Tram flap vs implant

seof

Ladies,
I have had a double mastectomy with expanders put in because I will be having reconstruction after chemo and radiation are done. I have talked to Dr. about recon. So far the best options seem to be Tram flap or implants. The biggest problem I have with implants is that they have to be re-done eventually, and the end result does not look and feel as "normal". Dr. said the tram flap for a bilateral results in siginificant weakness of the stomach muscles. I wonder if anyone has experience with double tram flap, and how much weakness there is?

Thanks, seof

phoenixrising

I don't know much about it as I use a prosthesis but I did an internet search and was wondering if this info was useful. I won't paste the whole article here but will include the URL that you can copy and paste to find the page. Good luck to you girl.
jan

http://www.hopkinsbreastcenter.org/artemis/200105/feature.html

Breast Reconstruction with Perforator Flaps: The DIEP and SGAP Flaps

Maurice Nahabedian, MD, FACS
Director: Reconstructive and Aesthetic Surgery of the Breast
Johns Hopkins Medical Institutions

Breast reconstruction using autologous tissue is most commonly performed using the TRAM flap. This flap has been in use for 20 years and has provided outstanding aesthetic results. However, the downside to this flap is related to its donor site morbidity, namely the abdomen. The pedicle TRAM frequently requires use of the entire rectus abdominis muscle while the free TRAM may use as little as a postage size portion of the muscle. Abdominal complications resulting from a sacrifice of all or a portion of the rectus abdominis muscle include a reduction in abdominal strength (10-50%), abdominal bulge (5-20%), and hernia (< 5%).

Perforator flaps have gained increasing attention with the realization that the muscle component of the TRAM flap does not add to the quality of the reconstruction and serves only as a carrier for the blood supply to the flap. Thus, the concept of separating the flap (skin, fat, artery, and vein) from the muscle was realized as a means of minimizing the morbidity related to the abdominal wall and maintaining the aesthetic quality of the reconstruction. The DIEP flap (Deep Inferior Epigastric Perforator flap) was introduced in the early nineties and is identical to the free TRAM except that it contains no muscle or fascia. Use of this flap has been popular in the European countries for a number of years and is now gaining popularity in the USA. It has been performed at Johns Hopkins for the past 2 years. Candidates for this operation are similar to those for the free TRAM in that there must be adequate abdominal fat to create a new breast. However, caution must be exercised in performing this technique in women who require large volume reconstruction to prevent the occurrence of fat necrosis or hardening of the new breast. The operation can be performed immediately following mastectomy or on a delayed basis. Performance of this operation is slightly more difficult than the free TRAM because it requires meticulous dissection of the perforating vessels from the muscle. The operation takes approximately 5 hours for a unilateral and 8 hours for a bilateral reconstruction and requires 3 days of hospitalization. The drains remain in place for 3 to 10 days. Like the TRAM flap, the DIEP flap is a one-time procedure, and can be performed for either a unilateral or bilateral reconstruction. Major complications following this operation include flap loss (3%) and abdominal bulge (< 5%). Patient satisfaction at our institution has been extremely high following DIEP flap breast reconstruction. Of 18 women who have had this operation, that includes 3 bilateral DIEP flaps, no abdominal weakness, bulge, or hernia has been reported or appreciated.