Breast reconstruction using tissue from your tummy

About breast reconstruction using tissue from your tummy

Reconstructed breasts are usually made using tissue from your tummy (abdomen). Most women have a reconstruction called a free DIEP flap (deep inferior epigastric perforator flap). There are some other types of reconstruction that use tissue from your tummy.

DIEP flap

This stands for (deep inferior epigastric perforator flap). The surgeon uses a flap of fat and skin from the tummy area to create a breast shape. They separate the tissue and its blood vessels from your tummy. They then move the flap to the breast area and connect it to a new blood supply in your chest.

Free SIEA flap

A superficial inferior epigastric artery flap (SIEA) IS similar to the DIEP flap, but the surgeon uses a different blood vessel to create the new blood supply.

TRAM flap

This stands for transverse rectus abdominus muscle flap (TRAM). The surgeon uses a muscle, as well as fat and skin, from your tummy area to create a new breast shape. This is usually done as a free flap operation. After removing the muscle, the surgeon may put a mesh in. This is to strengthen the tummy wall and stop a bulge or hernia developing.

MS-TRAM flap

A muscle sparing transverse rectus abdominal muscle flap (MS TRAM) is when the surgeon takes only a part of the muscle from your tummy area. This creates a new breast shape and is usually done as a free flap operation.

This photograph shows a woman who has had an immediate DIEP flap to her right breast.

This photograph shows a woman who has had a DIEP flap to her left breast and nipple reconstruction.

This photograph show a woman who has had a delayed SIEA flap.

Who is it suitable for?

This type of reconstruction may be suitable for women:

with breasts of any size
who do not want an implant
who need to have both breasts reconstructed.

It may not be suitable for women who:

have previous scarring on the tummy area
are very slim and do not have enough tissue on their tummy
smoke
have diabetes or other illnesses, such as rheumatoid arthritis or other autoimmune diseases, that interfere with blood circulation to their tissue.

What are the limitations?

You may have a patch of skin on your breast which is a different skin tone.
You will have a scar across your tummy below your belly button, from hip to hip.
Most operations using tissue from the tummy are successful. But they have a slightly higher risk of complications than operations using tissue from the back.
Some women have some loss of sensation (numbness) in the tummy area.

What are the risks?

With any operation, there are risks, such as infection. There are also some specific risks with this type of reconstruction.

Fluid under the wound (seroma)

Sometimes, after wound drains are taken out, fluid builds up under the wound. This is called a seroma. A seroma sometimes happens after the operation, but it usually gets better within a few weeks. You may be asked to buy supportive underwear to wear for 6 weeks after surgery. Wearing this will support your tummy and help to reduce swelling and seroma.

Muscle weakness

TRAM flaps use one of the muscles from the front of the tummy (the ones that form the six-pack). These muscles are important for lifting and physical work. They also work with the back muscles. If they are weakened, you may get back pain and find some sports and physical activities more difficult. A physiotherapist may give you exercises to do to strengthen your tummy.

A MS-TRAM flap uses only part of the muscle. Because of this, it is less likely to cause muscle weakness than a standard TRAM flap operation.
In a DIEP or SIEA flap, no muscle is used. This preserves the strength of the tummy more.

Hernia or bulge in the tummy area

Some women develop a bulge or hernia in the tummy area. If a muscle is used in the breast reconstruction, there is a higher risk of this happening. But a bulge can develop after any type of flap surgery that uses tissue from the tummy.

Sometimes the surgeon will use a mesh to strengthen the abdominal wall. This is used to try to prevent a bulge or hernia. This mesh may be permanent, or it can be designed to dissolve away in time.

About our information

References

Below is a sample of the sources used in our breast cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

European Society for Medical Oncology. Primary breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Annals of oncology 26 (supplement 5): v8–v30. 2015.

Morrow M, et al. Chapter 79: malignant tumors of the breast. DeVita, Hellman and Rosenberg’s cancer: principals and practice of oncology (10th edition). Lippincott Williams and Wilkins. 2014.

National Institute for Health and Care Excellence (NICE). Early and locally advanced breast cancer: diagnosis and management. July 2018.

Scottish Intercollegiate Guidelines Network. SIGN 134. Treatment of primary breast cancer: a national clinical guideline. September 2013.

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Rebecca Roylance, Consultant Medical Oncologist.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.