruction is a deeply personal journey, and while the DIEP Flap method offers many benefits, it’s essential to understand that it might not be the optimal choice for everyone. Let’s explore the factors that determine the suitability of this method for different individuals.

Anatomy and Physical Health

  • Blood vessel assessment: The DIEP method requires suitable blood vessels for microsurgery in the abdominal area. A pre-surgery examination and CT scan will determine the state and availability of these vessels for the procedure.
  • Previous abdominal surgeries: Surgery like abdominoplasty or significant scar tissue in the abdominal region might affect the viability of using the DIEP method.
  • Overall health: As with any surgery, being in good health can influence recovery and the success of the procedure. Conditions like diabetes or cardiovascular issues need to be discussed with Dr Soliman during the consultation.

Personal Preferences and Lifestyle Considerations

  • Recovery time: While many find the recovery from DIEP less intense due to the non-involvement of muscles, the procedure itself can be lengthier, and initial recovery might still take time.
  • Desire for natural tissue: If you have a strong preference for using your own tissue over implants, the DIEP method aligns with this choice.
  • Activity level: If you lead a very active lifestyle, preserving abdominal muscle strength (which DIEP offers) might be a significant factor in your decision.

Emotional and Psychological Factors

  • Expectations: It’s essential to have realistic expectations about the outcomes, both in terms of appearance and sensation.
  • Support system: Having a strong support system during the recovery phase can play a role in your decision. While the DIEP method often has a smoother recovery, the initial days post-surgery will require assistance and care.

FAQs about Brest Reconstruction

What are the primary reasons individuals opt for breast reconstruction?

Breast reconstruction is a surgical procedure designed to restore the appearance and feel of the breast after a mastectomy (complete removal of the breast) or lumpectomy (partial removal). The primary reasons individuals choose this procedure include:

  • Restoration of body symmetry: Post-mastectomy, there might be a noticeable asymmetry between the two breasts. Reconstruction helps in achieving a balanced appearance.
  • Personal comfort and sense of wholeness: The absence of one or both breasts can affect how some individuals perceive their bodies. Reconstruction can offer a sense of physical restoration.
  • Clothing fit: Some might find that clothes fit differently or less comfortably after a mastectomy. Reconstruction can assist in regaining the previous fit of clothing, especially bras or swimsuits.

Are there different types of breast reconstruction procedures?

Yes, there are various methods of breast reconstruction, each with its advantages and considerations:

  • Implant-based reconstruction: This involves using silicone implants to recreate the breast mound.
  • Autologous or flap reconstruction: Tissue from another part of the patient’s body (like the abdomen, back, or buttocks) is used to form the breast. Common methods include TRAM flap and DIEP flap.
  • Combination of flap and implant: Sometimes, both the patient’s tissue and an implant are used to achieve the desired result.

How soon after a mastectomy can breast reconstruction be done?

Breast reconstruction can be approached in three ways concerning timing:

  • Immediate reconstruction: The reconstruction starts during the same surgery as the mastectomy. Once the breast is removed, the reconstruction process begins.
  • Delayed reconstruction: Reconstruction is done in a separate surgery, weeks, months, or even years after the mastectomy.
  • Staged reconstruction: This is a combination approach. A preliminary reconstruction begins during the mastectomy, with further surgeries later on to refine the results.

The best timing often depends on individual medical circumstances, personal preferences, and additional treatments required, like radiation.

Are there risks associated with breast reconstruction?

Like all surgeries, breast reconstruction comes with potential risks, which can vary based on the method chosen:

  • Surgical risks: These can include bleeding, infection, and complications from anaesthesia.
  • Cosmetic outcomes: There might be dissatisfaction with the appearance of the reconstructed breast, including asymmetry or differences in size and shape compared to the natural breast.
  • Specific procedure risks: Depending on the method, there could be risks like implant rupture, fat necrosis (in flap procedures), or abdominal muscle weakness (in TRAM flap).

Further Reading about DIEP Surgery with Dr Bish Soliman

Medical References about DIEP Breast Reconstruction

About Dr Bish Soliman

Dr Bish Soliman - Sydney Plastic and Reconstructive Surgeon, about us 01 2x
Specialist Plastic, Reconstructive and Cosmetic Surgeon
FRACS (Plas), MS (Plas), MBBS (Hons 1), BCom

AHPRA Registered Medical Practitioner MED 0001679053 Specialist Registration in Plastic Surgery

Dr Bish Soliman is a Sydney-based Specialist Plastic and Reconstructive Surgeon who performs aesthetic surgery of the face, breast, and body as well as skin cancer surgery.

He currently holds two consultant microsurgery positions in major Sydney hospitals performing complex microsurgical reconstruction including DIEP breast reconstruction.

After graduating from The King’s School, Dr Bish completed a Bachelor of Commerce degree at the University of Sydney. After working briefly at a major Sydney finance firm, he decided to pursue his passion and long-term goal of a career in medicine. He graduated from the University of Notre Dame at the top of his class, receiving First class honours and the prestigious Bower and Sherrard medal. He then went on to complete his junior medical training at Westmead Hospital during which time he was awarded Junior Medical Officer (JMO) of the Year, as well as a finalist for NSW Doctor of the Year.


Next Steps

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