Semin Plast Surg 2002; 16(1): 119-130
DOI: 10.1055/s-2002-22689
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Abdominal Donor Site Morbidity: Impact of the TRAM and DIEP Flap on Strength and Function

Catriona M. Futter
  • Department of Physiotherapy, West of Scotland Regional Plastic and Maxillofacial Surgery Unit, Canniesburn Hospital, Glasgow, United Kingdom
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Publication History

Publication Date:
22 March 2002 (online)


Abdominal complications following breast reconstruction with a pedicled transverse rectus abdominus myocutaneous (TRAM) flap include decreased abdominal strength, bulge and hernia, pain, and difficulty with lifting, housework, work, and sport. Research work has shown that the muscle-sparing free TRAM flap does not necessarily prevent these complications, as removing a portion of one rectus abdominis reduces the integrity of the whole donor muscle. The deep inferior epigastric perforator (DIEP) flap was developed in an attempt to minimize donor site morbidity, and trials that have been conducted comparing the free TRAM and DIEP flaps suggest that the DIEP flap does have less impact on abdominal muscle strength and function, although problems can still occur. Recent work by the author confirms that the DIEP flap does reduce donor site morbidity and that an additional benefit in terms of a subjective improvement in outcome can be obtained from preoperative abdominal exercises. Progressive postoperative abdominal exercises and advice on posture and returning to functional activities from a physiotherapist familiar with the surgical techniques are recommended to ensure optimal outcome.