Abdominal Tissue Breast Reconstruction

Abdominal tissue reconstruction uses skin and fat from your lower abdomen to rebuild your breast after you’ve had a mastectomy or lumpectomy. Using your own tissue instead of an implant can create a soft, natural look and feel. 

These techniques are sometimes called DIEP flap or TRAM flap reconstructions, based on the specific area where surgeons remove tissue from your body.

At Banner MD Anderson Cancer Center, our surgeons specialize in advanced microsurgical techniques for these complex procedures. They work to help you heal comfortably after abdominal tissue breast reconstruction. Request a breast reconstruction consultation.

Learn more about autologous (tissue flap) reconstruction.

How abdominal flap reconstruction works

First, you usually use a tissue expander to stretch the skin and tissue in your breast area for a few months.

However, for some patients, abdominal flap reconstruction can be performed immediately following a mastectomy or lumpectomy without the need for an in-between tissue expander. 

Then, during the procedure, your surgeon takes a section of skin and fat from your lower abdomen and moves it to your chest. 

• The tissue is carefully shaped into a new breast mound for natural-looking results.
• Using a microscope, your surgeon reconnects tiny blood vessels to restore healthy circulation. 
• The DIEP flap procedure leaves your abdominal muscles in place.
• The TRAM flap procedure may use a small portion of abdominal muscle if it’s needed for strength or blood flow.

Because the tissue comes from your body with natural breast reconstruction after mastectomy, the reconstructed breast looks and feels more natural and changes with your body over time.

You may also consider having nipple and areola reconstruction or 3D tattooing.

DIEP flap vs TRAM flap

Both of these procedures use tissue from your lower abdomen but there are important differences:

• Deep inferior epigastric perforator (DIEP) flap breast reconstruction
  • Uses skin and fat only, keeping the abdominal muscles in place
  • Usually has faster recovery and less weakness in your abdomen
• Transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction
  • Uses a small portion of muscle along with skin and fat
  • May be an option if your blood vessels aren’t suitable for a DIEP flap
  • Can provide strong, long-lasting results

Less-common types of abdominal flaps include:

• Muscle-sparing and perforator flaps: A flap is created and little to no fascia or muscle is removed. This may reduce problems that can happen when these supporting structures of the abdominal wall are removed.
• Free superficial inferior epigastric artery (SIEA): A flap is disconnected from its blood supply and connected to the blood supply in the chest. This is not a common procedure because often the superficial inferior epigastric artery and vein are too small.

If you don’t have enough abdominal tissue for either of these procedures, you have had abdominal surgery in the past or you plan on getting pregnant, your surgeon may recommend back tissue reconstruction instead.

Benefits of abdominal tissue reconstruction

Abdominal tissue reconstruction has some advantages:

• Your breasts have a natural appearance and feel and they age with your body
• You get long-lasting results without the need for implants
• You may have a flatter, firmer abdomen after surgery
• The procedure can be performed at the same time as your mastectomy or later 
• No foreign material is used, so there’s no risk of an implant rupturing or needing to be replaced

Risks and considerations

While abdominal flap reconstruction can give you excellent results, it’s a complex surgery and you’ll need more recovery time than you would with implants. The surgery may take six to twelve hours and you should expect to stay in the hospital for three to five days.

Possible risks include:

• Scarring on your breast and abdomen
• Changes in breast sensation
• Longer surgical time 
• Risks of anesthesia
• Longer recovery and healing time for both your stomach and breast
• Poor wound healing
• Fluid collection (seroma)
• Blood clots
• Infection
• Bleeding
• Tissue death (necrosis) due to low blood supply
• Possible loss of the entire flap reconstruction (rare)
• Loss of sensation around your abdomen where tissue was removed
• Abdominal weakness or hernia

Your surgeon will help you understand the risks so you can decide together whether this procedure is a good match for your health and lifestyle.

Learn more about risks and complications.

Recovery and aftercare

Most people spend a few days in the hospital after surgery. Your care team will encourage you to take gentle walks soon after surgery to help with circulation and healing.

After you go home, it’s important to:

• Follow your care team’s guidance on caring for your incisions and drains. 
• Avoid lifting heavy objects or performing any strenuous activity for six to eight weeks.
• Expect some tightness or numbness around the abdomen. This is normal and usually gets better with time.

Find out more about recovery and aftercare.

Who may be a good candidate

You may be a good candidate for DIEP flap or TRAM flap reconstruction if you:

• Have enough tissue in your lower abdomen
• Are in good overall health 
• Do not smoke
• Haven’t had major abdominal surgery that affected your blood vessels
• Prefer a natural look and feel over implants
• Have had or plan to have radiation therapy
• Your weight is in the safe range for surgery

If you don’t qualify for abdominal tissue breast reconstruction, your surgeon may suggest implant-based reconstruction or hybrid reconstruction. 

Learn more about deciding what’s right for you.

Why choose Banner MD Anderson Cancer Center?

At Banner MD Anderson, our surgeons have advanced training in microsurgical breast reconstruction, including DIEP flaps and TRAM flaps. We work closely with your oncology team to make sure your reconstruction is safe, personalized and coordinated with your overall cancer treatment plan.

Our team focuses on both your physical recovery and emotional healing, helping you feel whole again after breast cancer.

Request an appointment