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Semin Plast Surg 2004; 18(2): 97-104
DOI: 10.1055/s-2004-829044
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001 USA.

Update on Breast Reconstruction Using Free TRAM, DIEP, and SIEA Flaps

Pierre M. Chevray1
  • 1Department of Plastic and Reconstructive Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX
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Publication History

Publication Date:
14 June 2004 (online)

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Breast reconstruction using autologous tissue is commonly accomplished using the transverse rectus abdominis myocutaneous (TRAM) flap. The establishment of microvascular surgery led to the development of the free TRAM flap because of its increased vascularity and decreased rectus abdominis sacrifice. The muscle-sparing free TRAM, DIEP, and SIEA flap techniques followed in an effort to decrease abdominal donor site morbidity by decreasing injury to the rectus abdominis muscle and fascia. Data have accumulated over the past decade that show that muscle- and fascia-sparing techniques, such as the use of DIEP flaps, result in measurably better postoperative abdominal strength. However, muscle-sparing techniques do not appear to decrease the risk of abdominal bulging or hernia, and there are no significant differences in patient-reported abdominal weakness or functional impairments. The SIEA flap is presented as a reemerging method that can virtually eliminate abdominal donor site morbidity. Sensory nerve coaptation to improve reconstructed breast sensation is also reviewed.

KEYWORDS

Breast reconstruction - flap - TRAM - DIEP - SIEA

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Pierre M ChevrayM.D. Ph.D. 

Assistant Professor, Department of Plastic and Reconstructive Surgery, Unit 443, The University of Texas M. D. Anderson Cancer Center

1515 Holcombe Boulevard

Houston, TX 77030

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